Panda eyes, raccoon eyes, dark circles – there’s no denying that those pesky dark shadows are no fun. Dr. Andrew Chua unveils the mystery behind dark circles and what we can do to get rid of them!

How often have you been asked, "Did you sleep badly yesterday?" or told, "You have been looking very tired lately…". The root of such questions is a problem you just can’t seem to shake off – those dark shadows below your eyes.

There are many causes behind dark circles and this issue is a common reason for consultation in aesthetic dermatology; almost everyone has had to deal with them, both men and women alike.

Many patients express their distaste for their dark circles. The eyes can convey a lot about a person’s mood and health, hence, it is no surprise that something as simple as a shadow can change the way you look to others and ultimately, begin to affect how you feel.

While dark circles are harmless, they can make you appear unhealthy or very tired-looking. Nobody likes having them, and almost everyone has tried everything from purchasing eye creams that promise to rid you of those circles, to sleeping as much as possible and drinking lots of water. But sometimes, the real cause could be more than just a simple case of lack of sleep.

The Facts

Apart from the skin on our lips, the skin below our eyes is the thinnest on the body. As we age and our skin and muscles lose elasticity, the first signs of the aging process are usually seen around the eyes in the form of wrinkles.

However, this thin skin brings about another disadvantage – the many blood vessels in this area can show through this delicate skin. If the vessels become dilated, this can appear as dark circles (this is more noticeable if you are fair-skinned).

But dark circles can also be caused by several other factors. A dark circle around the eye is basically dark coloured skin or a depression in the periorbital (around the eye socket) area, particularly in the subpalpebral (underneath the eyelid) region, that casts a ‘shadow’ below the eye, giving the appearance of a dark circle.

There are many postulated causes behind dark circles – amongst them aging, allergies, poor blood circulation, bone and facial structure, fluid and fatty deposits, sun exposure, fatigue, extreme weight loss, sinus and nasal problems, and constant eye rubbing, to name a few.

Dark eye circles can be a result of a multitude of possible reasons, but the main cause is unfortunately hereditary; if your parents have them, chances are you are most likely to have them too. While you can still try to do something about your dark circles if the cause is indeed hereditary, do be prepared for minimal success in completely eliminating the problem.

Fade Those Shadows

Dark circles can be due to several factors. Hence, one simple treatment may not successfully fade those shadows. Instead, a variety of treatments are available that can bring about a more successful outcome – specific for the problem at hand. The initial assessment to ascertain the cause of the dark circles is of utmost importance, as it directs the subsequent treatment paths.

Here we list some treatments and methods that are available to combat those dreaded dark shadows.

• Hide Them
  A simple (and instant) solution to hide your dark circles is to apply a yellow-based or skin coloured concealer to camouflage the problem.

  Use a brush to apply the concealer under the eye, and then use your pinky or ring finger to lightly pat and blend in the concealer.

• Protect With Sunscreen
  Dark circles are also commonly caused by hyperpigmentation (darkening of an area of skin caused by increased melanin), which is caused by sun exposure. Therefore, it is very important to apply sunscreen daily around the eye to avoid the sun’s rays from darkening the skin in this delicate area. Use a sunscreen that is especially made for the face (or choose eye creams that contain sunscreen) with a

  Sun Protection Factor (SPF) of at least 15 and above. Additionally, avoid the sun from 10am to 4pm when the sun's ray is at its strongest. Protective glasses also help shield skin from those harmful rays.

• Identify Allergens
  Allergies can be one of the more common causes of puffiness around the eyes and dark circles. Allergies can cause the eyes to itch – constant eye rubbing irritates and breaks tiny capillaries beneath the skin, causing puffiness and discolouration.

  Whether you have hay fever, eczema or may be allergic to something else such as certain foods, it’s best to identify the problem and treat the allergy, or avoid what is causing it all together. Once you do this, you will notice that your dark circles will fade quite promptly.

• Lighten and peel
  If your dark circles are due to hyperpigmentation on a superficial level (in the top most layers of the skin), then a mild chemical peel or creams that contain lightening agents can help.

  A mild chemical peel with a fruit acid (kojic, phytic or glycolic acid) involves applying a few layers of light strength acid on the skin under the eyes with a brush or cotton pad. After the procedure, there may be mild peeling of the skin (though this is usually not apparent with a mild peel containing 20 percent glycolic fruit acid). This peeling effect removes the superficial layers of the skin that may contain the pigmentation causing the dark circles.

  Regular use of sunblock is needed to avoid a recurrence of darkening under the eye – monthly visits to your dermatologist for chemical peels also help keep the problem at bay. A chemical peel around the eye area usually costs between RM180 to RM300 per treatment.
  Lightening creams that contain hydroquinone, as well as retinol and vitamin K, can also be used to lighten dark circles to some degree. Mild lightening creams that contain two percent hydroquinone can be purchased over the counter, however, creams that contain four percent (or more) hydroquinone have to be obtained from your dermatologist.

  These creams will need to be applied to the eye area about twice a day – mild hydroquinone is usually sufficient (there have been some side effects associated with the application of high strength hydroquinone). Some individuals do not respond to hydroquinone, so do check with your dermatologist beforehand to know whether you are likely to observe results with this form of treatment or not.

• Zap Them
  Some lasers, such as the 1064nm Q-switched Nd:YAG (commercial brands include MedLite® and Quanta®) can selectively target melanin when used in the photorejuvenation mode, hence lightening dark circles to some degree. Treatment time takes about five to 10 minutes and is relatively painless – one will only feel a tinge of warmth during treatment. After the session, the under-eye area will appear a little pink for a few hours, but this should subside quite fast.

  Repeat laser treatments on a monthly basis is possible and treatment usually costs between RM200 to RM300. Treatment with the 1064nm Q-switched Nd:YAG laser can only help lighten your dark circles if it is caused by hyperpigmentation.

  However, if your dark circles are caused by visible small blood vessels under the skin, then treatment with the long pulse 1064nm Nd:YAG (for example GentleYAG™) laser is the treatment for you, as it targets the blood vessels, causing them to contract and shrink.
  Treatment is quick and minimal pain is involved; one can expect to observe results after one or two treatment sessions. The cost of treatment usually varies depending on the extent of the observed blood vessels, but expect to spend at least RM200 or more per treatment. However, if your dark circles are caused by larger blood vessels, then treatment with this type of laser will not help.

• Fill Them
  The appearance of dark circles can also be due to a depression or hollowness under the eye area – the shadow that is cast appears as dark circles.

  In this instance, reports of treatment with fillers have been known to help and generally cost around RM200 per treatment. However, it has to be done well and carefully to avoid over corrections.

  Most fillers contain hyaluronic acid, which is a natural substance found in the body, hence will unlikely cause an allergic reaction. Results can be observed immediately and a repeat treatment will be required after about nine months to a year.

Summary

There are many causes behind dark circles – some can be treated easily with creams while some require a more extensive treatment, such as peels or a laser treatment. It has even been said that a series of tiny injections on the skin surface with hyaluronic acid can help cover the hyperpigmented area.

In some instances, your dark circles could also be caused by muscle hypertrophy (in which case treatment with botulinum toxin has been known to help). Even eye bags can give the appearance of shadows (a surgical procedure known as blepharoplasty is popular to remove eye bags).

Regardless the cause of those pesky dark circles (and before seeking treatment), it is important to obtain a proper diagnosis from a dermatologist who will then decide what the best treatment for you is.

The causes of dark circles are poorly understood. During a congress in 2006, the French Society of Aesthetic Medicine attempted to classify and simplify this difficult topic. From the meeting, dark circles were largely grouped in the following manner:

1. Inherited eye ring – blood vessels become visible due to deficiency of vitamins, melanin (dark brown to black pigment found in hair and skin), or hemosiderins (microscopic pigment composed of iron oxide);
2. Acquired eye ring due to skin aging;
3. Full eye ring due to lymphatic stasis (where lymph flow in the lymphatic system – a network of vessels that conveys
   electrolytes, water, and proteins – has ceased), excess periorbital fat, or muscle hypertrophy (growth and increase of the size of muscle cells);
4. Hollow eye ring due to fat atrophy (wasting of fat cells) and facial bone structure;
5. Pigmented eye ring found in people with excess melanin or skin aging;
6. Compounded eye ring made up of the combination of the above.

What Causes Dark Circles?

While dark eye circles are usually an inherited trait, other causes could also include:

Aging: As we age, the fat pads below our eyes thin, producing a sunken appearance.

Allergies: Allergies can cause the eyes to itch – constant eye rubbing irritates and breaks tiny capillaries beneath the skin, causing puffiness and discolouration.

Bone and facial structure: Deep set eyes can cast a shadow under the eyes to appear as dark circles.

Fluid and fatty deposits: With increased fluid retention and fatty deposits, eyes appear puffy and blood vessels can become engorged and dilated and seen as dark circles. Sun exposure: Sun exposure not only darkens pigments, but can also cause age spots around the eyes and weaken the skin.

Fatigue: Lack of sleep reduces circulation, and causes blood vessels to become more visible through the skin. Additionally, lack of sleep causes our skin to become paler, increasing the appearance of shadows.

Extreme weight loss: This can cause a sunken look and hence, cast a shadow under the eyes.