Many of my patients complain that they have dark circular areas under their eyes that they just can’t seem to lighten up. There are many causes of these dark areas and each one has its own solution. Finding out the problem first is essential, unfortunately, it’s not all that easy. Here’s some tips on how you might help these depending on the problem that is causing the darkness.

Problem #1: Pigmentations

One common problem is pigmentations under the eyes. The causes of these can be several. Genetic causes are sometimes difficult to treat for the pigmentations are always there, “in your genes.” Other causes of superficial pigmentations are from sun exposure (sun spots) or just the aging process (called age spots). They can also cause darkening under the eyes. If you have these, treatment could be some sort of lightener cream or some type of resurfacing to literally “scrap” the pigmentations off.

Tip #1: Lytera

The first thing you could do to decrease unwanted pigmentations is to use a product that balances the coloration on your facial skin. One of the many products is called Lytera. This cream can lighten the pigmentations and make them appear more like the surrounding skin, i.e. balancing the color in a smoother way.

Studies using Lytera have shown effectiveness similar to hydroquinone cream in reducing and lightening pigmentations of the skin. Not only is it helpful for pigmentations producing dark circles under the eyes, but it also can be useful for pigmentations all over the face.

Tip #2: Retinol

Retinol is a form of retinoic acid, which is a vitamin A derivative. These have similar actions deep within the skin layers. They work on the basal layer of the skin, which is the lower layer and the layer where replication of new skin cells occurs. I prefer Retinol over Retin-A because Retinol doesn’t cause as much annoying peeling of the skin and redness as the latter.

Retinol affects the replicating skin cells of the basal layer of the skin reproduce in in essentially a more “youthful” fashion. It makes the cells replicate in a more parallel fashion giving the skin a smoother look. It stimulates the formation of collagen and elastin, giving it more fullness and firmness, components of the skin that are necessary for a more youthful look.

Most importantly, for this topic, it distributes the melanocytes throughout the skin in a more uniform homogeneous fashion, helping to smooth out the abnormal pigmentations all over the face. Melanocytes are the cells that produce the pigmentation of your skin. So, if you can control their spread in a more uniform fashion, you get less irregularity and a more consistent skin color.

I actually believe that you should be using Retinol anyway, even if you don’t have dark circles under the eyes. You can benefit from the above actions of this age-defying cream to prevent many of the problems that can occur to your skin as you age. I recommend to start at a lower concentration first, around 0.25% to 0.5%, and increase the strength to 1%. Apply it daily.

Results are not immediate; a point to remember. It takes several months for your basal cells to reproduce and then mature through the layers of your skin (epidermis). By the time they are seen externally, several months have passed. You’ll see fewer fine lines, more fullness to your skin, a more homogeneous coloration, and simply a more youthful appearing skin. Thus, keep putting it on, even though you may not see the results immediately.

Tip #3: Chemical Peels

There are many peels that one can use to reduce pigmentations under the eyes or anywhere on the face. For instance, trichloroacetic acid or phenol peel are excellent choices. However, these do have downtime, especially the latter (2 to 6 weeks you could be peeling). Generally, to get the best results, you need a peel that is relatively deep, necessitating some type of moderate to deep sedation to perform the peel. Results are usually very good to excellent as long as you can put up with the downtime.

There are some quick peels that can help many people do superficial peeling of their skin that does not necessitate long downtimes. Lower strength TCA peels and some overnight peels may be used and result in a down time of a few days to just overnight. They are certainly a great option to try if you need to avoid downtime. Plus, they work mildly to moderately well, not only for pigmentations but for fine lines too, making the skin smoother. Unfortunately, results are short term.

Tip #4: Laser resurfacing

Another modality to reduce pigmentations, and to smooth the skin, is the CO2 laser, but it does have a downtime. It also may require some type of deep sedation, especially if these pigmentations are secondary to a problem called melasma. Melasma is usually caused by hormones and the pigmentations can be anywhere on the face. I recommend the fractionating CO2 laser for this since it has the shortest downtime, which is around 7 to 10 days.

If you can spare a lot of downtime (4 to 6 weeks), you could do a total resurfacing CO2 laser. It’s not fractionated, so the entire area is ablated removing all the pigmentations. It can give great results, but if it’s not done evenly, irregular hypopigmentations may occur, thus I recommend you stick with the fractionated type. The problem with hypopigmintations is minimal with the fractionated type of laser.

Tip #5: BBL, or Broad Band Light

BBL treatments are also called Photo facials. Here a beam of light with a specific wavelength is applied to your skin. Pigmentations absorb the light energy more strongly than non-pigmented skin. The high absorption of light energy can destroy the pigment, resulting in a more homogeneous color look to the skin.

Another benefit to BBL photo facials is they act on the DNA of the cells to make them function in a more youthful manner. Thermographic studies have demonstrated this through color interpretations comparing older skin (with and without long-term BBL use) and younger skin. People who had been consistent on doing BBL’s for many years showed a more youthful pattern to these studies.

Problem #2: Thin skin showing deep veins

Not only can thin skin under the eyes show wrinkles more, but it can also show blood vessels, particularly veins, that are deep underneath. These can show up as dark circles under the skin and may be difficult to resolve because you can’t get rid of your veins. If you have this problem causing the dark circles under your eyes, consider volume enhancement options as listed below.

Problem #3: Age-related loss of volume

As you age, you might develop a line that forms a curve 1-2 cm below the lower lid of the eye. This curve is due to lack of volume along that line creating an indention that may appear darkened when the light reflects on it. This isn’t an actual pigmentation, but more a shadow, and is due to age or genetic-related loss of volume of fat above the ligament that forms that curved line.

Solution: Volume enhancements

The best method to help resolve the problem of veins showing through thin skin or loss of volume of fat below the lid is to fill the skin tissue with volume. Commercial fillers may be adequate to do these, such as Voluma, which is a hyaluronic acid filler. It is relatively thick and thus fills well. One benefit is that it may last longer than some of the other fillers; up to two years for some people.

Other fillers may also be used to fill volume, such as Juvaderm. One must inject these deep into the tissues, otherwise they may present a problem. These have an unusual characteristic with reflection of light. With thin skin, they may be placed too superficial and can reflect light with a greyish discoloration, called a Tindell effect. This grey discoloration is a very undesirable look. Generally, Voluma does not create this problem like Juvederm does.

An alternative to commercial fillers is your fat. Fat can be transferred from one part of your body to the areas below your eyes to fill this with volume that is your own fat. These results can be quite remarkable, not only reducing the dark colorations, but also can give needed volume to these areas if that also is a problem. Moreover, it will not produce the Tindell effect, so no greyish discolorations and a more natural “you” color.

Problem #4: Hormones

Melasma is a condition that can be caused by certain hormones, such as in birth control pills or hormones seen during pregnancy. The pigmentations caused by these can be a cause of the dark circles. Solutions include those listed ablative or skin peel options noted above, but sometimes these can be hard to treat and may recur.

Another opposite problem can be lack of hormones. Lack of hormones cause you to age rapidly. Hormone replenishment can increase the “youthfulness” of your skin in many ways. Estrogen stimulates the formation of collagen, which thickens the skin, giving it more volume. More volume means it is not so thin, and can thus hide some of the discolorations produced by deep veins in some people.

Testosterone can increase the vascularity of the skin. This not only brings in more nutrients to the skin and can hydrate the skin better, but it also can give the skin a rosier color. A more rose color is a more youthful looking skin color and more desirable.

Thus, if you are low on hormones, make sure you replenish them adequately if your medical conditions allow this. Hormones can bring a more youthful look to your skin in addition to helping your mental state and improving your internal health.

Problem 5: Overnight dehydration

Lack of volume can be a short-term problem of too much to drink the night before or just dehydration or just darn tired! These usually resolve on their own, as you probably already know, with just good hydration and a return to a more “healthy” life.


If you suffer from dark circles under your eyes, you may benefit from one or more of these options, depending on your particular problem causing the dark circles. To know the best option for you, consult your cosmetic surgeon or aesthetic expert. You need to know the problem causing the dark circles first, and then consider the many treatment options for you to help resolve your issues.

It is with much sorrow we must share with you our wonderful physician, Dr. Robert True, passed away. Because his death was not anticipated, we are in the process of finding a physician to care for our patients and have a temporary physician and nurse practitioner in place. If you are in urgent need of your medical records, please contact us at 817-399-8783 so we may send you the legal medical records request form. We appreciate your patience as we work through this situation to try and maintain our practice.