How to remove dark circles under the eyes?

Treatment Approaches for Dark Circles Under the Eyes

Autologous platelet concentrates (APCs) like PRP and PRF are effective treatments for periorbital dark circles, with high patient satisfaction rates and significant improvements in skin thickness and appearance.1

Understanding Dark Circles (Periorbital Hyperpigmentation)

• Dark circles under the eyes, known as periorbital hyperpigmentation (POH), are a common cosmetic concern that can make individuals appear tired, sad, or older than they are 1, 2
• Dark circles are multifactorial in nature and can be classified into different types based on their causes 3, 4:
  • Pigmented type (brown) - 5% of cases 4
  • Vascular type (blue to purple) - 14% of cases 4
  • Structural type - 3% of cases 4
  • Mixed type (combination) - 78% of cases 4

Evaluation of Dark Circles

• Wood's lamp examination and ultrasonography can help determine the specific type of dark circles 4
• Assessment should include evaluation of:
  • Color (brown, blue/pink/purple hues) 3, 4
  • Periorbital puffiness 4
  • Shadow effects 4
  • Infraorbital palpebral bags 4
  • Infraorbital grooves 4
  • Skin type 3

Treatment Options

Autologous Platelet Concentrates (First-line treatment)

• Platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) have shown significant effectiveness for treating periorbital dark circles 1
• PRF has demonstrated superior results compared to PRP for periorbital rejuvenation, particularly for canthal smoothness and wrinkles 1
• Administration methods:
  • Microneedling at a depth of 0.25 mm 1
  • Intradermal papule injection to the eye area 1
  • Recommended protocol: Three sessions at 1-month intervals 1

Topical Treatments

• Multicorrective topical eye creams containing:

  • Tetrahexyldecyl (THD) ascorbate (vitamin C)
  • Prebiotic Inula Helenium
  • Bioavailable peptides
  • Botanical extracts
  • Chrysin
  • Caffeine
  • These have shown significant improvement in infraorbital dark circles by reducing microvasculature congestion, melanin accumulation, and hemoglobin degradation-related pigmentation 5

• Vitamin-containing formulations (3% Vitamin C, 0.1% Vitamin A, 0.5% Vitamin E) have demonstrated improvement in:

  • Skin brightness (L* value)
  • Melanin index
  • Overall appearance of dark circles 3

Chemical Peels

• Chemical peels have shown superior results compared to PRP for treating POH 1
• Studies indicate that chemical peeling is more effective, tolerable, and satisfying than PRP treatment 1
• 38% of patients treated with chemical peels showed excellent improvement, while none in the PRP group achieved this level 1

Other Treatment Options

• Sun protection is a cornerstone of therapy for preventing worsening of dark circles 2
• For structural causes of dark circles:
  • Hyaluronic acid fillers placed in the pre-periosteal plane can give good results in patients with thick eyelid skin 6
  • For patients with thin skin, microdroplet subdermal placement of filler in the preseptal tear trough area has shown good aesthetic outcomes with low risk of complications 6

Treatment Algorithm Based on Dark Circle Type

1. For all types: Sun protection and topical vitamin formulations (C, A, E) 2, 3

2. For pigmented type (brown):

   • First-line: Chemical peels 1
   • Second-line: PRP/PRF treatments 1

3. For vascular type (blue/purple):

   • First-line: PRP/PRF treatments 1
   • Adjunct: Topical treatments with caffeine and chrysin 5

4. For structural type:

   • First-line: Hyaluronic acid fillers (for thick skin) or microdroplet filler technique (for thin skin) 6

5. For mixed type (most common):

   • Combination approach:
     • PRP/PRF treatments (three sessions, 1-month intervals) 1
     • Daily topical treatments with vitamin formulations 3
     • Consider chemical peels for more prominent pigmentation component 1

Cautions and Considerations

• Safety is of utmost concern when treating dark circles to avoid worsening pigmentation 2
• Patients with thin eyelid skin and moderate fat prolapse may experience worsening outcomes with traditional filler techniques, including Tyndall effect (blue-gray discoloration) and contour irregularities 6
• Without intervention, periorbital hyperpigmentation usually progresses over time, so early intervention is encouraged 2