Dark under eye circles are a very common concern and can be a frustrating issue for people
who want to do something about them. Patients who come to see me about under eye dark circles
complain that they look tired or worn down, even when they feel vibrant and energetic.
Dark circles can be caused by superficial skin discoloration, ethnic pigmentation; thin
eyelid skin revealing the underlying anatomy such as the orbicularis oculi muscle and blood
vessels; iron deposits from blood pooling under the eyes; and even post-inflammatory
hyperpigmentation, or PIH, from previous laser or other treatments. I’ll discuss how I
help people who come to my practice with dark under eye circles with lasers and other therapies.
I’m Dr Amiya Prasad. I’m a Board Certified Cosmetic Surgeon and Fellowship Trained Oculofacial
Plastic & Reconstructive Surgeon. I’ve been in practice in Manhattan and Long Island for
over 20 years.
I specialize in all types of eyelid surgery for both primary and revision surgery. I also
perform non-surgical procedures for the eyes, including injectable filler placement, laser
and radiofrequency treatments, microneedling, and platelet-rich plasma treatment.
There are different causes of dark circles under the eyes, and more than one type of
laser can help in improving the skin. When used carefully, lasers like fractional CO2,
Nd:YAG and Erbium lasers can stimulate collagen production to improve the skin’s thickness
and make the skin healthier. By improving the relative thickness of the thin eyelid
skin, which is the thinnest skin of the body at half a millimeter, there can be some improvement
in the coverage of the underlying anatomy, which contributes to the appearance of dark
under eye circles. Depending on the type of laser and the energy delivery settings, lasers
can partially ablate the skin, or remove some of the top layer of skin to allow a new fresh
layer of skin to come in, also known as skin resurfacing. Ablation can be very helpful
if the top layer of skin or epidermis is discolored and is contributing to the perception of dark
circles. Your skin’s natural pigment is more concentrated in the junction between
the epidermis and dermis as well as the dermis itself, which is the deeper skin layer. Proper
judgment in the use of a laser device is very important since overly aggressive treatment
can have a negative effect and make the eyelid skin thinner and worsen the problem. Thinner
eyelid skin from overly aggressive laser treatment makes the eyelids crepey and creates more
wrinkles. The right amount of heat from laser or radiofrequency devices can tighten the
dermis and stimulate collagen production, which improves the appearance of wrinkles.
I’ve developed treatment strategies to minimize the risk of laser overexposure. Since the
goal is to maximally stimulate collagen production, I use non laser technology to complement the
laser induced stimulation of the skin. For example, I routinely combine laser treatment
for the lower eyelids with platelet-rich plasma, or PRP. PRP is derived from your own blood
- it’s a concentration of the wound healing and growth factors needed for tissue repair
such as when you have a cut. PRP is prepared by drawing your blood as is done for a routine
blood test, and spinning the blood in a centrifuge to concentrate the platelets to create a clear,
yellow serum. PRP stimulates collagen production, and improves blood supply and circulation
to make the eyelid skin healthier and thicker without using heat energy. I find that PRP
and laser treatment work very well together in the eye area.
Dark under eye circles are often associated with relative hollowing in areas such as the
tear trough and cheek, which creates shadows and contributes to the tired looking appearance.
This is more of a volume issue so I routinely place hyaluronic acid fillers using minimally
traumatic techniques with blunt cannulas. I find that frequently, volume correction
has the most significant impact on the appearance of dark circles. On a related note, I’ve
seen a good number of patients who came in concerned about dark under eye circles without
recognizing that they had puffy under eye bags. Puffy under eye bags, make the discoloration
aspect of dark circles more prominent and makes the shadow of relative hollowing under
the eye bags appear even darker. The optimal strategy is therefore to address the under
eye bags. I address under eye bags everyday in my practice with fillers as well as a minimally
invasive surgery called transconjunctival blepharoplasty which is done from the inside
of the lower eyelids without any incisions or sutures on the outside. This is a procedure
I perform in my office facility with local anesthesia and LITE IV sedation with minimal
swelling and bruising so our patients are able to return to work typically in 1 week
looking refreshed.
Lasers are great tools to help address under eye dark circles. It’s critical to have
a proper assessment in order to determine what the anatomic variables are which contribute
to the appearance of your dark circles. I look at this area from the inside outward,
so I look for hollowing, puffy under eye bags, vascular and muscle elements, melanin or ethnic
skin pigmentation and epidermal or superficial factors which contribute to this appearance.
As an experienced Oculofacial Plastic surgeon, I’m able to help my patients with everything
from lasers, injectable fillers, PRP and surgery for under eye bags. In the modern aesthetic
marketplace, practitioners have biases to sell procedures they can do and ignore procedures
they can’t do, essentially not looking after the patient’s best interest. I can attest
to this as patients often find themselves dissatisfied with treatments done elsewhere
and come to me for evaluation. It’s important if you are looking for a solution for dark
under eye circles that you be educated before your consultation and the doctor you have
a consultation with spend time with you and provide you with a satisfactory explanation
for the therapeutic strategy they recommend for you.
I hope you found this information helpful...thank you for your question