What causes dark under-eye circles?

Mommy says, "Guinness is good for dark undereye circles!"

Mommy says, "Guinness is good for dark undereye circles!"




Dark undereye circles are relatively common and are caused typically by one of three anatomical defects, either alone or in combination.  The first possibility is that there is actual deposition of pigment into the skin of the lower eyelid.  This pigment deposition is commonly due to post-traumatic hyperpigmentation, where the skin of the lower eyelids has been perpetually irritated, usually from chronic tearing due to allergies or dry eye.  Skin pigmentation is the easiest cause of dark undereye circles to treat because it responds well to a combination of carboxytherapy and home bleaching regimens.  I do not use hydroquinones, the  over-the counter bleaching agent, on delicate eyelid skin because in some individuals this can worsen the dark circles.  Instead, I prescribe a combination of kojic acid and arbutin to help reduce the hyperpigmentation.  This gives my patients something safe and gentle that they can use at home while the carboxytherapy sessions are performed in my office. 

The second cause of dark undereye circles is vascular pooling.  The capillary network of the lower eyelids is vast, but it can become congested for a variety of reasons.  Normally, the tears drain from the eyelids into the nose, but if there is some obstruction of this anatomy due to chronic nasal congestion from seasonal allergies or a nasal fracture, the drainage apparatus becomes stagnant and the bloodflow to the lower eyelids becomes sluggish, giving rise to the boggy blue tinge known casually as “allergic shiners.”  The lack of appropriate oxygenation to the lower eyelid skin allows the deoxyhemoglobin’s bluish cast to show through the thin skin of the eyelids.  Carboxytherapy works to improve the capillary network of the lower eyelids, as well as to increase the dermal collagen layer in the lower eyelid skin.  By injecting a small amount of carbon dioxide gas into the affected areas, bloodflow is increased and improved capillary networks are formed for longer lasting circulatory benefit.  The bluish cast of deoxyhemoglobin is replaced with the healthy pink tone of well perfused tissues.  Once a series of four to six sessions is completed, the skin has a more luminous appearance that lasts approximately six months.

The third major cause of dark undereye circles is a depression beneath the lower eyelids called a “tear trough deformity.”  Tear trough deformity is a commonly inherited trait in the African American and Indian communities, but it can also develop in Caucasians over time due to the normal loss of bony architecture in the inferior orbital rim, which is the top of the cheekbone area.  In the event that a tear trough deformity exists, a temporary filling agent such as Restylane or Juvederm can be placed in the valley to plump up the depression, thus improving the appearance of the dark circles.  The treatment is not painful, and it is a one-time procedure performed after a small amount of numbing cream has been applied to the skin.  Since my specialty is oculoplastic surgery, I perform this procedure in my office at least twice a day with very gratifying results that last approximately eight months to one year. 

As I mentioned earlier, dark undereye circles can be caused by hyperpigmentation of the lower eyelid skin, vascular pooling, and/or tear trough deformity.  Usually, dark undereye circles are caused by some component of all three of these individual factors at once.  With the appropriate application of at home topical bleaching agents, carboxytherapy, and hyaluronic acid fillers, great strides can be made toward improving the appearance of this common problem of the periorbital region.

Have a Beautiful Day!

Dr. Lisa

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