Dark Circles Under the Eyes: Diagnosis & Treatment

by Samuel Lam, M.D.

I want to talk about a subject that a lot of patients ask me about: dark circles under the eyes.

Everyone wants to know what causes dark circles to form under the eyes. And is there surgery for dark circles, perhaps by using a laser?

The first thing we have to do is figure out what is causing the dark circles. There are a variety of diagnoses.

Treating Dark Circles on the Surface of the Skin

First of all, we have to define what is the depth of the problem. If it’s on the surface, sometimes there is a brown discoloration on the skin.

This is usually caused by an allergic reaction, or a general allergic type of entity called atopy.

If you have allergies also known as allergic shiners, this can be caused by vascular engorgement or blood vessel engorgement.

Sometimes it’s just due to the fact that you keep rubbing the itchy area under your eyes, creating a streak of hyperpigmentation or darkness.

If the darkness under your eye looks like a brown streak that extends all the way across, that can be an indication of hypermelanosis or darker skin color around the eye itself.

The way to determine that is to touch the skin with your fingers and gently stretch it out. If it stays the same brownish color when you do this, that is usually an indication that there could be some atopy or allergy involved.

It’s best to consult an allergist or a doctor that specializes in the head and neck region to help you with this.

Treating Dark Circles with Skin Lighteners

Clearly, the best thing to do is treat the cause of the dark circles, which is possibly an allergy. Beyond treating the allergy itself, it is also possible to treat the effect.

The way to treat the effect would be to lighten it. My feeling about using lasers near the eyes is that I prefer not to do it.

Lasers that use any type of photothermolysis technique where the laser is absorbed by color make me nervous. The retina has a huge amount of melanin in it, and your doctor needs to be sure to use appropriate eye shields that go onto the eye itself, in order for it to be safe.

But I prefer to use a skin bleaching product like hydroquinone or kojic acid. These products are prescription level and for use by physicians only.

Lower Eyelid Discoloration due to Hypervascularity

Another cause of dark circles is coloration due to hypervascularity. In layman’s terms, this means more blood vessels or very thin, translucent skin that has an apparent muscle or some degree of engorgement of the veins.

This usually doesn’t go across the entire lower part of the eye, but sits near the inner part of the eye toward the nose. This condition can also come and go in the case of women who are menstruating.

It’s very hard to treat. I do a lot of fat transfers, and it’s dangerous to put it that close to the surface of the skin. This is simply a very difficult condition to manage.

When the muscle is the issue, I have actually had success over the past few years using Artefill, a permanent filler, between the skin and the muscle to cover the exposed colored muscle.

Is There Surgery for Dark Circles Under the Eyes?

We have to first look at the surgical reasons for bags under the eyes. Is there just hollowness, or is there an eye bag?

Sometimes we just look too much at the bag, and we don’t pay attention to negative space, which is the area around it.

When you are younger, you have a lot of volume and fat around the eye. But the eye bag doesn’t go away despite changes in weight and age.

The real problem is just hollowness around the eyes that we need to refill. Many of my patients are getting fat transfers to manage this condition. This will help make the dark circles less obvious.

For people who aren’t ready to do a fat transfer, or have other reasons for avoiding surgery (like being very young or grossly overweight), Restylane or other types of injectable products can be very safe if performed by an experienced injector.

One more important point: I rarely cut the lower eyelid. Any time you cut on the lower eyelid through a skin muscle flap, even the best surgeon can distort the eyelid shape in a negative way, so be careful!

I hope this summary of reasons why some of us have lower eyelid dark circles and the treatment options available will come in handy when consulting with a plastic surgeon.

(published May 24, 2013)

Samuel M. Lam, M.D. is a double board-certified facial plastic surgeon and a board-certified hair restoration surgeon. The author of five major medical textbooks, Dr. Lam lectures monthly both nationally and internationally. He is the owner of the 27,000 square foot Willow Bend Wellness Center in Dallas, Texas, which supports meditation, revitalization, rejuvenation, relaxation and wellness. Dr. Lam has succeeded in recent years with his own physical transformation through a combination of proper diet and exercise, and would like to help others do the same.