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.