Patient: What treatment do my dark circles require? I have hereditary dark circles that I am really self-conscious about and thinking of getting them treated. Which treatment would best fix them?

Doctor: Thank you for your question. You submitted a single photo that's a little bit dark and you describe that your concern is about hereditary dark under eye circles. Well, I will like to tell you a little bit about how I approach dark circles in my practice and how things have changed over the years in terms of this situation. If you go to any retailer that offers creams of various kinds, you'll see a tremendous number of solutions for dark under eye circles. Of course they're all basically moisturizers, some with tint. When we look at dark circles, what makes it so difficult to treat? Well first figuring out the origin and when it comes to dark circles there're basically some categories. Of course there could be combinations. Genetics which means pigmentation within the skin that runs in families. If it runs in the family, clearly that's a genetic thing where there is darkness from the pigmentation from melanin. Then there is the skin quality. A lot of people have very thin skin. When the skin is very thin you actually see the underlying structure. It may be a bluish appearance. It might be a little bit dark you can see the vessels. Skin quality is an issue. Anatomy, sometimes the shape of the eye and the bones around the eye, the way the skin drapes it accentuates various areas of hollowing. Then of course there are environmental and age-related changed. As we get older or if we are in an environment such as excess sun exposure or wind, the collagen breaks down. The skin becomes creepier and the skin quality diminishes and you can get thinning of the skin and the skin can look dark or look like dark under eye circles.

When we approach a patient, we look at our patient and first we decide are we dealing with any other issues that are also contributing to the overall appearance of the eyes. For example, if someone has puffy bags under the eyes, well that's one part of what makes their eyes not look so good. At the same time, we look at skin quality and the volume effect of that skin quality in that area. When we think of volume, there is an option now of doing some type of filler like Restylane or hyaluronic acid filler along the tear trough area and along the rim to try to add some thickness to the tissue underneath the skin to give less of a hollow and in many ways it can improve the dark circles. Now doing this requires proper patient selection as well as finesse in the technique. As a cosmetic ocular facial plastic surgeon specialist, 20 years of experience, I do see almost every week people who come who actually got this treatment done elsewhere who we need to actually dissolve it because they got too much or it became irregular. That is one option. Another option that we've had a lot of success with even for hereditary dark circles is use of platelet rich plasma. Platelet rich plasma is derived from your own blood and what we do is we do a blood draw like we typically would do for a lab test. What we do is we centrifuge it or spin it and we get the growth factors and the platelets concentrated and that's why we call it platelet rich plasma. Even in hereditary dark circles and even in some younger people, we find that improving collagen skin quality as well as the blood supply will actually be a benefit, so that even if it's genetic we have had very nice results with platelet rich plasma. Now of course we draw the line when it's someone who is too young, the skin quality is really fine and we're not going to make that much of a difference. We're not going to treat that patient. A lot of times there are, it's a multi factorial issue where not only is it genetic but there are also maybe some other lifestyle related and environmental triggers.

For example we have patients who do a lot of watersports and they're out in the sun and they're young but they've got a lot of ultraviolet light exposure, which results in breaking down of the collagen. The skin becomes very dry, very creepy and so they do benefit from platelet rich plasma. I think that on top of that, a good moisturizer, even though I do mention with a bit of humor about all the topical moisturizers used for under eye circles, there is still a role for proper hydration of the skin. Eyelid skin is only half a millimeter in thickness, and so for a lot of patients who come in who, they have dark circles, they wear a lot of makeup and then they use a lot of makeup removal solution in order to get rid of the makeup so what happens, while they're placing thick makeup to cover the dark circles and then they're traumatizing their skin and they're drying it out. A lot of these stringents really have alcohol, witch hazel and they can be somewhat drying and irritating. We can't understate that moisturization does play an important role. ….

You Can Treat Dark Circles Without Surgery! Here's How

Dr. Amiya Prasad details the common causes of dark circles under they eyes and treatments from regenerating the skin to filling hollow areas to improve them.