What can I do about those dark circles under my eye?
Treatment of dark circles first begins with proper diagnosis of the cause . There are many things which can cause dark circles including allergies, aging, dehydration, congenital (genetic condition which runs in family), and abnormal blood vessel formation. Other factors which may contribute to dark circles: thryoid or allergy problems, and excess caffeine. Some skin types have a predilection for dark circles, typically olive complexion. It is also important to distnguish temporary dark circles from persistent dark circles.
Another less commonly discussed cause is a loss of volume around the orbit. When there are depressions along the face, it accentuates shadows and creates the appearance of a dark circle. When volume is restored, the depression is removed and the darkness is lessened. A small amount of temporary filer material, such as Restylane or Juvederm, around the eye can often dramatically improve dark circles.
As in any therapy, I advocate conservative therapy first prior to more aggressive modalities for skin related causes of dark circles. Regarding dark circles, the most conservative treatment for this is to start with a skin lightening cream then move to a slightly more aggressive treatment depending on your response.
Traditionally, people advocated cucumbers because there is a slight skin lightening effect. However, this is mild and mostly effective in teenagers.
There are a variety of lightneing agents which can be quite effective in some individuals. Most commonly they contain bleaching agents such as hydroquinone or Kojic acid. Hydroquinone should be used in concentrations less than4% because of the potential for a black sooty condition, termed ochronsis.
Trilima cream is perhaps the most well publicized lightening agent and is primarily used for hyperpigmentation but can be used for dark circles. Triluma contains 4% hydroquinone as well as a mild steroid and tretinoin. See below for instructions on its use.
If the hydroquinone does not work effectively for you, several more aggressive options are available. IPL (intense pulsed light) can be effective for dark circles. IPL will specifically target the darkness and is effective, also great on brown spots and telengectasias/spider veins. The other option is a TCA peel to the lower lids which can also be effective. TCA peel will offer some skin tightening of fine wrinkles and is a peel of moderate strength. More aggressive modalities can cause pigmentation discoloration and should be used with extreme caution.
Instructions for triluma cream-
Apply once a day at night, 30 minutes prior to bed
Wash face gently
Apply small amount on your finger (size of a pea)
Feather out to about a 1/2 inch of normal skin when applying
Rub until invisible on skin
If you use moisturizer, use can use during the day over affected area as well as cosmetics