What are dark circles and how do you treat them?

Dark circles under the eyes is a particularly common concern we see in patients visiting our clinics, with patients often remarking that their eyes make them look tired, even when they are not. Dark circles can result from many factors including general ageing, genetics, lifestyle choices, and skin conditions. External factors, in particular, sun exposure, smoking, and poor nutrition are all important considerations as these can accelerate the underlying ageing processes of the skin around the eyes. Ultraviolet (UV) radiation from the sun is a particularly important factor in this.

Fortunately, there are a number of effective nonsurgical treatments available to treat dark circles - avoiding the need for surgery wherever possible. In our clinics, our practitioners take a comprehensive approach to treating dark circles based on in-depth knowledge of the anatomical layers that can be affected by ageing around the eye. In this article, I explore the treatments available from skincare products (exploring the question I’m often asked: do eye creams actually work?), to mesotherapy, PRP, polynucleotides, tear trough fillers, and ultimately surgical options including blepharoplasty and fat transfer, helping you understand which option might be best for you.

How does the skin around the eyes age?

The ageing process of the tissue around the eye area is complex and involves changes in multiple anatomical layers, from the bony skeleton to the soft tissue and skin itself. As we age, the bony skeleton, including the orbital margin (i.e. the eye socket itself), undergoes resorption, leading to a decrease in structural support for the overlying tissues. This can accentuate the appearance of the eye sockets and contribute to the formation of hollows under the eyes.

Ligaments and soft tissues around the eyes also undergo changes. The orbital septum, a fibrous membrane that holds back fat pads, weakens, allowing fat to protrude, leading to under-eye bags. The supporting ligaments and skin lose elasticity and collagen, leading to sagging and the development of wrinkles and fine lines.

Festoons or ‘saddle bags’, which are accumulations of loose skin and fluid below the lower eyelid, can also develop as lymphatic drainage around the eyes is affected by ageing changes. These differ from eye bags, which are primarily caused by fat pad protrusion. Festoons often appear as swelling on the cheek, just below the eyelids.

How can I prevent dark circles under my eyes?

While dark circles may not always be entirely preventable, there are several proactive steps you can take to minimize their appearance and maintain a bright, refreshed look. Here are some simple yet effective strategies to help prevent dark circles and keep your under-eye area looking radiant and healthy.

Get Sufficient Sleep: Aim for 7-9 hours of quality sleep each night to prevent fatigue-related dark circles.
Stay Hydrated: Drink plenty of water throughout the day to keep your skin hydrated and prevent puffiness around the eyes.
Use Sun Protection: Apply sunscreen or wear sunglasses to protect the delicate skin around the eyes from sun damage.
Maintain a Healthy Diet: Consume a balanced diet rich in fruits, vegetables, and antioxidants to nourish your skin from within.
Avoid Rubbing Your Eyes: Rubbing can irritate the delicate skin and lead to dark circles. Be gentle when cleansing or applying skincare products.
Use Eye Creams: Incorporate eye creams containing ingredients like vitamin C, retinol, or hyaluronic acid to brighten and hydrate the under-eye area.
Practice Stress Management: Stress can contribute to dark circles, so incorporate stress-relief techniques such as meditation, yoga, or deep breathing exercises into your daily routine.
Limit Alcohol and Caffeine: Excessive consumption of alcohol and caffeine can dehydrate the body, leading to dark circles. Moderation is key.
Get Regular Exercise: Regular physical activity improves circulation and can help reduce the appearance of dark circles by promoting healthy blood flow.

What is a ‘tear trough’?

The formation of the 'tear trough' – a deep crease between the lower eyelid and upper cheek – is another common age-related change under the eye. This occurs due to the weakening of supporting structures and loss of soft tissue volume in the area, creating a hollowed appearance in the form of a distinct groove under the eye. This causes shadowing in the area, which can make the eyes have a tired appearance.

What about undereye skin and pigmentation?

The skin around the eyes undergoes several changes as we age, making it particularly susceptible to signs of ageing. This area of skin is thinner and more delicate compared to the rest of the face, which makes it more prone to damage and ageing effects. One of the primary changes is the loss of collagen and elastin, the proteins responsible for skin's elasticity and firmness. As these proteins diminish, the skin becomes looser and more prone to wrinkles and sagging. The thinning of the skin also makes the blood vessels more visible, contributing to the appearance of dark circles. Additionally, the skin around the eyes is subject to constant movement due to facial expressions, such as smiling, squinting, or frowning. Over time, this repeated movement can lead to the formation of dynamic wrinkles, such as crow's feet at the corners of the eyes. Hydration levels in the skin also decrease with age, leading to dryness and a more crepey texture.

Do eye creams really work for dark circles? An overview of skincare products for the eye area

A fundamental aspect of treating under-eye dark circles is using the right skincare products to help optimise collagen production in the skin, and also minimising the appearance of hyperpigmentation. The needs of the skin around the eyes are no different that elsewhere on the face, however, the skin is generally thinner (i.e. the dermis layer is more delicate) and the skin may be more sensitive to certain products in this area. The approach is no different - the skin needs ingredients that will protect it from UV light and oxidative stress (i.e. antioxidants and sunscreen), as well as ingredients that can help stimulate collagen production and minimise hyperpigmentation. It is important to choose eye products that balance these effects without causing irritation to the delicate underage skin.

Which Skincare Ingredients help with dark circles?

A few key ingredients have been shown to help with dark undereye circles. Some key ingredients you might find in eye creams include:

Vitamin C esters: Helps in combatting oxidative stress in the skin as well as minimising hyperpigmentation. Ideally choose a vitamin C ester rather pure vitamin C (ascorbic acid) for the eye area, such as tetrahexyldecyl ascorbate at levels under 3% - these penetrate better into the skin but tend to cause less irritation
Glutathione: An antioxidant that neutralises free radicals and helps in melanin production, leading to an even skin tone and reduced appearance of dark spots and hyperpigmentation
Niacinamide: Known for its skin brightening and anti-inflammatory properties.
Retinoids: retinoids are molecules based on vitamin A, which have numerous benefits including collagen stimulation, minimisation of hyperpigmentation as well as encouraging cellular repair in the skin. Choosing a lower concentration of a stronger retinoid (such as retinaldehyde) for the undereye area vs the rest of the face can help minimise any risk of dryness or flaking that may be associated with stronger retinoids.
Caffeine: The ultimate de-puffer, caffeine acts to reduce swelling and puffiness under the eyes to give an overall brightening effect on the skin
Escin: a compound derived from horse chestnut seeds, is known for its anti-inflammatory and vasoprotective properties. It helps reduce under-eye puffiness and dark circles by strengthening capillary walls and improving circulation in the delicate undereye skin.
Peptides: these are short chains of amino acids which play roles in collagen production, which in turn may reduce fine lines and wrinkles and improve skin texture

Which treatments are best for dark circles?

Many treatments are available for treating the delicate undereye area and finding which treatment is best for you should involve a thorough consultation with an expert in treating dark circles. Treatments focus on the various layers of the skin, which all age and change to different extents from person to person, based on your individual genetics and lifestyle. I always recommend booking in for a consultation with a skin expert prior to deciding on which treatment you should have. The most effective treatments for dark circles include:

1. Mesotherapy

The Bright Eyes treatment is a specialised mesotherapy procedure designed to target dark circles, pigmentation, and crepey skin around the eyes. This anti-aging treatment involves nano-injections of a blend of vitamins and glutathione with hyaluronic acid, stimulating collagen and elastin production and also skin brightening. It revitalises and hydrates the skin while minimising hyperpigmentation under the eyes. A typical course includes three sessions of this treatment - with minimal downtime, it is a good option for those with early signs of ageing around the eyes.

2. PRP for Dark Circles:

Platelet-rich plasma (PRP) therapy utilises the patient's own blood to rejuvenate the skin. In this treatment, a small blood sample is taken, and the platelets are separated and concentrated in a centrifuge machine. The PRP is then injected into the under-eye area, promoting natural healing and rejuvenation. This can lead to reduced dark circles and a more youthful appearance. Often several sessions are needed for best results. This treatment is ideal for patients wanting to have a natural way of reducing dark circles, without injecting exogenous materials into their skin.

3. Polynucleotides:

Polynucleotides are small fragments of DNA and RNA, often derived from fish, such as tuna or salmon. There are various brands of polynucletides, including Nucleofill, Plinest and Plenhyage. Polynucleotide treatments involve microinjections of a thin polynucleotide fluid that stimulate fibroblast cells to produce collagen and improve skin quality. They have also been shown to reduce hyperpigmentation around the eyes. This treatment provides deep skin hydration, smoothens fine lines and wrinkles, and boosts collagen and elastin levels. Usually a course of treatments is needed for best results.

4. Tear Trough Filler:

In cases where there is a distinct volume loss or ‘tear trough’. As we age, this area can become more prominent, resulting in a tired or aged look. Tear trough filler can be used to specifically target bony volume loss in the area between the lower eyelid and upper cheek. Often a little filler in the cheek can be used in addition to support the area from below also. The treatment involves injecting a hyaluronic acid based dermal fillers to plump up the hollows, smoothing out the skin, and restoring a more youthful and refreshed appearance. As with any filler treatment, minimal volumes should be used to prevent an ‘overdone’ look and to minimise swelling in this delicate area.

5. Blepharoplasty/Fat Transfer:

For more permanent results, or in patients who may have more dramatic changes in the underage area, lower lid blepharoplasty or fat transfer surgery can be considered. Lower lid blepharoplasty is a surgical procedure that removes or repositions excess tissue from the eyelids to correct droopy eyelids and reduce under-eye bags. Alternatively, fat transfer involves taking fat from another part of the body and injecting it into the under-eye area to restore volume and reduce dark circles. We always recommend consulting a fully-qualified plastic or oculoplastic surgeon for this treatment to minimise side effects associated with this permanent surgical procedure.

Treating under-eye dark circles effectively requires a tailored approach, considering the individual's specific needs, anatomy and skin type. In my clinics, we offer a range of treatments, from topical skincare products to advanced aesthetic procedures, providing options for everyone seeking to rejuvenate their under-eye area and achieve a brighter, more youthful appearance. To book in for a consultation with on of our experts, click here