#AskID : Prof Niki Ralph about dark circles/bags under the eyes!

We asked Prof Niki Ryan:
‘Dark circles and bags under the eyes have long been a universal skin concern for both men and women.
There are a variety of different reasons why dark circles appear under the eyes and therefore treatment should be directed to the cause, however contrary to popular belief fatigue is not one of the main causes.

Hyperpigmentation - a common place to see increased skin pigmentation is below the eyes. This may be caused by a combination of genetic factors (more common in those with darker skin types) and environmental factors such as UV exposure and hormonal therapies.
Treatment for those with hyperpigmentation on the face, also known as Melasma, includes daily use of Zinc based physical sunscreen,use of sunglasses, avoidance of oestrogen containing hormonal treatments such as the combined oral contraceptive pill, hydroquinone (depigmenting cream) to reduce the appearance of the pigmentation by reducing melanin production. It may also be more apparent during pregnancy due to hormonal changes and may improve somewhat postpartum.

With age, there is loss of volume in the face, fat and collagen. This is especially apparent under the eyes, which may result in a sunken appearance in this region and dark circles under the eyes. Also for those who suffer with seasonal allergies/nasal congestion this may lead to dilation of the veins under the eyes making them bigger and appear darker.

Poor sleep is not the direct cause of dark circles under the eyes however it may exaggerate the appearance. Therefore, trying to get a good nights sleep and being slightly elevated on pillows may reduce puffiness under the eyes also.
Research has also shown that smoking worsens dark circles, therefore do whatever you can to quit for multiple health reasons.

Therapies to manage dark circles include:

A chemical peel may be used for those who have dark skin under the eyes due to pigmentation. Peels may be used to improve melasma and age spots, however are not suitable to the very thin skin directly under the eyelid. A course of light chemical peels containing lactic and glycolic acid may improve hyperpigmentation over time.
Lasers may also be used to target pigmentation, however the eye is vulnerable to injury from laser therefore ensure you are being treated by an appropriate laser and also an experienced practitioner.
Microneedling, a minimally invasive procedure which makes tiny micropunctures in the skin inducing new collagen formation. This may therefore be used to improve acne scarring, overall skin rejuvenation and improve dark circles under the eyes.
PRP - Platelet Rich Plasma is used for entire face rejuvenation however it is particularly good for the crepey thin skin of the eye area. PRP helps to promote collagen production and kick-starts the skin’s regenerative capabilities. This produces a plumping and tightening effect on the treated area. The skin is rejuvenated and rehydrated resulting in reduced wrinkles, healthy, regenerated glowing complexion which looks smoother and more youthful.
Camouflage with concealer or primers containing ingredients which can “bounce” the light from under the eye due to subtle light reflective products may be used in those who do not wish to have any invasive procedures. This will only be suitable for younger individuals with dark circles who do not have any sagging of the thin skin below the eye, otherwise concealers may emphasise the wrinkling/crepey skin in this area.
Tear trough filler is an established, very popular non-surgical treatment for the management of dark circles/sunken skin under the eyes. Hyaluronic acid fillers are used to replump the area which pushes the skin up and away from the blood vessels, hence reducing the appearance of dark circles.
For those who feel they have both dark circles but also significant sagging or “bags” below the eyes one may consider the surgical option of lower lid blepharoplasty. This is a day case procedure with removal of the excessive fat below the eye and small amount of skin to tighten the area resulting in reduction of wrinkles/sagging skin and also the dark appearance of the thin skin of the under eye area. Post surgery one may consider maintenance PRP or Exilis Ultra 360.
Exilis Ultra 360 - This treatment is the first and only technology combining radiofrequency and high-frequency ultrasound. This is a type of monopolar radiofrequency that is strong enough to reach the deeper layers of the skin safely, comfortably, and efficiently, to stimulate collagen and elastin production and remodeling of the treated area. It is very effective on the eye area resulting in tightening of the skin both above and below the eye and also reduction in dark circles. The beauty of this treatment is that there is No Downtime!! One can have the procedure in less than 30mins and return to normal immediately. It is compared to having a hot stone massage.