Laser Resurfacing for Dark Circles Under Eyes?

Laser skin resurfacing can remove dark pigmentation under the eyes, but there can be many other underlying causes and potential treatments:1) Hyperpigmentation: Excessive or irregular pigmentation of the skin beneath the eyes. This can be treated with creams that "bleach" the skin or laser skin resurfacing, which removes the dark patches. 2) Hypervascularity: Blood vessels beneath the skin surface. Certain lasers (V-Beam, Pulse Dye Laser, etc) as well as IPL may alleviate some of these vessels.3) Dermatochalasis: Shadows caused by lower eyelid "bags". Subtle cases can be improved by placing fillers in the shadowed area to the level of the puffiness to mask the problem. For more serious cases, surgery to remove the baggy skin is the definitive option.

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Hello,All good feedback from other panel members.In our experience, lasers are not ideal for this condition...including expensive creams and serums.  In cases where there is some hollowing or a depression under the eyes, we reach for Restylane filler to perform a "tear trough filler" treatment.  By adding subtle volume, we not only allow for more light into the areas when we elevate the surface, but we chase out the shadows.  This allows for immediate improvement for darkness under the eyes for male and female, young and older alike.  The below link has before/after photos to demonstrate how this works:

Treating dark circles under the eyes is different for every patient. There is no “one size fits all” approach to eliminating dark circles, so determining which treatment would be best for you is not possible without an in-person evaluation. If your dark under-eye bags are the result of pigmentation problems or skin damage, laser resurfacing may be a good option for you. However, under-eye circles can also be caused by lost volume. In this case, dermal fillers are the recommended option to restore the lost volume and rejuvenate the skin.
If you would like to learn more about your available options, schedule an evaluation with a board-certified plastic surgeon. Hope this helps.

The most important thing to recognize is that dark circles under the eyes vary from one patient to another. Dark circles may be caused by a shadow effect from bulging of the fatty pads under the eyes, wrinkling of the lower eyelid skin, genetic hyperpigmentation, or medical issues like allergies. It is important to treat the underlying cause in order to achieve the best result. 
Laser resurfacing of the under eye area can work well to improve wrinkling and occasionally to help with pigmentation issues, but this is less predictable. When used in combination with a lightening agent, such as a medical-grade eye cream or hydroquinone, some pigmentation improvements are possible. Often the best result is achieved through a combination of surgery, laser, and topical treatments.
Be sure to find a facial plastic surgeon or plastic surgeon specializing in facial aesthetics to review all of the options in detail.
Best,

Despite having studied cosmetic dermatologic surgery in a fellowship after residency, and practicing this subspecialty since 1993, and being aware of the newest technology in the use of lasers, devices, fillers and topical products, I have not found one treatment that consistently improves dark lower eyelid circles. We know that some darkness is actually an inherited trait (familial periorbital hyperpigmenation) and that some dark circles could be related to the combination of water content in the dermis and the blood flow in the skin, but we don't understand why it can change from a day to day basis, why it looks worse when we're tired, if it's a venous or arterial circulation issue, etc. Any of these treatments used for this condition has risks and without a consistently good effective result I am often reluctant to treat this condition, especially in those with a skin type that is more apt to develop a post inflammatory hyperpigmentation, and usually don't do filler in those patients that have preexisting puffiness from allergies or sinus issues. There are risks with fillers that have to be discussed prior to use in this area and there is downtime with many of these procedures.ThermiSmooth radiofrequency has helped some of my patients with no downtime and Fractional laser resurfacing has helped some as well, but there is some downtime with the latter. I have definitely had patients though, from every treatment that has been treated in which  I did not see improvement, even in a some cases when my patient thought there was improvement, I did not appreciate a difference. In the cases of improvement that I have seen and my patients are happy, it never has been a 100% improvement and all patients need to have realistic expectations prior to spending money and incurring risk, no matter how safe the procedure, before undergoing the treatment.The information provided in Dr. Shelton's answer is for educational purposes only and is not intended to constitute medical advice.  The information provided should not be relied upon as a substitute for consultations with a qualified health professional who may be familiar with your individual medical needs. 

There are many causes of eye circles. Some are shadow issues, some are discoloration issues.  Most people have a multifactorial problem meaning they have more than one problem causing this demarcation. You are young so be conservative with what you select. Below are some of the most common causes and my treatment protocols. Laser is definitely an option. Combining laser with fat transfer would really make a big difference from what I can tell from your photos. 

1. Prolapsed orbital fat through the orbital septum: treated with lower lid blepharoplasty and fat transpositioning. Can also be helped with fillers or auto fat transfer to the face but the ideal treatment in my hands is surgery for this issue.

2. Eczema: much more common in young people with fair skin. The treatment for this is to hold off on makeup and any manipulation of the lower lid for a few weeks and try some topical anti inflammatory creams. If you have allergies those should be treated also.  A dermatologist is the best person to see for this. We have a multidisciplinary clinic with myself, a plastic surgeon, and my partner, a dermatologist which I think is ideal!

3. Fluid accumulation and/or redundant skin. Could be possible in young patients but would need a good facial analysis and exam to determine. A low salt diet (< 1000mg/day) and a warm compress can help.  I would consider treating with filler/fat transfer, lower lid fractional ablative laser and/or lower lid blepharoplasty.

4. Descent of midface cheek pad. This then causes the nasojugular ligament to become more prominent creating a demarcation and separation of the eye from the cheek subunit. Treated with mid face lift and/or fat transfer.

It is all about the balance of this transition from the orbit to the cheek. There are many ways to treat this and they vary by the underlying cause. I recommend seeing a surgeon who also does a lot of these treatments. This can make a big difference as most people have a combination of the above that lead to the issue.

Hope this helps.

Best of luck,

DrC

Dark circles under the eyes are usually caused by a combination of several factors: volume loss, increased pigmentation, increased vascularity, and fine lines and wrinkling. If fine lines and wrinkling is the main contributing factor, then laser resurfacing can be an excellent treatment option. However, volume loss is better addressed with fillers and pigment and vasculature is best addressed with pigment and vessel-specific lasers. Usually, combination treatment will result in the best outcome. As this can be a tricky area to treat, it’s best to see an expert laser surgeon who has a solid understanding of the various causes of dark undereye circles to tailor your best treatment.

The main causes of dark circles are due to
1. Bulge below the eye- treated by fat removal or repositioning, usually from inside the eyelid
2. Hollow area below the eye bulge. Treated temporarily by fillers, typically Prevelle or Restylane. Treated more permanently by various grafting techniques including fat injection and LiveFill TM, an ultrashort incision cheeklift (i.e. USIC or LUSIC)
3. Loose skin below the eyelid. Minor relief with skin care products, Retin A, More permanent results with laser resurfacing or an ultrashort incision cheeklift. NOT recommended is a conventional blepharoplasty with canthopexy, in my opinion, as this may predispose to an alteration in eye shape.
4. Pigmentation. Temporary relief with make-up or possibly minimal relief with bleaching agents. Also possible to perform laser with pigment-specific lasers (variable success).
5. Prominent globe (forward set eye). Temporary relief with fillers. More permanent relief with autologous fillers (fat injection, LiveFill TM). Augmentation must be conservative in my opinion.
The lower eyelid is a very delicate area and choosing a surgeon with great experience with the midface and an excellent reputation are your best bet for achieving your best result.
Your pictures are a bit difficult to interpret with the shadowing effect and make-up and angle of the photograph.

There are a number of causes for dark circles under the eyes, therefore treatments should be directed accordingly. From outside in, the skin can have fine wrinkles. These may respond to creams and superficial peels, including lasers that smooth the skin. If the underlying muscle is over-active it can be relaxed with minute amounts of Botox. Eyelid skin is very thin, dark circles can be due, in part, to bluish blood vessels seen through this thin skin. Going deeper, eye-bags or herniated fat will cast a shadow that no concealer or eye cream can fix without surgery to reduce the bags. Lastly, there is pigment that is more common in certain ethnic groups. Response to laser for pigment is variable.
The first thing I do is lie patients back to remove the shadows to check for pigment. So, to answer your question, lasers will help fine lines and even visible blood vessels. See a facial surgery specialist to discuss your best options.