work for me. Hi, I have dark circles since I was born. Concealers and creams don’t

work for me. Is there a more permanent way to get rid of them? I am 26 years old. Thank

you in advance.

Thank you for your question. You’re 26 years old and you’re asking is there a permanent

way to treat dark circles and you stated categorically that under eye creams and concealers don’t

work for you. So your frustration is something that is very common, we know this from the

retail world because there are so many creams that offer solutions for dark under eye circles.

I’ll share with you a little about my approach to dark circles under the eyes and over the

years we’ve actually had a lot of advances that actually are helpful, they may be helpful

to you.

So let’s start with just the genetics. Dark under eye circles – 20 years ago when I

started my practice and for many years when people came in with dark under eye circles

even as an oculofacial plastic surgeon, I didn’t really have that many options to

offer them. We would do things like glycolic acids and retinoids and things like that to

try to improve the skin quality but still we were limited. Around 2005 with the introduction

of hyaluronic acid fillers, we started to see some possible options even though they

weren’t initially used for dark circles under the eyes.

Move the clock forward, in my practice I analyze the dark circle situation in a couple of ways.

One is I first look at the anatomy, is there an opportunity to attribute some of the dark

circles to a relative hollowing. Now if that hollowing is a genetic hollowing or volumetric

loss from aging, it’s part of that decision making plan. Now if there is a volume loss,

we can actually use a hyaluronic acid filler like Restylane to augment or to restore some

volume under the skin at a level that’s closer to the bone and there we call the tear

trough. Now that of course has to be done very carefully and very meticulously, unfortunately

a lot of people don’t get the best results because we see them in consultation having

them done in elsewhere and they come in and we actually dissolve them with a material

called hyaluronidase. So that’s one option in determining what would be right for you.

Second option is we have been in a leadership position in the world of regenerative medicine.

We were using platelet rich plasma for a lot of things and this is a kind of extension

of what was already being done in orthopedic surgery and oral surgery. Platelet rich plasma

is derived from your own blood and what we do is we spin your blood and we concentrate

the platelets which are the critical cells for healing and the concentration of growth

factors. When platelet rich plasma is injected under the skin in the appropriate candidate

it improves skin quality, improves the blood supply, improves the collagen. So we find

that improving the thickness of the skin and the skin quality can also help under eye dark

circles.

So in terms of a permanent solution, I have to say that we really don’t have a procedure

that’s a one-time treatment that’s a permanent solution. For people with lighter skin type,

we also have other options including lasers but somebody with a darker skin type, lasers

are usually not an option because there’s a risk of hyper- or hypopigmentation. In other

words, too much pigment or loss of pigment neither of which looks aesthetically good.

So in our practice what we do especially with the procedure like platelet rich plasma, if

we follow our patients and every three to four months we re-evaluate. If the skin quality

looks improved and the patient is satisfied then we just basically wait and see how long

this particular treatment last for them. There are some patients who come in for PRP treatments

or platelet rich plasma treatments once a year, others come twice a year, others come

three to four times a year. It’s very individual, if there are confounding factors such as age

and environmental factors then we also customize.

I wouldn’t completely write off moisturizers as a solution because moisturizes do have

a role. They don’t completely resolve the problem but when things work in combination,

so for example I have a patient who benefits from hyaluronic acid injection, platelet rich

plasma and a good topical cream their under eye circles look a lot better and it’s also

in the context with the rest of the face.

If your under eye circles are really a genetic issue and since you are young and you’re

26 you may hit a wall as to the potential complete resolution of your issue. You may

have to change your definition of success to improvement rather than cure.

So I think it’s probably a good idea for you to meet with some doctors now that you’ve

learned more about these options you can actually ask more specific questions, look for examples

of before and after and see if it’s an option for you to give this a try.

Both hyaluronic acid and platelet rich plasma are not permanent solutions but in a way that’s

an advantage because unlike surgery it’s something that you don’t have to live with

forever. You can see how you can respond to it and then decide if you want to integrate

that as something in your lifestyle. Nobody wants to do that but if you don’t have other

options, it’s something you do. It’s like all other filler procedures, if everyone could

have just one definitive surgical procedure there would never be a role for fillers which

are temporary but they do provide a valuable asset in the augmentary little cosmetic surgeon.

So once again think of volume, skin quality, think topical moisturization. So I hope that

was helpful. I wish you the best of luck and thank you for your question.