I have dark spots under my eyes; will laser help remove my dark spots under my eyes? (Photo)

Please post photos in better lighting for evaluation. Dark spots on the face can be improved with a combination of skin care, lasers, and peels. I suggest seeking an expert. Best, Dr. Emer

Thank you for your question. You submitted a single photo with your eyes closed, asking if laser will help remove the dark spots under your eyes. The photos are taken at a distance so I can see more of the broad picture, and not so much the detail of the eyes, but I think I understand what you’re asking.

I’ll give you a sense of how I counsel patients like yourself who come to my practice with his type of situation. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I’ve been in practice in Manhattan and Long Island for over 20 years. The challenge before us every day in our practice is dealing with  dark under eye circles. I think the core of your issue is you have dark circles under the eyes, and you want to know if laser will remove those circles. It is understandable why you are asking this question as we are immersed with incredible claims about the benefits of laser, but unfortunately that tends to confuse a lot of people because we have to differentiate what a laser does, and how it fits into this type of issue. I’ll go through the steps of how I evaluate patients like you, how I first find the problem, then define the solution.



In your under eye area, I first noticed some puffiness. Puffiness is not a skin issue, but something called lower eyelid fat prolapse, which means the fat pockets normally around the eyes have pushed forward and created these bulges. If this puffy area is not constant and is either fluid or just happens to be the way as the photo was taken, we can at least understand that puffiness isn’t something a laser specifically removes. Constant puffiness is treated with a more interventional approach, such as surgical procedure called transconjunctival blepharoplasty, where the fat pockets that create this type of puffiness are reduced from the inside of the eyelid. I prefer this technique especially for people who have darker skin types, meaning a light olive skin tone and darker. Transconjunctival blepharoplasty is generally done as there is no evidence of extra skin, and it avoids issues with an incision causing discoloration or scarring.



Skin type is one of the major decision points when choosing a laser treatment or alternative treatment l. Laser is the use of a particular wavelength for certain amount of time to target a particular type of chromophore. The three major chromophores are blood, water, and melanin. When you look at someone with dark circles under their eyes, we need to see if those elements are related when considering laser treatment. There are lasers that, for example, target water so they can be applied fractionated or ablative to remove top layers of skin. The top layers of the skin can also contain some pigment that could help make the dark circles look better. There are also lasers that target the pigment itself called melanin, and other lasers also target blood. The point of this is understanding whether or not a laser would potentially cause someone with a darker skin type to actually make the area look even darker, so you have to be mindful of where laser fits in.



When we treat under eye circles, with or without addressing puffy under eye bags, we routinely do a combination of platelet-rich plasma (PRP). PRP is derived from your own blood, and is a concentration of wound healing and growth factors that stimulate collagen and improves the appearance of dark circles . We’ve done this very successfully as a standalone procedure without laser,  getting the benefit of improving skin quality, and improving the texture and health of the skin. It’s actually been shown that platelet-rich plasma (PRP) prevents hyperpigmentation, and can be used in situations where there is hyperpigmentation, which has been shown in formal studies as well as clinically for years.



Although there are a lot of options, I think laser can have a place in your treatment plan, but you can also consider other options before going with laser. I think it’s natural to ask this question because people are so fascinated by lasers, and certainly this industry of aesthetic medicine does hype new lasers, and there’s some basis for that. Unfortunately, often the hype and the usability don’t always go together.



A laser is a tool, and it may have a role in your treatment, but it cannot be a standalone type of tool in my opinion. If I do a laser, I often combine it with platelet-rich plasma (PRP) because I want to get the benefit of the laser as a resurfacing tool, and the platelet-rich plasma (PRP) to improve skin quality and texture. Sometimes even injectable fillers can have a role in improving dark under eye circles.



There are a lot of different elements to address particular anatomic issues. I think you have to make some decisions about choosing a doctor to have a proper consultation, and learn about the recommended options  even go so far saying to meet with several different doctors. You are going to get a lot of different opinions. Find a doctor you feel comfortable with, and you feel makes sense with your unique situation. Remember, skin type is very important. The same modality I would use for a lighter skin type for a person like an Irish blue-eyed person with dark circles is very different from what I do for an Indian or Arab skin type, or an even darker skin type like of with African origin, so it really has to be customized. I hope that was helpful, I wish you the best of luck, and thank you for your question.This personalized video answer to your question is posted on RealSelf and on YouTube. To provide you with a personal and expert response, we use the image(s) you submitted on RealSelf in the video, but with respect to your privacy, we only show the body feature in question so you are not personally identifiable. If you prefer not to have your video question visible on YouTube, please contact us.