Dark Under-Eye Circles: Your Questions Answered

Treatment advancements for dark under-eye circles and tear troughs can brighten up that tired look

By Dr. Fred Weksberg, MD, FRCP.

Dark under-eye circles can affect people of all ages, races and genders. But there are helpful treatments and products that can reduce the appearance of dark circles. Here are some frequently asked questions about under-eye circles and what can be done about them.

What causes dark and depressed circles under the eyes?

Sometimes dark circles can be hereditary, but most often they are a result of the aging process causing thin skin, a loss of fat, and prominent capillaries. In some patients, dark circles are a reaction to eczema, or caused by too much sun exposure. Tear troughs develop secondary to the changes in aging skin around the eyes.

What treatments can I try to diminish dark circles? 

If the dark circles are due to increased visibility of blood vessels, then laser treatment may be helpful. Additionally, people can consider fat grafting, or injecting hyaluronic acid (HA) fillers. If the dark circles are due to melanin pigment, then lasers (different from those used for blood vessels) may help as well as sunscreens. Topical agents such as Universkin can reduce pigment formation, and can also stimulate new collagen formation to thicken the skin, reducing the prominence of the blood vessels.

How do I know if I am a good candidate for dark circle and tear trough treatment?

Anyone can undergo treatment for dark circles. The treatment plan is formulated dependent on the patient’s age, ethnicity, and findings on examination. Depressions or tear troughs may need surgery if they are severe, but in mild to moderate cases, HA fillers can provide instant results. A proper consultation with a doctor is needed to assess whether a patient is a good candidate.

I heard about PRP for this condition. How is PRP performed? 

PRP is platelet-rich plasma. For this procedure, your blood is taken from your arm, and put into a centrifuge. This machine spins the tube of blood at a fast rate, separating the cells. The clear plasma fluid and only the platelet cells are withdrawn from the tube and injected with a tiny needle into the skin.

How many PRP and HA filler treatments are needed? 

PRP treatment is usually performed at least three times; sometimes up to five or six times. For tear troughs, usually one filler session is needed, with more advanced depressions possibly needing two sessions.

What is the recovery time for these procedures?  

Recovery time is minimal following laser treatment. After PRP or HA fillers, you may experience some mild redness, swelling, or bruising for several days.

Is the procedure painful? 

There can be some mild discomfort with all of these treatments, but they are not considered to be very painful. For sensitive patients, sometimes lidocaine topical cream can be applied to the treatment area prior to the procedure to numb the area.

What is the cost of the procedure?

Cost varies with the individual and the treatment. HA filler treatment can cost approximately $1,000 for a session. Laser treatments may vary from several hundred to $1,000 per session.

Do skincare products really work? 

Skincare products comprise an important part of the overall treatment strategy. There are some helpful compounds that can revitalize the skin. Common agents include Vitamin A and C, antioxidants, madecassoside, kojic acid, azelaic acid, isoflavones and hydroquinone. Universkin is a serum from France that is prepared at the doctor’s office according to a custom-made formula that the doctor selects for each patient.

Is this an ongoing or a one-time treatment?

Like most things, nothing is forever, but on-going maintenance depends on what treatment is performed. After the initial treatment, you may need to do maintenance or repeat treatments for HA fillers, perhaps at six to 12-month intervals. PRP treatments will need to be repeated to maintain improvement, on average twice per year. Lasers may need to be repeated depending on whether new pigment reappears, or there is continued thinning of the skin.

Dr. Fred Weksberg MD, FRCP is the owner and medical director of The Weksberg Centre for Cosmetic Dermatology. He is recognized as a leader in the field of cosmetic dermatology focusing his practice on Botox Cosmetic, injectable fillers, lasers for skin rejuvenation, skin care and sclerotherapy. He is committed to excellent patient care and ongoing research and education.

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