In my practice as an aesthetic doctor, I’d say that dark eye circles is probably the most commonly mistreated condition. And the difference between a proper treatment and misdiagnosed one is speed.

Bad treatments don’t mean they don’t reduce the dark circles. However, you’d end up waiting longer and usually spending more (because more treatment material is used than necessary)

The reason for this is simple. While they may look like just one problem, dark eye circles actually have a variety of causes. A study in South-East Asian patients (1) showed the common causes to be: blood vessel congestion (most common), eyelid pigmentation and lastly a shadowing effect. Up to 80% of dark eye circles were a combination of blood vessel congestion in addition to another cause. This means that besides having multiple causes, dark eye circles also have a combination of the different ones.

Different people have different reasons for getting dark eye circles.

To effectively treat dark eye circles, we must first understand what’s causing it. It’s different for every individual patient!

Cause 1: Blood vessel congestion

(blood vessel congestion showing under the thin skin of this Asian patient)

(after treatment with vascular laser)

This is the #1 cause of ineffective dark eye circles treatment in Singapore. That’s because it’s the most common cause of dark eye circles, which is pooling of blood in the blood vessels under the eye. This can be genetically predisposed or due to environmental factors such as thin skin (from aging), late nights and congested nose.

Why do blood vessels show up as dark eye circles instead of darkening over the rest of the face? This is because the eyelid skin is the thinnest over the entire human body, and is more likely to reveal the dark congested blood vessels right underneath the eyes.

Most aesthetic centres only treat pigmentation, which is why dark eye circles do not improve much even with multiple sessions of treatment!

Cause 2: Pigmentation

(pigmented lower eyelids)

Pigmentation causes about 50% of dark eye circles. It is further split into 2 types: deep and surface pigmentation. This again may require a combination of 2 types of lasers to achieve best results.

Cause 3: Shadowing effect

(lady with bulky lower eyelid and ‘tear trough’ sunkeness)

Shadowing effect gives the “false appearance” of dark skin but is actually due to sunken or protruding eyelids. Can you tell the difference? A wrong diagnosis will lead to wrong treatments.

These dark eye circles are fastest to treat and show results almost immediately.

Treatment Approach 1 – One Size Fits All Approach

The usual way to treat dark eye circles in Singapore is to inject a filler. It’s fast. It’s easy for the doctor. But is it really effective?

Single modality approach almost always certainly fails because the majority of dark eye circles have a combination of causes! More than 80% of dark eye circles have two or more causes, hence will require more than 1 treatment.

All treatments will work to tighten and thicken the skin of the lower eyelids, hence help to hide the blood vessel pooling under the eye. However, thickening of the skin takes very long for results to show, and multiple sessions of lasers/fillers. A proper vascular laser shows results from the first session!

Treatment Approach 2 – Holistic and Functional Aesthetics

My approach begins with medical and lifestyle correction. Patients with persistently blocked nose can cause a lot of blood congestion in vessels under the lower eyelids. After a quick medical examination, they can be started on suitable medical treatment which can decongest the nose and free up the blood congestion.

I know this will sound cliche, but it really is better to treat your symptoms first before tackling the aesthetics! It will help a LOT in the long run. Trust me on this.

Correcting insomnia and late night activities also reduce the strain on the eyes and help with dark eye circles.

Note: It is not possible to accurately diagnose this condition with simply photographs or phone consultation. Good photographs offer a good guess but doctors won’t be able to make a 100% complete diagnosis. To properly assess suitability for treatment, the lower eyelid skin needs to be clinically felt by a doctor as well.

Treatment Approach 3 – Combination approach

Since vascular and pigmentation were the most common causes in up to 80% of patients, I’ve recently created a combination laser approach to dark eye circles.

The VERSA3 Long Pulse Nd-Yag laser targets blood vessels and causes these vessels to shrink. A clinical study of 26 Chinese patients (2) with dark eye circles owing to venous congestion were completely cured after the course of treatment with this laser.

The Starwalker Picosecond laser clears pigmentation from the lower eyelids in fewer sessions than an ordinary Q-switch laser. If necessary, superficial pigmentation is mopped up with the Starwalker VERDE (long pulse KTP laser).

In those with structural shadowing, I recommend correcting the bulky lower lid muscles with botox and filled hollowing with fillers.

Here’s an example of a condition I treated using this technique:

(patient with mixture of vascular and pigmented skin dark circles. PM me for more photos)

(patient came to me for bulky lower eyelid and under eye hollowing. PM me for more photos)

Prevent Dark Eye Circles 

Usually patients ease into a maintenance regime for the lasers after the intensive sessions at the start. This ensures good long term results as it is harder to treat a full blown relapse.

I also highly recommend good eye skincare. My personal choice is using the Skinceuticals AOX eye gel which has different ingredients targeting pigmentation, skin thinning, as well as blood vessel congestion. It also comes in a gel form, which avoids possible skin clogging from thick cream formulation.

Disclaimer: I don’t work for Skinceuticals! I just think it’s a good product and recommend it to my patients.

References

  • Ranu H, Thng S, Goh BK, et al. Periorbital hyper-pigmentation in Asians: an epidemiologic study and a proposed classification. Dermatol Surg 2011;37:1297–303.
  • Ma G, Lin XX, Hu XJ, et al. Treatment of venous infraorbital dark circles using a long-pulsed 1,064-nm neodymium-doped yttrium aluminum garnet laser. Dermatol Surg 2012;38:1277–82.