Laser Resurfacing for Dark Circles Under Eyes?

I heard that laser resurfacing could help dark circles under eyes. Is this true? What can you do for dark circles under the delicate eye area, without going under the knife to tighten them? They seem to tell me that only a cream might help. I just think there surely is somethig out there that I could do at this spa im at. They offer quite a bit of stuff, but they don't tell me I can do anything for it. Thanks.

Doctor Answers 14

Dark Circles - Underlying Causes & Potential Treatments

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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.

Treating Dark Circles Can Be Challenging

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Treating dark circles under the eye is still one of the most challenging cosmetic concerns that we see on a regular basis in our office. First and foremost, make sure you are seeing a board-certified dermatologist or plastic surgeon who can thoroughly examine the skin and underlying anatomy to make a determination of why you are having these dark circles. If the problem is skin only, a really good skin care routine with an appropriate eye cream, may be helpful. And in 2014, many of the cosmeceutical companies are makinggreat eye creams, like the ones from Neocutis and Skinceuticals, amongst others.

If there are tear troughs present that are causing some of this darkening through shadowing, a filler may be very useful. Products such as Restylane, Juvederm, and Belotero all work here. Sometimes a laser procedure, a fractional non-ablative or fractional ablative procedure will make the skinlook much better, and with skin care, keep it lasting that way for a long time. And if there are bulging fat pads, we would recommend a surgical procedure,especially if all the other procedures and topicals do nothing at all. Again, this can be determined with your board-certified dermatologist.

Michael Gold, MD
Nashville Dermatologic Surgeon
3.9 out of 5 stars 17 reviews

Dark circles under the eyes have many causes

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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.

Steven J. Pearlman, MD
New York Facial Plastic Surgeon
4.9 out of 5 stars 141 reviews

Best treatment for dark circles under the eyes in my NYC practice

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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. 


Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 39 reviews

Laser for dark circles under eyes?

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Dark circles under eyes are frequently caused by a tight  insertion of the orbicularis oculi muscle at the lower orbital rim. It's an attachment to bone, well under the skin. Therefore, this problem cannot be corrected with laser. Correction of dark circles under the eyes, in my experience, is best performed by releasing that ligamentous attachment, and filling the hollow area with lower periorbital fat. This can fully correct the visible depression. If you have a bit of bulging fat under your eyes, plus dark circles--you may be a perfect candidate for a lower eyelid blepharoplasty with tear trough correction as described. However, this is surgery, with a week's recovery period. It is a good lifetime fix. 
If you don't want surgery, what are your options? Laser resurfacing is a good second choice as it will tighten and smooth the lower eyelid skin, reducing the apparent depth of the dark circles. This in combination with fillers, carefully injected under the orbitomalar ligament, can take the edge off the dark circles without invasive surgery. However, ablative laser should not be performed in patients with darker skin types due to the risk of PIH. 

Diane I. Duncan, MD, FACS
Fort Collins Plastic Surgeon
4.7 out of 5 stars 20 reviews

Dark circles under the eyes and laser resurfacing.

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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. I do believe that laser resurfacing, though reported, is too aggressive for the treatment of dark circle in most patients - especially darker skin types. 

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.

Drak circles under the eyes.

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There are many possible causes for the dark circles that range from anatomy, fat bulges, pigment, thin skin, hollows, etc. Depending on these the treatment can vary from injections/fillers, peels chemical or laser, bleaching creams, etc. Meet with a professional to discuss the best options for you. It is very difficult to tell from the picture what is best suited for your correction.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

Eye bag,circles and discoloration treatments, younger people

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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


Benjamin Caughlin, MD
Chicago Facial Plastic Surgeon
5.0 out of 5 stars 13 reviews

Laser Resurfacing for Dark Circles Under Eyes

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Depending on the underlying cause of the dark pigmentation, there are different options. Laser can be very effective for the appropriate candidate. Consult in person with an experienced and expert treating physician to understand your options.

Kris M. Reddy, MD, FACS
West Palm Beach Plastic Surgeon
4.5 out of 5 stars 56 reviews

Yes, Depending on the Cause

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Dark circles under the eyes have a lot of possible causes. Puffiness, inherited pigmentation, blood vessels, and hollows can all create the appearance of dark circles. Laser resurfacing with the Halo hybrid fractional laser can be an appropriate path to reduce pigmentation, but you may also find that bleaching the area with specialized creams is effective. But for puffiness (or bags under the eyes), you will probably need lower eyelid surgery. Schedule a consultation with a qualified plastic surgeon or skincare specialist to determine the cause and develop a treatment plan. Good luck to you.

Otto Weiglein, FRCSC
Burlington Plastic Surgeon
5.0 out of 5 stars 6 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.