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Physician Clinical Exchange > "Dark Circles under the Eyes" Users Group

How do you treat "Dark Circles under the Eyes"? Let's exchange protocols and tips. What are the causes? What are the treatments? Is the treatment different in different Skin Types? Different Ethnicities?

We have posted a picture of a gentleman with dark circles under his eyes. Please go to the following website to see the pictures and then tell us how you would treat this gentleman. He is South Asian (Indian) with Skin Type 4. The dark circles appear to be mainly pigment. How would you treat the pigment? If there was a component of "deep tear trough" how would you treat that?
click on "dark circles under the eyes" to see picture

09.5 | Unregistered CommenterCHMD

From looking at the photo, thu not very clear still, I would gather that he is a relatively young person who has loss of the submalar fat and now has bilateral tear troughs and bilateral subjugal and submalar "wasting". Taking into account of his ethnicity, I would go first with injection of juverderm or restylane for all areas or just for the tear troughs and Radiesse for the subjugal and submalar areas ( for longer lasting results). The "dark circle" appearance, I believe, is also partially due to the "light deflection and shadowing" due to sharp angles. When the "wasted areas" are filled in evenly with the rest of his face, "that" appearance will significantly improve due to resolution of sharp angles, thus much less light deflection and shadows.

09.5 | Unregistered Commenterpmdoc

Better pictures to look at:

I think there is a component of "deep tear trough", but I also think there is a significant component of pigment and perhaps vascular.

Perhaps a filler plus IPL?

Looking at this area with a Polarizing Light (Syris) would help teasing the pigment from the vascular.

09.8 | Unregistered CommenterCHMD

Bringing this thread to Dark Circles Users Group. JEE


Apologies for posting as a patient but I am in desperate need for genuine guidance, assistance and accurate information due to the conflicting information I am encountering. I am of East Indian origin and suffer from 'Extremely Dark Circles Around The Eyes' caused by excessive pigmentation to the area. After having tried a number of products which have all failed to eliminate the problem, I feel now that the only avenue I can explore is the cosmetic surgery/treatment route in which you all are experts.

In the past, I have been told that any cosmetic procedure whether laser, peels, light therapy etc are simply not suitable for my skin type. I am wondering now if there is any new technology or treatments that can be safely used and that genuinely eliminates dark circles around the eyes for people of East Indian ethnicity? I would be very grateful for any assistance you can give me.

Thank You,


03.28.2008 | Bazzy77
Try using a Fraxel laser treatement. Its the latest laser available in the market with least sideffects.

Contact Dr. Walia at@ :

12.30.2008 | Dr Puneet Goel
I am treating an african-american patient with dark circles (pigment, not vascular or shadow) with Hydroquinone and MedLiteC6 1064 Q-Switched Laser. He looked like a racoon. 4 Treatments so far with 50% fading. Weekly treatments x 10 planned. You must be very careful. I use 4 mm spot size and 1.8 j/cm2. I use the Syris Headlamp to visualize the pigment granules and treat very gently. My only worry is that the pigment will come back (hopefully not for a while and not worse than when we started).

Dark circles around the eyes due to pigment is a very difficult problem. Still looking for the best solution. Any other ideas would be greatlly appreciated. What do you think of q-switched lasers for this problem?

I am afraid to use Fraxel because it makes Melasma worse sometimes. Who is Dr. Walia? Can he post here?

01.1.2009 | JE

01.1 | Unregistered CommenterJEE

l-ascorbic acid, magnesium ascorbyl phosphate or sodium ascorbyl phosphate in the mornings topically for suppression of excessive melanocyte production.
Examine the eye and make sure that the patient is not suffering form dry eye or allergies Optivar/ artificial tears/ punctual plugs usually makes a big difference because it help the patient to stop rubbing their eyes.
Elevation when sleeping along with cool compresses.
Have the patient cleanse the eyes with diluted tear free baby shampoo.
Uva at least 95% block & uvb at least 99% block sunglasses.
Typically nothing really works for very long if they are using hormone replacement therapy or birth control.
Fraxel/fractional technology DOES NOT help, it makes it worse! There is long-term inflammation and I could almost swear that it created lipoatrophy in the periorbital area. It dose give great contracture for wrinkles and laxity, but I have also noticed that there is an increase in superficial vasculature afterward that does not respond well to ipl or yag.

05.7 | Unregistered Commenterka


Please clarify: you believe that fractional tx on the periobital area produces inflammation which contributes to lipoatrophy and also creates vascular issues? Do you believe that is a problem with fraxel or all fractional... Ablative & non-ablative?

06.6 | Unregistered CommenterBeth


I was wondering if anyone has utilized Matrix RF for treatment of the the puffy eyes. Supposedly Matrix Rf is considered safe for all skin types because it utilizes radio frequency rather than optical energy. In addition, rather than a column of ablation it creates a triangular zone of ablation with the apex at the epidermis. I have a feeling it would work for fine peri-orbital lines for the darker skin types. The second issue is that regardless of technology utilized, darker skinned individuals are more prone to scarring and hyperpigmentation therefore one has to be careful. I have used Matrix RF for Fitzpatrick I,II, and III with good results and high patient satisfaction. I know Dr. Tess Mauricio is doing studies with type IV, V, VI but I would like to know if any members here have experience with this technology in the darker skin type.

In my years of practice, Restylane works better than any laser for under eye circles.

06.13 | Unregistered Commenterjoy anne

How about retinol topical creams? I read over the internet that this helps build up collagen after extended use. However, it may be a little hard on the skin. Will you recommend this?

06.25 | Unregistered Commenterchuma627

Try Mesotherapy Solution SB for skin whitening. Works wonders on my patients.

07.3 | Unregistered CommenterSimon

Q-switched Nd-YAG would be a good choice to break up melanosomes, but I would be very cautious around the eyes since 1064 tends to penetrate very deep and there is a potential retinal damage. I agree with using Restylane ( and now Belotero) for periorbital area. I would pair it with either Obagi NuDerm or any bleaching cream as well as topical Vitamin C.

10.18 | Unregistered CommenterRTMD

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