Under-Eye Circles
Minimally Invasive Ways to Erase These Early Signs of Aging
By Andrew A. Jacono, M.D., F.A.C.S.

Under-eye circles can be a very difficult problem to treat, and are often one of the first signs of facial aging, even in people as young as their thirties. Many women and men are frustrated after spending hundreds or thousands of dollars on creams to treat under-eye bags and circles, only to find out they don't deliver.

The reason that these topically applied treatments do not work is that the problem lies deeper than the surface of the skin. The three major causes of under-eye circles are blood vessels under the eyes, brown hyperpigmentation in the skin under the eyes, and lastly, bags and under-eye hollowing. Each one of these problems is treated differently, and all can be treated either without surgery or a with a minimally invasive procedure with minimal downtime.

The first cause of under-eye circles is blood vessels in the skin under the eyes. In this case the circles have a purple hue, and often are assumed to be the result of allergies or lack of sleep. These veins and blood vessels are hereditary, and their appearance can fluctuate with diet, sleep, alcohol intake, and smoking. The most effective way to treat this problem is with minimally invasive laser treatments that target the blood vessels. The best treatment is called Intense Pulse Light (IPL) therapy. This uses an intense broad-band wavelength of light that is absorbed into the vessels and makes them collapse. The skin gets slightly red after treatment, but there is no true downtime. Three or four separate treatments are required for resolution of the problem.

The next cause of the eyelid circles is brown hyperpigmentation in the skin. Melanocyte cells are the cells that tan the skin, and they can deposit too much color in the area in the hollow underneath the eyelid. This is brown, and not purple, like the blood vessel problem we described above.

This can be treated with a no-downtime laser that targets these melanocytes called Fraxel; each laser targets different types of colors with different wavelengths of light, so they are very specific in what they treat. Fraxel, or fractional laser resurfacing, not only helps get rid of the brown hyperpigmentation, but also helps reduce crows feet and wrinkles and tightens eyelid skin. Again, 3 to 4 treatments are required separated by 4 week intervals, and has no downtime so it can be done on a lunch break.

The last and most common problem is related to changes that occur with aging. With gravity, lower eyelid bags develop from sagging of fat bags deep underneath the eye. The cheek fat deflates along the eye socket, resulting in a hollow below it like a deep valley. This deep valley is accentuated by light as shadowing in this hollow under the eyelid bag makes it look darker.

One simple way to treat this problem is by filling the valley with an injectable treatment like Juvederm or Restylane, both hyaluronic acid products. This will last up to a year and has minimal downtime, but can cause a bruise for a day or two that can be covered up with makeup. The more permanent solution is a minimally invasive procedure that is less than an eyelid lift. It is performed from inside the eyelid through a small incision so there are no external scars. The fat bag is then lifted up and moved into the area where the hollow/valley under the eye exists, filling it in. This procedure takes less than an hour and can be done without general anesthesia. Bruising lasts 3 to 5 days, but lasts 10 years or more!

It is important to accurately diagnose the problem, so that the proper treatment is matched to your condition. No matter what the treatment plan is, the absence of under-eye circles will greatly improve your appearance.
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