Female Speaker: Is there a permanent way to get rid of my dark circles? Concealers and creams don't work for me. Hi, I have had dark circles since I was born. Concealers and creams don't work for me. Is there a more permanent way to get rid of them? I am 26-years-old. Thank you in advance.

Dr. Amiya Prasad: Thank you for your question. You're 26-years-old and you're asking "Is there a permanent way to treat dark circles?" You've stated categorically that under eye creams and concealers don't work for you. So your frustration is something that is very, very common. We know this from the retail world because there are so many creams that offer solutions for dark under eye circles. I'll share with you a little bit about my approach to dark circles under the eyes. Over the years we've actually had a lot of advances that actually are helpful. They may be helpful to you.

So let's start with just the genetics of dark under eye circles. Twenty years ago when I started my practice and for many years, when people came in with dark under eye circles, even as an ocular facial plastic surgeon, I didn't really have that many options to offer them. We would do things like glycolic acids and retinoids and things like that to try to improve the skin quality, but still we were limited. Around 2005, with the introduction of hyaluronic acid fillers, we started to see some possible options, even though they weren't initially used for dark circles under the eyes.

Move the clock forward, in my practice, I analyze a dark circle situation in a couple of ways. One is I first look at the anatomy. Is there an opportunity to attribute some of the dark circles to a relative hollowing? Now if their hollowing is a genetic hollowing or a volumetric loss from aging, it's part of that decision-making plan. Now if there is a volume loss, we can actually use a hyaluronic acid filler, like Restylane to augment or to restore some volume under the skin, at a level that's closer to the bone in the area called the tear trough.

Now that, of course, has to be done very carefully and very meticulously. Unfortunately, a lot of people don't get the best results, because we see them in consultation, having them done elsewhere. They come in and we actually dissolve them with a material called hyaluronidase. So that's one option in determining what would be right for you. The second option is we have been in a leadership position in the world of regenerative medicine. We were using platelet-rich plasma for a lot of things and this is kind of an extension of what was already being done in orthopedic surgery and oral surgery.

Platelet-rich plasma is derived from your own blood, and what we do is we spin your blood, and we concentrate the platelets which are critical cells for healing and the concentration of growth factors. When platelet-rich plasma is injected under the skin in the appropriate candidate, it improves skin quality. It improves the blood supply and it improves the collagen. So we find that improving the thickness of the skin and the skin quality can also help under eye dark circles.

So in terms of a permanent solution, I have to say that we really don't have a procedure that's a one-time treatment as a permanent solution. For people with lighter skin types we also have other options, including lasers. But for somebody with a darker skin type lasers are usually not an option because there's a risk of hyper- or hypo-pigmentation. In other words, too much pigment or a loss of pigment, neither of which looks aesthetically good. So in our practice what we do, especially with a procedure like platelet-rich plasma, is we follow our patients and every three to four months we reevaluate.

If the skin quality looks improved and the patient is satisfied, then we just basically wait and see how long this particular treatment lasts for them. There are some patients who come in for PRP, or platelet-rich plasma treatments once a year. Others come twice a year. Others come three to four times a year. It's very individual. If there are confounding factors, such as age and environmental factors, then we also customize.

I wouldn't completely write off moisturizers as a solution because moisturizers do have a role. They might not completely resolve the problem, but when things work in combinations, so for example, if I have a patient who benefits from hyaluronic acid injection, platelet-rich plasma, and a good topical cream, they're under eye circles look a lot better. It's also in the context of the rest of the face.


Battling Dark Under-Eye Circles: When Concealer No Longer Works

Dr. Amiya Prasad discusses non-surgical treatments for dark under eye circles that treat the pigmentation, loss of volume from hollowing, and improving the quality of the skin under the eyes.