What to do about Under Eye Dark Circles
One of the most common complaints I see in our clinic is dark circles under the eyes. These dark circles under your eyes can be frustrating. Not only do you see them every time you look in the mirror, but your friends and coworkers may frequently ask if you’re tired—even if you are feeling great. And this can be quite annoying. You’re not alone. Almost everyone has had these lower eye dark circles. Some are temporary and simply related to allergies or true fatigue. But many constantly have them and can be a big enough nuisance that they look for treatments. The most common first step is to try over the counter creams that claim to solve this problem. Some of these creams can be quite expensive, especially those endorsed by celebrities and sold in high-end department stores. Unfortunately, it’s not uncommon for many people to discover that these don’t work as well as advertised, and the expenses can be quite high.
When these creams don’t work, you will have to consider more advanced treatment options that are only available at a cosmetic practice. It’s important to realize there are different causes for your “raccoon eyes.” That’s why a consultation with a board certified cosmetic physician is so important. The most common cause for these dark circles is formation of bags under your eyes. But another possible cause is hyperpigmented skin. The treatment for this is different than for bags. Here, a lightening cream—or bleaching cream—is best. Finally, a less common cause is prominent blood vasculature under your thin eyelid skin.
But by far the most common cause for dark circles is fat pseudoherniation. This is when the fat under your eyes start to bulge out because the sling (septum) that holds it in place weakens. This can be due to aging or simple genetics. Often, these bags will create a tear trough deformity—the area between the inside of your eye and the nasal wall. Once this diagnosis is made, there are two main treatment options. The first—and definitive option–is to surgically remove and contour the fat so your lower lid is smoother with the cheek. This returns your lower eye and cheek to its more youthful appearance. There are various approaches to this surgery, called a lower blepharoplasty. Probably the most popular technique today is via a transconjunctival approach. Here, the incision is made behind the eyelid so there are no external scars. This also avoids the uncommon complication of weakening the lower lid complex. A weakened lower lid complex will result in more of your sclera (the white part of your eyeball) to show. This is unattractive, but can also cause some problems if severe. Frequently, a great result can be attained with transconjunctival blepharoplasty combined with periocular CO2 laser resurfacing or chemical peel. While a blepharoplasty will achieve the best results and last the longest, the biggest drawback is it is surgery. Today, most people are hesitant to undergo the knife and prefer office based minimally invasive procedures—which is the second option.
For that reason, a popular non surgical option is using fillers to address the lower eye bags. Rather than remove the bags, fillers improve your lower lid bags by camouflaging the bags. The strategy is to inject fillers into surrounding areas that lost volume and create a smoother contour. The most commonly used filler used are hyaluronic acid based fillers like Juvederm and Restylane. In past, Juvederm Ultra and Ultra plus were the only Allergan products. These tend to be more hydrophilic (attract more water) than Restylane. In the delicate areas under eyes, they tended to create more puffiness or swelling. That’s why I preferred Restylane, which is less hydrophilic than Ultra and Ultra plus. I still like Restylane, but Allergan has now introduced fillers that are manufactured using their new Vycross technology—Volbella and Vollure. The result is a less hydrophilic filler that delivers a very smooth result as well. Now, I prefer to use Volbella to correct the tear trough deformity. Volbella is the softest filler from Allergan and can be used very superficially. I have not had any patients complain of seeing a Tindel effect when I used Volbella to treat the tear troughs. I did use Vollure initially, but I found many patients report dissatisfaction with the results, saying they can see more lumps. So now I no longer recommend Vollure to the periocular region.
Injecting the tear trough area must be done carefully. This is a delicate area and has higher chance of bruising. I warn my patients that there is a slightly higher (about 10%) chance of bruising, as well as 20% chance that a touch up may be needed. Interestingly, perhaps due to the thin skin, ice works great as an anesthesia. After icing the area, injections are not very painful. In addition, all these fillers now have lidocaine in them so the injection gets better as the procedure progresses. Using micro cannulas (instruments that look like needles but have blunt tips) has significantly reduced my incidence of bruising. After injection, there may be mild swelling but should resolve by a week. The results typically last a year or more, making fillers to the eyes a very popular option.
For more information about lower blepharoplasties or injecting fillers, please visit our interactive website at www.dryuplasticsurgery.com. Dr. Kenneth Yu Facial Plastic and Reconstructive Surgery is a qualified team of experts serving the San Antonio, Texas area. To schedule a consultation, please contact our Concierge Patient Coordinator at (210) 876-6868 or info@dryuplasticsurgery.com.
