Dark eye circles are such a common issue that patients attribute it to a lack of sleep and put up with them for years.
We know that fatigue, lack of sleep, and environmental stressors such as excessive alcohol intake and smoking can worsen their appearance; simple lifestyle modification often provides some degree of improvement.
Many of my patients finally decide to seek help after having had just too many comments of “You didn’t sleep well last night again?” (even when they have been sleeping like a baby for the past week!), when they have an important event they need to look their best for, or when they are no longer able to conceal it adequately with cosmetics. Dark eye circles plague both young and old alike. They mar an otherwise attractive youthful face and when corrected using no downtime or minimally invasive dark eye removal aesthetic treatments, you can see a world of difference for a mature face.
Fortunately, apart from being a social inconvenience, dark eye circles seldom are a sign of any truly serious medical condition. However, the concern is no less real. Over the past decade, there have been several scientific journals and articles on the classification, causes, management, and removal of dark eye circles. This is my humble attempt at a simple, comprehensive discussion on this subject.
Without rambling further, let us dive straight into the centre of the pie.
Dark eye circles are defined as bilateral homogeneous pigmented patches over the infraorbital (undereye) region and are frustratingly multifactorial. They can be classified under three main causes: (1) excessive pigmentation, (2) structural causes, and (3) prominent blood vessels. Identifying the underlying cause is crucial in the assessment of dark eye circles, and essential for an effective management plan.
Excessive pigmentation may be constitutional, due to a genetic predisposition and seem commonly in darker skin types. It may also be due to pigmentary disorders such as melasma or ABNOM (acquired bilateral nevus of Ota-like macules) that often occur in the upper part of the face and can extend to involve the undereye area as well. It is also common for post inflammatory hyperpigmentation to occur as a result of irritated skin in atopic dermatitis (eczema) or contact dermatitis. Allergic shiners frequently present as dark eye circles are also a well-known symptom of allergic rhinitis, colloquially better known as “sinus”. Excessive pigmentation has a brown hue and is commonly accompanied by pigmentary changes on other parts of the face. It does not improve with lighting adjustment and does not lighten on stretching the skin.Source: Harneet Ranu, Steven Thng, Boon Kee Goh, Allan Burger, Chee Leok Goh. Periorbital Hyperpigmentation in Asians: An EpidemiologicStudy and a Proposed Classification. Dermatol Surg 2011;37:1297–1303.DOI: 10.1111/j.1524-4725.2011.02065.x
Structural changes are age-related but can also be seen in younger individuals due to their inherent skeletal face structure. The main factors contributing to structural change include volume loss and skin laxity of the midface and undereye area, sagging of the cheeks, and pseudoherniation (bulging) of fatty tissues around the eye. Hollowing in the undereye area causes a shadowing effect which contributes to the appearance of dark eye circles. Structural changes can be identified by adjusting the lighting angle on the patient’s face, by displacement of midface fat compartments or by stretching the skin which ameliorates the appearance.
Prominent blood vessels are due to a combination of superficially located blood vessels, a deficient subcutaneous fat layer, and thin translucent skin. Prominent blood vessels give a bluish or purplish hue and lighten when the skin is stretched. Close examination may also reveal fine superficial blood vessels. Additionally, venous stasis and congestion can lead to extravasation (blood leaking out from capillaries) and hemosiderin pigment deposition in the undereye skin.
The main treatment options for dark eye circles removal are topical agents, lasers, non-invasive energy treatments such as high intensity focused ultrasound (HIFU) and radio frequency (RF), as well as fillers.1. Depigmentation agents
Excessive pigmentation can be treated with depigmentation agents such as hydroquinone, retinoic acid, kojic acid, or azelaic acid which inhibit DNA synthesis in melanosomes or inhibit tyrosinase activity thus reducing melanin pigment formation. These topical agents require several months to be effective and may have side effects that include skin irritation, redness, itching, and even paradoxical hyperpigmentation. Topical vitamin C is an antioxidant which helps to neutralise free radicals in the skin that trigger melanin formation.2. Laser treatments
Lasers are the mainstay for treating excessive pigmentation in dark eye circles, like many other pigmentation issues in the face. Commonly used effective wavelengths include Q-Switched Nd:YAG (1064nm) and alexandrite (755nm) lasers. Nanosecond lasers break down melanin pigments through a photothermal effect while picoseconds have the additional benefit of breaking down melanosomes (cells in which melanin pigments are contained) through a photomechanical and photoacoustic effect.3. Ultrasound and Radio frequency (RF) treatments
Radio frequency (RF), Ultherapy, and HIFU are helpful in improving structural issues implicated in dark eye circles by stimulating collagen synthesis. RF improves skin laxity by targeting the dermis while Ultherapy and HIFU additionally provide a lifting and mild volumising effect by targeting deeper layers including the superficial muscular aponeurotic system (SMAS) layer of the face. As RF, Ultherapy, and HIFU are dependent on the tissue response, results may take up to 2-3 months before they become apparent.4. Fillers
Saving the best for last, hyaluronic acid (HA) fillers is an excellent choice for treating dark eye circles due to structural deficiency. Fillers replace volume directly in hollowed areas and provide support for saggy areas. Well-selected HA fillers do not cause any tissue reaction, have good tensile strength, yet spread evenly and integrates with the tissue layers, giving a natural look. The icing on the cake is that the procedure often takes no longer than 30 minutes and improvement is immediately appreciable.
By Dr. Mark LimReferences 1. Sarkar R, Ranjan R, Garg S, Garg VK, Sonthalia S, Bansal S. Periorbital Hyperpigmentation: A Comprehensive Review. J Clin Aesthet Dermatol. 2016;9(1):49-55. 2. Vrcek I, Ozgur O, Nakra T. Infraorbital Dark Circles: A Review of the Pathogenesis, Evaluation and Treatment. J Cutan Aesthet Surg. 2016;9(2):65-72. doi:10.4103/0974-2077.184046 3. Friedmann DP, Goldman MP. Dark circles: etiology and management options. Clin Plast Surg. 2015;42(1):33-50. doi:10.1016/j.cps.2014.08.007
Are you still looking into the mirror and wondering which dark eye circle removal treatment method is suitable for you? Consult our doctors at Halley Medical Aesthetics to find out.Halley Medical Aesthetics Tel: +65 6737 8233 WhatsApp (Call/Message): +65 9816 6148 Email: firstname.lastname@example.org
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