What can be done to lighten the pigment under my eyes? (Photo)

Fractional CO2 laser is an excellent tool for skin rejuvenation in our center in Santa Monica. We use the fractional multi-depth ablative approach to help resurface the skin, recontour acne scars, improve incisional plastic surgery scars, and reduce surface irregularities from skin tone to dark pigmentation. Our approach utilizes a multi-depth approach that targets melanocytes in the epidermis and collagen fibroblasts in the dermis. This approach can be combined with a TCA Peel in a process known as a sapphire peel. Fractional laser is excellent for acne scars and contour scars in the skin. Patients are advised to undergo skin protocols with Melarase creams before and after treatment to help reduce pigmentation. Melarase AM, Melarase PM, and Melapads can seriously improve surface sun damage and UV related pigmentation. After the laser, we expect redness for a few weeks as the skin improves. PRP and Hydrafacial enzyme facials can further improve skin quality after fractional co2.

Best,
Dr. Karamanoukian
Realself100 Surgeon

After filler, you should focus on pigment with topical options that can lighten the tissue. Hydroquinone alone, Hydroquinone + Viatmin C, or Hydroquinone + Vitamin C + Kojic Acid are products that can help with skin brightening. I would try that first before moving on to invasive lasers.
J Scaljon

I'm certainly not surprised by the lack of efficacy of the PRP, since the science to support its cosmetic use lags woefully behind the heavy marketing to promote it. And I have been cautioning my readers for years already to exercise a great deal of buyer beware skepticism when it comes to PRP. Sorry. From what I can see, there is still quite a bit of hollowness under the eyes, meaning that the addition of an appropriate filler, properly injected in the area is likely to reduce the appearance of the dark circles. Likewise, a series of superficial peels supplemented by at-home use of prescription strength bleaching medications, such as azelaic acid, may prove further helpful. Make sure to consult with an experienced, board certified cosmetic dermatologist. Best of luck.

At home peels like cosmelan, enlighten and aerify along with dermarolling (MTS roller with anteage MD ampules) should be started now. There are many things you can do to treat under eye hollows and dark circles. A surgical option to remove skin and/or fat will such as lower eyelid blepharoplasty with or without fat pad repositioning will be the best long term. There are many things you can do to treat under eye hollows and dark circles without surgery. Non invasive less downtime options such as fillers (Belotero, Juvederm Volbella​), lasers (Moxi/Halo/Fraxel/CO2​), Renuvion (J-Plasma), microneedling/PRP, stem cells and microneedling RF like Fractora PiXel8 or Morpheus can all help give some improvement. Accutite can often be used or stronger lasers like erbium or co2 spot treatment can tighten the skin and give very quick improvement in wrinkles and texture. A surgical option to remove skin and/or fat might be the best solution long-term. I suggest you get a formal consultation to see what is best for you and your goals. Best, Dr. Emer.