The Lighter Side of Under-Eye Circles

Dr. Furnas (00:04):
French actress and model Clemence Poesy told Vogue, dark circles under the eyes can be one of the most moving things on a human face. Maybe some people would prefer their dark circles move somewhere else. Is that possible? Can we get rid of them? Welcome to Skintuition. I am Heather Furnas.

Dr. Korman (00:30):
And I'm Josh Korman. As two plastic surgeons, we lay aside our scalpels and explore the non-surgical world to bring you what's new, what's safe, and what to look for when you're ready to hit refresh.

Dr. Furnas (00:45):
First, Josh, what do we mean by dark circles under the eyes?

Dr. Korman (00:51):
Well, if you got it, you know it, I think pretty clear. I think sometimes people don't really know exactly what's causing the dark circles, but it's pretty clear when they have 'em or when it bothers them because it's area under the eye, they can develop shades of blue and purple, brown or black, depending on your natural skin color. And dark circles can result from a few things. One is a lot of times people have under eye puffiness, and the dark circle comes just because the light can't reach the recess between the puffiness and the bottom and the skin below, and that's what creates the under eye dark circle in that case.

Dr. Furnas (01:42):
So it's a shadow really.

Dr. Korman (01:44):
Yeah, I think it's, it's... It's beyond a shadow of a doubt.And it's also other things, volume loss in certain areas, hyperpigmentation is just a dark circle, which can be caused from a lot of different things. Among other things that the inherent color of the surrounding skin and also the visibility of the blood vessels in the under eye area, eyelid skin, including lower eyelid skin, is among the thinnest skin in the body. So you can see a lot of the things that are going on underneath the skin that's being reflected in the color of the skin themselves.

Dr. Furnas (02:26):
So it can be really, if we break that down, shadow, pigment and visibility of the blood vessels because the skin is so thin. When we say blood vessels, they're the fine capillaries that can give a reddish or bluish or purplish hue versus pigment, which is more a brown, black sometimes with a slightly purpleish hue. So in order to address how to fix it, if you can, you really need to look at the cause. So we mentioned aging. And so Josh, you see somebody older complaining of dark circles, particularly dark circles in bags that often goes hand in hand, but also dark circles. You mentioned the bulging and that can be shadow, but then there's the tear trough. Can you explain that?

Dr. Korman (03:31):
Yeah. So the anatomy of our lower eyelids is a little involved and certainly we won't have a big anatomy lesson here, but there is this thing called the nasojulal groove. Naso like nose and jugal is the area between this groove is between what's essentially the cheek or the nose and what's the eyelid. And in that you can all see it in yourselves, just look in a mirror. And it's the area where the lower eyelid transitions onto the cheek. And so there is this trough that's called the tear trough or scientifically or anatomical, the nasojugal groove. And there's a lot of explanation of what's that actually from. And we won't go into that here, but it is sort of a negative space compared to the positive space of the eyelid, the lower eyelid above and the cheek below.

Dr. Furnas (04:33):
So it's like a valley and the lower lid is like a mound. And so the mound drops down into the valley and that's where that groove is. And the groove can, because it is a groove, can cast a shadow and that can really irritate people. A lot of people will get filler to fill that out, creating less of a shadow. Sometimes there's too much filler and it can actually create a mound which is distracting. So there's that. There's the thinning of the skin and the aging person. So you can get a bluish cast and just more visibility of the blood vessels.

Dr. Korman (05:17):
And sometimes what happens is that people, lighting plays a big role in this. So when people are looking up and looking in a mirror or there is a fluorescent light above or light below, it changes. And so what people see in their bathroom may be different than what they see when they are in a department store walking by in a mirror or when they're in the bathroom at work. And it can be quite troubling because it is not generally a particularly aesthetic look.

Dr. Furnas (05:57):
Yeah, when you're looking in a typical bathroom, you've got the overhead lights and that can really exaggerate shadows with a light coming from above. Whereas if you're looking in a makeup mirror like an actor, actor, you know, an actor would be using before going on stage or on camera, you've got lights all over. And so that is more flattering.

Dr. Korman (06:22):
But with all of our cell phones, you should never look down at your cell phone. That always makes everyone look worse. So it is, light has a big deal and a big effect on what you see in the dark circles under the eyes.

Dr. Furnas (06:42):
There are bags of fat just behind the skin in the lower lid. And when you move your eye around, you change the appearance of those bags of fat. And so as Josh said, just the appearance of your eyeball, I mean the direction of your eyeball can impact the way that fat settles, the way all the anatomy of the lower lid looks. And we talked about pigmentation, and that tends to be a genetic or family trait. Some people just have darker pigmentation. The lower lids, that can get worse with age can get more emphasized, I should say, with age. Rubbing your eyes, if you have allergies or something and you rub, rub, rub, that's irritating. It can cause the blood vessels to dilate. And that can also exaggerate that darkness. The blood vessels can break and if that happens, you can leak a little bit of blood out and that can actually stain the skin with something called hemosiderin, which comes from the blood. It's a chemical that comes from the blood and can stain the skin a brownish color.

Dr. Korman (07:59):
But then, that's nice about all these different things, but make it go away already. How can you, make it go.

Dr. Furnas (08:09):
Let's talk about a couple things like lack of sleep you get, dehydration, you can get kind of sunken in, fluid retention like salty meal or allergies, you know, you bulge, you can get the shadow. And then excessive alcohol use that will dilate your blood vessels and make the blood vessels more obvious. And smoking just ages the skin. Okay, so now we talked about all the things that contribute. What can we do? Bottom line is there's no really dramatic fix, but we'll get into some of the things that can help.

Dr. Korman (08:53):
So I would disagree that a little bit. I think dramatic fix, nonsurgically.

Dr. Furnas (09:00):
Okay. Thank you.

Dr. Korman (09:02):
We're talking non-surgically. You certainly can do things surgically that have dramatic results, but although I have to say that a touch of filler in the right places can be quite dramatic. I think the parts that I find challenging the most is the color when it's not a shadow, when it actually is color. Because using bleaching creams, and I know I'm just preempting a little bit what we're going to talk about, but bleaching creams can be irritating and won't really have the color go away completely.

Dr. Furnas (09:40):
And Josh is right with the shadows, we can do something, it's the color that is the harder thing. And sometimes even color can improve with filler or with fat transfer, which is a surgical procedure. By reducing the bags that create the shadows, that's through surgery. We can improve the shadows, but the color is a little bit harder to deal with. And so they're the things like get more sleep, sleep on more pillows or wedge of pillows, cold compresses to get the blood vessels to calm down. And you see these for centuries, decades, maybe throughout humanity since the Egyptians, I dunno, who started wearing cucumbers on their eyes, but the evidence is weak, that cucumbers help, but they are moist and they do contain some vitamins and minerals. And so some people feel that they work to some degree.

Dr. Korman (10:54):
I think the biggest thing is they're cold.

Dr. Furnas (10:57):
They're cold.

Dr. Korman (10:58):
Cold. I think that's what the big thing is. They look refreshing, but they are and they're round like eyes when you slice a cucumber. But I think mainly because it's cold, because another big thing that has been used by runway models for decades is Preparation H in the refrigerator. Because that, you know, what does Preparation H do? It shrinks tissues. So while you certainly don't want to get it in your eye, you don't want to use the gel, the more you want to use the cream. And I'm not saying that's the best thing to use, but that is certainly something that has been used for a very long time is Preparation H in the refrigerator.

Dr. Furnas (11:36):
Yeah, exactly. And tea bags, that's another remedy, probably not as effective as Preparation H, but teabags contain caffeine which constrict the blood vessels so.

Dr. Korman (11:51):
They also contain tannic acid. So the tannic acid, not in the herbal teas, but in the black teas, it contains tannic acid, which is good for bruising and it is good to help with color. Again, it's not magic, magic, but it has some evidence of working.

Dr. Furnas (12:11):
And a lot of eye creams will contain caffeine for that same reason. Sometimes just plumping up the skin can help. So hyaluronic acid is a moisturizer we've talked about before that can plump up and brighten the skin. Vitamin C can also help, it can have a brightening effect on the skin. And there are brighteners that some skin creams contain that will reflect the light.

Dr. Korman (12:43):
Yeah, I think there's a lot of things. One thing that I was mentioning a little earlier is this bleaching cream, hydroquinone. And hydroquinone is actually banned in many countries. It's not banned in the United States, and they're come in different percentages and different strengths. But it's really important to be really careful with lower eyelids because the skin is so thin and you don't want to have a reaction that makes it irritated. So that's certainly another option. There are other moisturizers like dimethicone and cyclomethicone, and these are emollient moisturizers, which just means that they make the skin look smoother and silkier. There actually was a product that was roaming around in the past, if you put it on, it would instantly tighten the skin and it would last for six hours. The thing is it would mostly dry the skin, but it sort of came and went. Then what's very popular now are peptides. So Heather, what are peptides?

Dr. Furnas (13:59):
Well, there are these little chains of protein that strengthen and they can actually kick up some chemical reactions to promote collagen production. And that can strengthen and thicken the skin around the eye because we've talked about how the eyelid skin is so thin that it can be transparent. And so a thicker dermis is really protective against those dark circles. And I think with discoloration, concealer is probably the most effective treatment. And Anna Wintour dark glasses, the editor in chief of Vogue, if you see photos of her, she wears dark glasses in most of them.

Dr. Korman (14:48):
Well, one thing I would just say is if you have bags under your eyes or you have pigmentation and you really don't want to draw attention to it, even short of the Anna Wintour dark glasses, it's just glasses. Because I find that if people wear glasses, people are not really looking at your eyes. They look, they are covered by the glasses of any shape. Just glasses sort of the one layer down. And so it's more visible when people don't wear glasses. And I do think that there really are a lot of options to improve. And it is certainly, our eyes and our necks are two areas where we really show age first. So as much as dark circles and puffiness may bug you, you can be sure that there are people, every doctors and companies and many people in the industry working hard every day to come up with new treatments for it.

Dr. Furnas (15:57):
And it is a very common complaint. So we've mentioned sort of several specific items, but a lot of these skin creams will combine ingredients. And so that's going to be the most effective. And so I mentioned concealers being particularly effective simply because it covers everything, but the texture of the skin it doesn't help. And so a lot of these things in combination and then if needed a concealer is helpful, but there are a lot of products that are effective, particularly when used together. And then as we mentioned earlier, get sleep, stay hydrated, and that helps as well.

Dr. Korman (16:41):
Thank you for listening to this episode of Skintuition. Join us every two weeks as we tackle topics from hair loss to hormones and pimples to wrinkles and dark circles under the eyes, discovering new ways to feel better about ourselves.

Dr. Furnas (16:57):
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