Q: Dr. Eppley, I have a very severe case of dark circles under my eyes. I am 30 years old and am of Indian ethnicity. I know this is a common problem in people of my heritage. I have tried numerous topical crèmes for dark circles but none of them have done anything. I am sending you some pictures for your assessment. Do you think there is anything you can do to help me?
A: Thank you for sending all of your pictures. There is no question that you have is a fairly severe case of dark circles. Much of it is actual skin hyperpigmentation rather than a hollowing effect. And the zone of skin hyperpigmentation extends fairly far outward from the eyelid area. I don’t think on seeing this extensive collection of photos that you have a really significant tear trough or hollowing problem. There is some mild hollowing but that is not the true cause of the problem, the hyperpigmentation of the skin is.
I don’t know how much improvement can actually be obtain in such a severe case of dark circles but some effort is certainly justified given the magnitude of the problem. I would approach your dark circles with a combination procedure of fat injections to fill out some mild hollowing, a pinch lower blepharoplasty to remove some excess skin (you do have some despite your young age) and a 25% TCA peel to try and remove some of the superficial hyperpigmentation.
How effective this combined approach would be is undetermined and I would never assume it to be a complete cure or solution…as there is no such thing with such severe dark circles. The goal is to see what degree of improvement can be obtained.
Dr. Barry Eppley
Q: I have very dark circles under my eyes that bothers me a great deal. I have tried all sorts of creams and lotions without any improvement. Are there any more result-oriented surgical approaches that will work?
A:Some of the best results for dark circles improvement is based on volume addition, either using injectable fillers or surgically done with orbital rim implants. (synthetic implants or dermal grafts) The cause for the appearance of dark circles in some patients is that the orbital rims (lower eyelid socket) is weak or underdeveloped. This causes the lower eyelid tissues to lack support so they fall inward, creating both a trough or depression whcih is also prone to looking darker due to shadowing. It is easy to see whom may have orbital rim hypoplasia by a side view. If the front part of the eye (cornea) sticks out further than the lower orbital rims one has lower eye socket hypoplasia.
The success of orbital rim implants can be predicted by initially using injectable fillers. Injectable fillers are both a diagnostic test and a treatment. Unlike the lips or nasolabial folds, which are exposed to a lot of muscle movement, the tear trough and lower eyelid area is not so injectable fillers can last a much longer time in this area.
Since any form of orbital rim implant must be put in through a lower eyelid incision, this also gives the opportunity to do a little skkin removal and tightening which can also help improve the dark circle appearance.
I would have to see pictures of one’s anatomy to determine if orbital rim hypoplasia is making a major contribution to one’s dark circle appearance.
Dr. Barry Eppley