Pause and think next time you reach for an expensive cream to get rid of dark under-eye circles. Facial plastic surgeon Caroline Banks, MD, explained why some marketed treatments are only temporary, and why surgery is sometimes the only way to fix the issue.
“You look tired.”
Anyone with persistent dark circles, or bags, under their eyes has heard this remark countless times from well-meaning peers.
However, some people have had these circles from a young age. And no matter the treatment they find online or in the makeup aisle, they can’t seem to get rid of them. That’s because these treatments do not address the underlying cause of the circles.
“It might just be that the fat under the eyes is protruding, causing the dark under-eye circles, and most non-surgical treatments won’t change that,” Dr. Caroline Banks, a facial plastic surgeon at Mass Eye and Ear, told Focus.
Dr. Banks explained what options patients have to alleviate these dark circles.
What causes dark under-eye circles?
Dark circles under the eye can be caused by overall puffiness and fluid, pigmentation, excess skin, blood vessels, fat protruding in the lower eyelid, or a combination of all these factors. Each factor is treated differently.
Aging leads to thinner tissue in the lower eyelid and volume loss, causing the fat pads under the eye to become more visible. Aging can also make the blood vessels under the eye appear more prominent. This can present under the skin as dark circles.
In some patients under-eye circles are genetic, due to pigmentation, location of blood vessels or more prominent fat pads.
Protecting the lower eyelid skin
Regardless of the cause of under-eye circles, it is important to protect the skin from damage and premature aging from the sun. Dr. Banks recommends a tinted mineral sunscreen daily on the entire upper and lower eyelid. This will assist with pigmentation, maintain collagen, and prevent skin cancers, which are common on the eyelids.
Creams and rollers offer temporary fixes
There are topical treatments that can temporarily improve the appearance of under eye circles. For patients with pigmentation, Dr. Banks recommends over-the-counter retinol or gentle prescription retinoid creams. Patients can also look for creams with brightening agents, such as vitamin C, niacinamide or alpha hydroxy acids.
Overall puffiness and fluid can have many causes including allergies, poor sleep, too much salt intake, alcohol, or smoking. Treating the underlying cause and making lifestyles changes can make a huge impact. Cool compresses or rollers and creams that contain caffeine can temporarily de-puff the under eye area, and many people will do this before a public event or before photos are taken.
Dr. Banks cautions that many eye creams often come in small amounts with a high price tag, and the results are only temporary.
“I tell patients that the price tags for some of these creams might not be worth the end results they are seeking,” said Dr. Banks.
Laser and surgical options
For some patients, laser procedures can tighten the skin under the eye, help lighten pigment, and improve the appearance of blood vessels.
For many people, surgery is the most effective treatment for dark circles under the eye, particularly those who have fat protrusion and volume loss. Blepharoplasty is a lower eyelid surgery in which excessive fat and loose skin from under the eye is removed. In some cases, the fat is shifted into areas of the lower eyelid that have loss of volume, such as in the tear trough.
These procedures are considered cosmetic and are an out-of-pocket expense. An important point to keep in mind for any aesthetic surgery, though you can see results quickly, full healing takes up to a year, and sometimes longer.
“Patients are often surprised when they still have bruising one or two weeks later,” said Dr. Banks. “Like any surgery, this takes time to heal, and I tell them that everything is right on track.”
Patients also need to keep in mind that these surgeries are permanent, she said. That might cause some individuals to seek out a more temporary option.
Turning to tear trough fillers?
Fillers known as “tear trough fillers” are becoming an increasingly popular treatment option marketed to fix dark under-eye circles. Here, the fillers are injected into a crevice under the eye to smoothen the area.
However, Dr. Banks urges caution when considering this approach. If too much filler is used, it can cause the under-eyes to have an unnatural appearance, especially when performed by someone who is not as specialized with this procedure.
“While a small amount of filler can help some patients, the filler is ultimately not correcting the underlying problem like surgery might,” she said.
The bottom line is this: A thorough evaluation with a specialist who is board-certified in facial plastic surgery or oculoplastic surgery can help determine the root cause of the dark under-eye circles and recommend a treatment that works best for your needs.
“Not everyone will need surgery,” said Dr. Banks. “But for some, the effects can be a permanent solution to the problem.”
About the expert
Caroline A. Banks, MD, is a double-board certified Facial Plastic and Reconstructive Surgeon who specializes in the treatment of facial nerve disorders, aesthetic facial surgery and facial reconstruction. She sees patients at the 243 Charles Street and Longwood locations in Boston.