What causes dark circles under the eyes?

Dark circles appear under the eyes for many reasons and may simply be a genetic condition. ‘Periorbital hyperchromia’ – is a technical name that refers to the area around the eye socket caused by excessive pigmentation and is one of the most common reasons for circles under the eyes seen in all ages.

Other people have the appearance of dark circles just due to their anatomy and the shape of the structures around the eyes. In certain lights, shadows are cast in any hollows and under any protruding eyelids or eyebags, which make the area look dark.

Other causes of Dark Circles include:

• Dehydration of the skin cells makes dark circles more noticeable.
  Simply drinking more water can bring about a marked reduction in the circles. Sometimes a topical B5 serum is needed to improve the skin’s hydration.
• Stress / Lack of sleep: can make the skin appear more sunken or make eye bags look puffier, which can make dark circles more noticeable.
• Drinking alcohol: The consumption of alcohol allows the small blood vessels in the skin to dilate or expand, so dark circles under the eyes may become more prominent. Dehydration also occurs, which adds to the problem.
• Ageing: As people age, their skin becomes thinner due to a reduction of fat and collagen, making the blood vessels beneath it more noticeable, which thereby makes the area under the eyes appear darker. In addition, the ligaments under the eye weaken and in some people the fat loss causes the skin to sag and create a tear trough and sometimes a bag. These create a shadow on the skin, creating the appearance of dark circles under the eyes.
• Pigmentation: The eyelids’ skin is often darker than that of the rest of the face. But in some people, this can be more pronounced. This can be genetic or caused by environmental factors. The most common cause is sun exposure. Pregnancy, hormones and trauma to the skin, such as excess rubbing of the eyes, can also increase pigmentation. A good SPF eye cream is recommended if you are at risk of high sun exposure.
• Vascular congestion: This is an area containing many small blood vessels. In some people, these are congested, causing a somewhat purple discoloration. Patients who suffer from allergies could get venous congestion under the eye creating dark circles.

What can be done to improve dark circles?

To improve dark circles, you first need to understand the cause.

After this, the key is to work out if the causes are treatable or not. You can not change the shape of someone’s face however some simple causes can be improved.

Treatments to be considered include:

Concealer

The right coloured concealer applied in the right way can make a massive difference to dark circles. If you struggle to do this, it is worth booking in with a reputable makeup artist who can teach you how to do it more effectively.

Avoid Dehydration

Sometimes drinking more water or applying a B5 serum for hydration is all that is needed.

Treatments to reduce pigmentation:

Topical treatments can be applied to gently lighten the skin and an SPF can be applied to prevent further pigmentation for any sun exposure.

Dermaquest Melaquest Eye Cream  is excellent for this, as is ZO Eye Brightening Crème.
An eye SPF is also recommended to prevent further pigmentation caused by sun exposure.

Treatments to improve skin texture:

Improving the skin texture and stimulating increased collagen helps obscure the vessels under the skin that create the appearance of dark circles.

Topical treatments can be applied to stimulate collagen our most popular products for this are:

• Obagi ELASTIderm Eye Cream
• NeoStrata Skin Active Intensive Eye Therapy
• pHformula SOS eye rescue

Collagen Stimulation

Collagen Stimulation using Radiofrequency technology can also be effective using the Endymed 3D Deep or ThermaClinic these treatments are relaxing and non invasive with no downtime but a course of 6 is required every 1- 2 weeks.

Ultraformer HIFU

Ultraformer HIFU treatment is another device treament which uses Ultrasound Energy to stimulate collagen. It is a little bit more painful and more aggressive but is more effective. We recommend 3 treatments one every month.

Neogen

Neogen is another excellent collagen stimulator. This device uses Nitrogen Plasma to stimulate collagen. This causes some mild discomfort and sometimes  3-5 days down time. A course of treaments is usually required for best results.

The CACI Eye Revive

The CACI Eye Revive is a three step treatment that stimulates collagen using radiofrequency and also by infusing  products in to the skin that hydrate stimulating new collagen. It can give a temporary improvement after one treatment but for best results a course of treatments is recomended. It is also a great way of boosting the eye area before a special event.

Juvelook Under Eye Treatment 

Juvelook is a biostimulatory injectable combining: Hyaluronic acid (HA) for hydration which can brighten and reduce the look of shadows right away and also Poly-D,L-lactic acid (PDLLA). PDLLA stimulates the body’s collagen production over weeks to thicken and strengthen the under-eye skin. Thicker skin is less transparent and shows less of the bluish vascular shadow that contributes to dark circles.  This dual action supports skin improvement over time by adding hydration and encouraging collagen growth. It reduces the shadow effect and brightens the under-eye area.

Due to it being an injectable treatment, slight swelling or bruising can occur which could last several days. A course of three treaments are usualy required.

Juvelook tends to be most effective when the dark circles are due to:

• Thin under-eye skin that reveals underlying vessels
• Hollowing/tear troughs casting shadows
• General aging/texture changes around the eyes

Treatments to improve Tear Troughs:

Tears develop due to soft tissue volume loss in the cheek and eye area. The ligaments of the lower eyelid weaken and the bony area under the eyelid becomes accentuated. This can also lead to the appearance of lower eyelid fat pockets (eye bags), and both of these changes can lead to a dark shadow or hollow beneath the eyes and can cause a tired appearance.

At Cheshire Lasers, we treat Tear Troughs with the following:

Dermal Fillers:

At Cheshire Lasers, we use hyaluronic acid Dermal Fillers to treat tear troughs. These fillers slowly break down over time, and in most patients, results can last a year. You may need a top-up procedure to achieve the best results.

Depending on your anatomy and your medical practitioner’s preference they may use Juvederm, Restylane, Belotero or Teosyal Redensity 2 a filler designed especially for the tear trough area.

PRP Treatment

PRP treatments for the under eye and the upper eyelid lead to stimulation of your own collagen and elastin and regeneration of new healthy skin tissue for gradual, natural and real results that improve in the 2-3 months following a single treatment.
We recommend two to three treatments, 2-3 months apart. PRP injection treatments below the skin in the under-eye area do not have immediate results. Unlike Dermal Fillers, which are instant, PRP is resorbed by your body within 2-3 days. There is then a gradual tissue regeneration which continues for months. You see the final results 3-4 months after each treatment. PRP treatments improve fine lines, texture, loose skin, loss of volume, deep wrinkles and some pigmentation.

Treatments to improve Eye Bags:

We can do very little at Cheshire Lasers to help with eye bags. In most cases, the best treatment is surgery.

Some of the treatments mentioned above can help, but the results are subtle and will not last long without regular treatments to maintain results.

The CACI Eye Revive

The CACI Eye Revive is our favourite non-surgical treatment for eye bags. It can give a temporary subtle improvement and is worth trying. If it helps, it is an excellent way to boost the eye area before a special event.

What can I do at home to enhance my results?

The skin under the eye is the thinnest of the face. As we age, the blood vessels underneath become visible and create a darkened reflection. Investing in an Eye Cream: that includes Retinol, Peptides, Caffeine, and Antioxidants is key. Retinol works by exfoliating dead skin cell leading to collagen production. Peptides applied topically send “signals” to through the skin to prompt the formation of new collagen. Caffeine constricts blood vessels which reduces puffiness and redness. Antioxidants (ex: Vitamin C or Green tea) offer powerful protection from the sun and also brighten the skin.

Please get in touch with us if you require more information about some of our medical-grade products to help the eye area.

Cheshire Lasers often receives enquiries asking how we can help treat scarring and acne scars.

Dr Teri Johnson discusses the various treatments available for scars and how they work.

What are Scars?

Scars develop after trauma to the skin; this can be due to an injury, post-surgery, or skin conditions such as acne. They are a natural part of the body’s healing process and occur when the skin’s deeper layers are damaged. This results in the formation of fibrous tissue to repair the injury. Scars may vary in appearance, texture, and size, depending on factors such as the type and severity of the injury, individual healing characteristics, and the scar’s location on the body.

When it comes to acne scarring, any type of acne spot can lead to scarring, but it’s more common when the most serious types of spots (nodules and cysts) burst and damage nearby skin. Scarring can also occur if you pick your skin or squeeze a spot, so it’s important not to do this.

While scars are permanent, they often fade and become less noticeable over time but may still remain visible.

Which Treatments Help Scars?

At Cheshire Lasers, we provide the following treatments for acne scarring:

• Polynucleotides
• Microneedling
• RadioFrequency Microneedling
• Rioblush Carboxytherapy
• Microdermabrasion

Other treatments you can consider include:

• TCA CROSS treatment
• Surgical Excision of scars
• Laser Treatments: can be ablative and non-ablative.
• Punch techniques

Sometimes, for best results, a combination of treatments is required.

Polynucleotides

Polynucleotide therapy is a new way to treat scars. It involves injecting special substances made of DNA and RNA into the scar tissue. Here’s how it works:

1. Makes Skin Stronger: These substances help the skin make more collagen, which is like a building block that makes skin stronger and helps scars heal better.
2. Helps Skin Repair: PN therapy helps damaged skin repair itself faster, making scars look better over time.
3. Reduces Redness and Itching: Scars can be red and itchy because of inflammation. PN therapy can help calm down this inflammation, making scars less red and itchy.
4. Makes Skin More Flexible: Scars often feel tight and stiff. PN therapy can make the skin more flexible by adding more collagen so scars feel softer and move better.
5. Improves Scar Colour: Sometimes, scars are darker than the surrounding skin. PN therapy can help lighten the colour of scars, making them blend in better with the rest of the skin.

Polynucleotide injectable treatments are safe with very little downtime. They work well in combination with other treatments to enhance the results.

Overall, they strengthen the skin, helping it repair faster and reducing redness and itching. It’s a simple treatment that can make a big difference for people with scars.

Microneedling

Microneedling, also known as skin needling, involves using small needles to cause tiny punctures in the skin. These small contact points encourage the body to create a wound-healing response. The needling also can break down old scar tissue and stimulate the production of new skin cells. New collagen and elastin grow as the skin repairs to give a smoother, plumper skin surface.

This treatment also improves skin texture leading to smoother skin and reduces pores size and fine lines. Microneedling can also reduce pigmentation, which is sometimes seen with some scarring.

Before and after three microneedling treatments for acne scars at Cheshire Lasers.

RadioFrequency Microneeding

This treatment combines microneedling with radiofrequency energy.  The combination treatment is much more effective than microneedling on its own. The radiofrequency energy heats the tissue in the region of 55 – 65°C and, depending on the depth, it stimulates cell renewal, new collagen, increased hydration and also skin resurfacing. The heat is more effective at stimulating fibroblast action, which is responsible for healing and repair.

Radiofrequency Microneeding is a more aggressive treatment than normal microneedling; however, surprisingly, the downtime is often much less. Here at Cheshire Lasers, we have found that fewer treatments are usually needed to deliver the same results.

Rioblush Carboxytherapy

Carboxytherapy is also a good treatment for treating acne scars. A tiny needle is used to inject Carbon dioxide into the scar. The same needle can also be used to gently subcise deeper scars, which allows blood to pool under the affected area. The blood clot helps form connective tissue, which pushes up the rolling scar so it’s level with the rest of the skin’s surface. Carboxytherapy also increases blood flow to the scar promoting healing, reducing redness and stimulating collagen and elastin production. The result is smoother, fresher, more healthy-looking skin.

Carboxytherapy can cause bruising but otherwise has very little downtime.

The following research paper compares carboxytherapy with microneedling.

Carboxytherapy Versus Skin Microneedling in Treatment of Atrophic Postacne Scars: A Comparative Clinical, Histopathological, and Histometrical Study

At Cheshire Lasers, we sometimes combine microneedling with Carboxytherapy to achieve the best results.

Before and after three carboxytherapy treatments at Cheshire Lasers for acne scarring.

Microdermabrasion

Microdermabrasion involves deep exfoliation of the top layer of skin.  Your skin will look red after treatment but will soon settle down.

Although this treatment claims to treat scars, it only helps with minor superficial scars, such as mild surface acne scarring.

You will need a course of treatments for the best results.

Other Treatments for Acne Scarring

The following treatments are also options for treating scars. These treatments are not available at Cheshire Lasers. However, we can recommend local clinics that provide them.

TCA CROSS treatment

TCA CROSS treatment involves the application of trichloracetic acid at high concentrations to the base of a scar. This causes trauma to the scar tissue, which triggers an inflammatory response that stimulates the production of new collagen. After each treatment, the scar gradually fills in from the bottom up and reduces in appearance.

This treatment is very useful for various Acne scars, including ice pick, box and rolling scars. It can also help with chickenpox scars and enlarged pores

View more information about TCA CROSS treatment from Dr Maeve Kenningham, who provides this treatment at her Wrexham Clinic.

Laser treatments

You can also consider Laser treatment to treat mild to moderate acne scarring. There are 2 types of laser treatment:

• Ablative laser treatment – where lasers cause skin trauma and remove some scar tissue, to produce a new, smooth-looking area of skin. This treatment can have significant downtime.
• Non-ablative laser treatment – where lasers are used to stimulate the growth of new collagen (a type of protein found in skin), which helps to repair some of the damage caused by scarring and improves the appearance

Punch techniques

Punch techniques are surgical methods that can treat ice-pick scars and boxcar scars. There are three types of punch technique:

• Punch excision – used to treat mild ice pick scars. The scar is surgically removed, and the wound is sealed, leaving smoother and more even skin.
• Punch elevation – used to treat boxcar scars. The base of the scar is surgically removed, leaving the sides of the scar in place. The base is then reattached to the sides but lifted up so it’s level with the surface of the skin. This makes the scar much less noticeable
• Punch grafting – is used to treat deep ice-pick scars. As with punch excision, the scar is removed, but the wound is “plugged” with a sample of skin taken from elsewhere on the body.

Surgical Subcision

Subcision is a surgical treatment which can treat deep rolling scars. The upper layer of the skin is removed from the underlying scar tissue, allowing blood to pool under the affected area. The blood clot helps form connective tissue, which pushes up the rolling scar so it’s level with the rest of the skin’s surface.

Once subscision has been completed, additional treatments are usually needed to improve the appearance of the scar further.