Dark Circles Treatment: Hyrdoquinone or Retina-A or Filler or Nothing?

i'm middle eastern and have been blessed with a beautiful natural tan but cursed with REALLY dark undereye circles. i've tried every "safe but effective" cream with things like kojic, high vitamin k from expensive to cheap! nothing works!

so i asked a family friend who is a plastic surgeon and he pulled my skin etc and then recommended a mix of hydroquinone and retin-a. i'm scared of discoloration (does hydro bleach or stop melanin?). i went to a dermatologist and she told me that he's crazy and to NEVER DO THAT which scared me even more. what do i do?

Doctor Answers 5

Treating dark circles caused by thin skin and lack of fat

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Retin A, hydroquninone, triluma, kojic acid are not what you need.

Your issue is not too much skin pigment. Your dark circle is optical: thin tear trough skin with no subcutaneous fat. That darkness is the result of light penetrating the skin and being absorbed by the dark red muscle that lies just below the thin skin. No skin bleacher will make a difference here.

However, by filling this area with Restylane, it is possible to lift the skin slightly filling the hollow and changing the way light interacts with this area. This will make the area look much less dark. These treatments last well over a year and in come case two years.

Take a good look at my website for before and after examples and a lot more information on this subject.

Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

How to treat dark circles under the eyes?

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First of all one has to determine the CAUSE of dark circle. In most cases this is racial (I have them as well), in some cases, it is due to deep tear troughs, in others a combination of PIH or skin hyper pigmentation due to eczema, and in many cases a combination of factors.

In the US, we use Restylane in this area to correct volume loss due to deep troughs, however in Australia, Restylane and JUVEDERM VOLBELLA can be used. I do place the filler deep- namely on bone, this reduces the chances of a Tyndall effect (blue tinge).

Other ways to treat dark circles under the eyes include -

1. Treat any skin irritation - namely simplify your skin care regime- use a good eye cream- this can reduce inflammatory changes on the skin
2. Low dose Q switch lasers
3, Microneedling and PRP
4. Low strength HQ creams – this is used to decrease melanin activity
5. Multiple sessions of either Clear + Brilliant or Low Level Fraxel 1550 - I do however believe that Picosure Focus is better than Fraxel in my hands for dark circles- 3-4 sessions needed.
6. Very low strength peels including 6-8% TCA – five to six peels in combination with fading agents.

Even with multiple treatment methods, dark circles can only be reduced, and not totally eliminated. Realistic expectations are crucial in treatment of this problem, and combination tailored to EACH patient.

All the best
Dr Davin Lim
Laser and aesthetic dermatologist
Brisbane, Australia.

Prominent nasojugal crease

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I agree that you likely do not have a problem with hyperpigmentation (treated with hydroquinone and retin A) but a lack of fat and thin skin over your infraorbital rim which causes the shadow. This area is also called the nasojugal crease. In my San Diego practice we use restylane (for a long lasting solution) or fat grafting (permanent) to improve or correct this. What you want is a smooth lower eyelid that blends into the cheek without an intervening "valley."

Roy A. David, MD
San Diego Facial Plastic Surgeon

Proptosis and scleral show should be evaluated by an Ophthalmologist.

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There are 2 interesting features in the photo you provide: 1) You may be proptotic (eyeball protrudes too far) 2) You have a lot of scleral show (We see too much of the white of your eye below your lid margin).

Since these may be present, you should consult a board-certified Ophthalmologist for an evaluation. Proptosis can be due to an overactive thyroid (Grave's Disease), and this may also lead to excessive scleral show.

After a medical evaluation, you could consider an Injectable Filler treatment to fill the hollow area between your lower eyelid and cheek. Bleaching creams (or any other creams) are completely ineffective in treating lower eyelid dark circles.

I hope this is helpful for you.

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 435 reviews

Restylane Injections for Lower Eye Lid Dark Circles

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Hi Anon,

You are correct in that there is not an effective treatment for dark circles. Fillers do help a little in that they fill the shadow so that there is an illusion that the circles are not as dark. I would think that based on your photo, Restylane will help. This is a very delicate and unforgiving area for injection so do make sure that you choose a physician who is experienced and skilled with lower eye lid injections.

Good luck and be well.

Dr. P

Michael A. Persky, MD
Encino Facial Plastic Surgeon
4.8 out of 5 stars 39 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.