Thank you for your question.
You submitted a single photo with your eyes closed and you’re asking will laser help
remove the dark spots under your eyes.
And the photos are taken at a distance so I actually can see more of the broad picture
and not so much the detail of the eyes but I think I understand what you’re asking.
So, I’ll give you a sense of how I counsel patients like yourself who come to my practice
about this type of situation.
A little bit of background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon.
I’ve been in practice in Manhattan and Long Island for over 20 years.
And the challenge before us every day in our practice is dealing with people who are concerned
about dark under eye circles and I think that’s really the core of your issue is you have
dark circles under the eyes and you want to know if laser will remove those circles.
It is understandable why you are asking this question.
We are immersed with incredible claims made about the benefits of laser and unfortunately
that tends to confuse a lot of people because we have to differentiate what a laser does
and how does it fit into this type of issue.
So let me just get through the steps of how I evaluate patients like you and what I want
to do first and first is to find the problem and then define the solution.
So let’s start with the under eye area.
What do I see when I see the under eye area?
First, I noticed some puffiness.
So understanding that the puffiness is not a skin issue but rather something called lower
eyelid fat prolapse.
Lower eyelid fat prolapse means that the fat pockets that are normally around the eyes
have pushed forward and created these bulges.
Now if this puffy area is really not something that is constant and is either fluid or just
happens to be the way as the photo was taken, we can at least understand that if there is
puffiness that a laser doesn’t really specifically remove, that without its application in a
more interventional approach, for example, when we deal with under eye bags and puffiness,
we perform a procedure called transconjunctival blepharoplasty.
This is a procedure where the fat pockets that create this type of puffiness are reduced
from the inside of the eyelid.
Now, I prefer this technique especially for people who have, let’s say, darker skin
types and that means anybody who has like a light olive skin tone and darker.
The reason for that is generally there is no evidence of extra skin and you avoid issues
with incision in terms of discoloration or scarring even though those are not major but
it doesn’t justify making decision if you can avoid it.
Now beyond that and on the topic of skin type, that is where one of the major decision points
about choosing a laser treatment or alternative treatment becomes absolutely critical.
Laser is the use of a particular wavelength for certain amount of time to target a particular
type of chromophore.
And the three major ones are blood, water and melanin.
Now when you look at someone with dark circles under their eyes, we have to ask ourselves
what of those elements are related that can potentially have a role with laser.
But beyond that, I would say, it is very important that you also consider what kind of impact
laser has when you do a treatment.
So there are lasers that, let’s say, target water.
Well those are the lasers that can be done fractionated or ablative to remove top layers
of skin.
The top layers of the skin can also contain some pigment that could help make the dark
circles look better.
There are also lasers that target the pigment itself called melanin and there are other
lasers that also target blood.
Now, the point of this is understanding whether or not a laser would potentially cause someone
with a darker skin type to actually make the area look even more darker.
So in that respect, you have to be mindful of where laser fits in.
For example, when we treat under eye circles and if it’s in combination with or without
addressing puffy under eye bags, we routinely actually first do a combination of platelet-rich
plasma (PRP) which is derived from your own blood and has a concentration of wound healing
and growth factors that stimulates collagen and improves the appearance of dark circles
. We’ve done this very successfully as a standalone procedure without laser and basically
getting the benefit of improving skin quality, improving the texture and health of the skin
and it’s actually been shown that platelet-rich plasma (PRP) prevents hyperpigmentation and
actually can be used in situations where there is hyperpigmentation and that’s been shown
in formal studies and we’ve seen these clinically for years.
So, I think that although there are a lot of options, I think laser may be something
that could have a place in your treatment plan but I think that you can also consider
other options before going with laser.
I think it’s natural to ask this question because people are so fascinated by lasers
and certainly this industry of aesthetic medicine really continuously hypes new lasers and there’s
some basis but unfortunately, a lot of times, the hype and the usability doesn’t always
go together.
A laser is a tool and it may have a role in your treatment but it cannot be a standalone
type of tool in my opinion.
If I do a laser, I often combine it with platelet-rich plasma (PRP) because I want to get the benefit
of the laser as a resurfacing tool and the platelet-rich plasma (PRP) as to way to improve
skin quality and texture.
And sometimes even injectable fillers can also have a role in improving dark under eye
circles.
So if you understand, there are a lot of different elements that can be used to address particular
anatomic issues.
I think that you have to, at this point, make some decisions about choosing a doctor to
meet with and have a proper consultation and learn about what the recommended options are
and I would even go so far to say that when you meet with several different doctors, you
are going to get a lot of different opinions.
So you are going to find a doctor that you feel comfortable with it and you feel makes
sense with your unique situation.
Remember, skin type is very important.
Same modality that I would use for a lighter skin type for a person like an Irish blue-eyed
person with dark circles is very different from what I do from let’s say an Indian
or Arab skin type, someone who is brown and then further and even darker skin type like
of someone with African origin.
So it really has to be customized.
So I hope that was helpful, I wish you the best of luck and thank you for your question.