Dark circles under the eyes are a common complaint, and their appearance is likely due to multiple factors that include genetic hyper pigmentation, excess pigmentation due to inflammation from allergies/eczema, swelling, thin skin allowing blood vessels and eye muscles to be visible through it, and anatomical changes leading to shadowing such as depression of the tear trough. Each one of these causative factors needs to be addressed for maximal improvement.
To treat hyper pigmentation, one may benefit from chemical peels and the regular use of sunscreen and bleaching creams. If the increased pigmentation is due to inflammation from allergies or eczema, then the allergies or eczema need to be treated.
Muscles and blood vessels are dark in color, and they impart a darker tint to the overlying skin when they are able to be seen through it. Thin lower eyelid skin is difficult to treat, but chemical peels and prescription creams such as tretinoin (Retin-A) can help. Thick skin is less transparent.
Anatomical changes that lead to the appearance of a shadow under the eye include a depression in the groove along the lower eyelid. This groove is known as the tear trough. When this groove extends onto the cheek it is because the fat pad that creates the apple of the cheek has descended. These anatomical changes occur with age. The tear trough can be filled with products such as Restylane and Juvederm. In my experience, this is a very rewarding procedure. The cheek can be re-volumized with many different products, but one of my favorites is Radiesse for cheek augmentation. Protrusion of the fat pads directly behind the lower eyelid often need to be addressed surgically if they are very prominent.
In my Los Angeles Dermatology and Liposuction practice, patients often ask me what they can do about dark circles under their eyes. Although it is not always possible to completely eradicate them, many people can achieve significant improvement if the individual factors causing them are addressed.