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One of the most common conditions bringing patients to see us at Aesthetics on 5th, is dark circles under the eyes. Patients reach a point when they’ve had enough of people asking them if they’re tired or if they’re feeling ok. Whilst under-eye concealer often helps to mask the dark circles, who wants to be using lots of make-up every day?

There are three basic conditions that cause dark under-eye circles:

1. Pigmentation of the skin
2. Visibility of blood vessels through the skin
3. Loss of volume and hollowing under the eyes

One or more of these factors may be present in a patient and they are treated in different ways.

1. Pigmentation of the skin

The skin under the eyes is thin, delicate, and prone to sun damage and pigmentation. It tends to concertina together, concentrating the darkness and making it more noticeable. Hyperpigmented skin under the eyes can also be hereditary and is usually seen in darker skinned individuals. To determine if your dark circles are caused by pigmentation, look in the mirror and pull the skin under your eyes gently downwards and outwards. If the darkness moves with the skin, you have pigmentation.

Pigmentation can usually be improved with a combination of laser treatments and/or chemical peels to remove the pigmented cells and results can be maintained with the use of eye creams containing active ingredients such as antioxidants, retinol, and lightening agents. Use of sunblock in this area is very important and this area is often missed when we apply our daily sun protection. Pigmentation often tends to recur and annual treatments may be necessary to maintain results.

2. Visibility of blood vessels through the skin

Because the skin under the eyes is so thin and delicate, blood vessels are often visible under the skin and appear as bluish, under-eye circles. This is particularly prevalent in very light skinned individuals, but they can also be visible in those with darker skins. As a person ages, the tissue thins with loss of fat and collagen, making blood vessels more visible. Loss of fat in the mid-face region causes an elongation of the lower eyelid and also leads to increased visibility of blood vessels. Allergies, sinus congestion, stress, lack of sleep, dehydration, smoking, caffeine, and anemia can lead to increased pallor, congestion and dilation of blood vessels, and puffiness of the under-eye tissue. All of these factors can contribute to increased visibility of blood vessels which presents as dark, under-eye circles.

To determine if the visibility of blood vessels is causing your dark under-eye circles, pull the skin gently downwards and outwards and examine in a high magnification mirror. Individual blood vessels will be visible through the skin.

This condition is the most difficult to treat. Underlying contributing factors need to be addressed and treatments are aimed at improving the thickness and quality of the under-eye skin by increasing collagen production. Multiple treatments are needed with a gradual improvement in tissue condition over time. Carboxy therapy may help to improve the integrity and strength of blood vessel walls, helping them constrict and become less visible.

3. Loss of volume and hollowing under the eyes

There are numerous fat pads in the face that become smaller and resorb as we age. Loss of fat in the mid-face region and under the eyes leads to a loss of volume and hollowing which causes shadows which present as dark, under-eye circles. In some people, lack of volume under the eyes is congenital and dark circles can even be seen in young children. To determine if you have volume loss contributing to your dark circles, press the tissue under the hollow area and watch what happens in a mirror. If the dark circles improve because of an improved reflection of light, your under-eye circles are caused by volume loss.

This condition can be rectified with the injection of soft tissue fillers in the mid-face region and/or the tear troughs to correct the volume loss and resultant shadows, and to help reflect light. This procedure should only be carried out by an advanced and experienced injector. Results are often dramatic and typically last for 12-18 months.

Many patients have a combination of factors which contribute to their dark, under-eye circles. We manage these patients by doing a thorough assessment and prescribing an individualised treatment plan that will address all of them

Natasha Chapman

Dr. Natasha Chapman is an Aesthetic Medical Practitioner with over 16 years of experience in the aesthetics industry. She is passionate about what she does and regularly attends advanced training courses to keep up-to-date with the latest developments in the aesthetics world.