Physician's Advice: What to do about dark circles under the eyes
Certain rays of light called UVB will tan or sometimes burn your skin. Other rays of light will penetrate more deeply and do no tan you, but will disfigure the skin DNA setting you up for cancer at a later date. These rays are called UVA. These are the same rays that come in though glass windows. They penetrate so deeply that they will actually dissolve skin and fat along the way. This becomes apparent when one reaches their 30’s and looks in the mirror to see the "crows- feet" like wrinkles by the eyes. because of the 90-degree angle of the sun and our face, the cheekbones and nose absorb the greatest amount of energy. Light energy will not bounce off as much as it would if it were a different angle. This is why as we approach our 40’s we will see the fat dissolved around our eye socket and the deeper fat that protects the eyeball will sometimes pooch out. This is commonly referred to “bags,” or “dark circles under the eyes.” It looks like a dark circle because typically the light source in a room is from above and the brow casts a shadow on the upper cheek/eye area. You can prove this to yourself by looking in the mirror and tipping your head upwards as you watch the bags disappear. Compare your profile to a child’s; you will see a marked difference in the way the fat is accumulated in this area.
This is the first phase of the physical appearance of aging. Traditionally the treatment for this would be the plastic surgical removal of fat from around the eye so that the fat would not bulge any more. This works if done in moderation. Care must be taken to avoid a hollowed out appearance. In this same way, other areas of the face become affected as well. The analogy that I like to give is as a child your face is like an overstuffed couch. As you age more and more stuffing is removed until it looks like fabric on a frame. This is why plastic surgery will make you look different rather than better. Surgery does not do anything to address the volume loss of the lower face.
What can you do about it? Acid Creams and lotions will help about 10% for the wrinkles around the eyes by generating younger fatter cells in this area. Botox® can be used off label in this area and will help the wrinkles about 75%. It is off-label because when Botox® came out as a wrinkle reducer, the company could not conceive of all of the areas that it would be useful, so they did not go through the FDA application process for each area of the body that it is now being used for. Nor do they need to because the government assumes that each physician will do what is right concerning the evolution of a drug and each physician is liable for the repercussions of their actions. It has been used off label in this way for many years but is considered an advanced technique so make sure your Dermatologist is comfortable performing this procedure.
As far as the actual shadows beneath the eyes, if it is mild it can sometimes be corrected with the use of filler. Filler is a category of materials that when injected in the skin will provide volume in that area. The most versatile fillers are those composed hyaluronic acid because of their longevity, flexibility and ability to dissolve over time. They are useful for many wrinkles around the face and over the last year have evolved to be beneficial for this area we call “tear troughs.” Again, it is an off-label use of filler that has been FDA approved for use in other areas of the face. I have seen this be successful many times for mild to moderate situations. Severe cases typically will need some sort of plastic surgical intervention. Again, it is considered an advanced technique, so be sure your dermatologist is comfortable doing this procedure. The fillers typically last around a year and initial swelling or bruising is common. Beware of permanent options offered as the face changes as you age and the option that benefited you in your 40’s may curse you in your 50’s.
There are many fillers avaialble. While many are safe, they are best used under the advisement and experience of your Dermatologist. This guide is for informational use only. It is not meant to take the place of your health care provider recommendation and no doctor patient relationship is implied. If you are curious if these types of treatments are for you, please come see us for an appointment.