Hollow Eyes, Dark Circles? (photo)

The cause of dark circles is multifactorial and as such, there is no single answer to solving this common problem. The most common easily treatable causes are 1) bulging of the fat pads under the eye (pseudofat herniation) or commonly "eye bags" which cast a shadow underneath in ambient light, these can easily be treated with a 30 minute operation without an external scar known as transconjunctival blepharoplasty and 2) a curilinear depression under the eye bag commonly known as the tear trough depression which can be easily filled with an HA filler like Resylane, Juvederm or Belotero in the office.

Also common, but more challenging causes of dark circles are pigment changes that are either vascular, skin pigment (melanin) or both.  Small groups of capillaries (tiny blood vessels are common under the eye and as our skin ages and becomes thinner these vessels become more dense and apparent forming a shade of darkness.  Larger veins that tend to have a bluish hue can also be vascular contributing causes of pigment.  Both of these vascular causes can be treated with certain types of lasers like the Nd:YAG and broad band light (IPL).

IPL also treats the skin pigment changes caused by sun damage - deposition of melanin  - macules, "freckles or sun spots".  These spots often become confluent with the loose and wrinkling skin under the eye that worsens the appearance.

Finally, there are theories that a blood byproduct, hemosiderin can cause a brownish hue under the eyes as it contains small amounts of iron from its nascent molecule hemoglobin "leaking" from the small capillaries under the eyes - the result of slow circulation.  There is little or no scientific evidence to prove that this is a cause but this theory is often touted with creams and lotions marketed to improve dark circles.  I am very skeptical about these products.

Usually significant improvement can be achieved with a plan that includes one or all of the above mentioned causes and treatments.  In any case, no one needs to live with dark circles!

Generalized weight loss can affect the facial fat as well as body fat.  Unfortunately, there is no cream or topical medicine to help with hollows beneath the eyes.  Running on its own does not contribute to worsening the hollows, but the weight loss definitely can.  The treatment for under eye hollows can be accomplished with either use of a filler to fill in the hollowness, and/or surgery to remove some of the fat above the hollow.  Your consulting doctor should be able to go over your options and determine the best course of action in your particular case.  

Volume loss in the face is common with significant weight loss and can give a more aged appearance.  Looking at your photo, you have lost volume under your eyes and this exposes the rim your orbit which gives you shadowing and the appearance of dark circles under your eyes.  Because your problem is volume loss, eye cream would probably be ineffective.  Temporary fillers such as Restylane, Juvederm or a new product Belotero can be utilized to restore volume in this area and soften the contour from your eyelid to cheek.  Eliminating this shadow should improve the dark circle appearance. A more permanent option is autologous fat grafting, which transfers fat from one part of your body to restore volume under your eyes. If you anticipate more weight loss with your running, you many want to start with the hyaluronic acid fillers first, since fat grafts can vary with weight. 

Hello,

Thank you for the question and photo.  You may want to consider a transconjuctival blepharoplasty and fat grafting to the lower eyelid-cheek junction. The before and after photos below are from one of my patients and may give you an idea of what this entails.

All the best,

Dr Remus Repta

Congratulations on your hard work and weight loss. As we age, we lose volume (including fat) from our face. Your weight loss may now be accentuating these normal changes. Fortunately, running and weight loss makes everyone look and feel better overall, so I'm sure your eyes and the rest of you look better than before your new healthy lifestyle.

Unfortunately, no eye cream will solve this problem.

No, there is nothing special about running that is bad for lower eyelids, so keep on running. Nor does running require any special treatment different from anyone else.

There are plenty of plastic surgeons in NYC who can help you. Go to the American Society of Plastic Surgeons website to help you find a physician.

The hollows are most easily treated with a filler Restylane, Juvaderm, Radiesse, fat injections or Sculptra.

Creams won't help other than to improve wrinkles.

Juvederm swells less than Restylane, both will have you looking better as soon as you finish the treatment. These last longer in this location.

Sculptra is a great product which will last up to two years but requires at least two sessions.  This and fat injections are particularly useful in runners who loose their cheeks and develop hollows in the tempels and below the lids

Fat injections work well on 2/3 of patients giving years of correction, usually with minimal bruising and swelling. 

Costs are roughly the same in the long run for all of the above.