Treating Dark Circles – How Lasers can Treat Some Causes, and Other Treatments to Improve Color

Thank you for your question. You submitted a single photo with your eyes
closed and you’re asking will laser help remove the dark spots under your eyes. And the photos are taken at a distance so
I actually can see more of the broad picture and not so much the detail of the eyes but
I think I understand what you’re asking. So, I’ll give you a sense of how I counsel
patients like yourself who come to my practice about this type of situation. A little bit of background, I’m a Board-certified
cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I’ve been in practice in Manhattan and Long
Island for over 20 years. And the challenge before us every day in our
practice is dealing with people who are concerned about dark under eye circles and I think that’s
really the core of your issue is you have dark circles under the eyes and you want to
know if laser will remove those circles. It is understandable why you are asking this
question. We are immersed with incredible claims made
about the benefits of laser and unfortunately that tends to confuse a lot of people because
we have to differentiate what a laser does and how does it fit into this type of issue. So let me just get through the steps of how
I evaluate patients like you and what I want to do first and first is to find the problem
and then define the solution. So let’s start with the under eye area. What do I see when I see the under eye area? First, I noticed some puffiness. So understanding that the puffiness is not
a skin issue but rather something called lower eyelid fat prolapse. Lower eyelid fat prolapse means that the fat
pockets that are normally around the eyes have pushed forward and created these bulges. Now if this puffy area is really not something
that is constant and is either fluid or just happens to be the way as the photo was taken,
we can at least understand that if there is puffiness that a laser doesn’t really specifically
remove, that without its application in a more interventional approach, for example,
when we deal with under eye bags and puffiness, we perform a procedure called transconjunctival
blepharoplasty. This is a procedure where the fat pockets
that create this type of puffiness are reduced from the inside of the eyelid. Now, I prefer this technique especially for
people who have, let’s say, darker skin types and that means anybody who has like
a light olive skin tone and darker. The reason for that is generally there is
no evidence of extra skin and you avoid issues with incision in terms of discoloration or
scarring even though those are not major but it doesn’t justify making decision if you
can avoid it. Now beyond that and on the topic of skin type,
that is where one of the major decision points about choosing a laser treatment or alternative
treatment becomes absolutely critical. Laser is the use of a particular wavelength
for certain amount of time to target a particular type of chromophore. And the three major ones are blood, water
and melanin. Now when you look at someone with dark circles
under their eyes, we have to ask ourselves what of those elements are related that can
potentially have a role with laser. But beyond that, I would say, it is very important
that you also consider what kind of impact laser has when you do a treatment. So there are lasers that, let’s say, target
water. Well those are the lasers that can be done
fractionated or ablative to remove top layers of skin. The top layers of the skin can also contain
some pigment that could help make the dark circles look better. There are also lasers that target the pigment
itself called melanin and there are other lasers that also target blood. Now, the point of this is understanding whether
or not a laser would potentially cause someone with a darker skin type to actually make the
area look even more darker. So in that respect, you have to be mindful
of where laser fits in. For example, when we treat under eye circles
and if it’s in combination with or without addressing puffy under eye bags, we routinely
actually first do a combination of platelet-rich plasma (PRP) which is derived from your own
blood and has a concentration of wound healing and growth factors that stimulates collagen
and improves the appearance of dark circles . We’ve done this very successfully as a
standalone procedure without laser and basically getting the benefit of improving skin quality,
improving the texture and health of the skin and it’s actually been shown that platelet-rich
plasma (PRP) prevents hyperpigmentation and actually can be used in situations where there
is hyperpigmentation and that’s been shown in formal studies and we’ve seen these clinically
for years. So, I think that although there are a lot
of options, I think laser may be something that could have a place in your treatment
plan but I think that you can also consider other options before going with laser. I think it’s natural to ask this question
because people are so fascinated by lasers and certainly this industry of aesthetic medicine
really continuously hypes new lasers and there’s some basis but unfortunately, a lot of times,
the hype and the usability doesn’t always go together. A laser is a tool and it may have a role in
your treatment but it cannot be a standalone type of tool in my opinion. If I do a laser, I often combine it with platelet-rich
plasma (PRP) because I want to get the benefit of the laser as a resurfacing tool and the
platelet-rich plasma (PRP) as to way to improve skin quality and texture. And sometimes even injectable fillers can
also have a role in improving dark under eye circles. So if you understand, there are a lot of different
elements that can be used to address particular anatomic issues. I think that you have to, at this point, make
some decisions about choosing a doctor to meet with and have a proper consultation and
learn about what the recommended options are and I would even go so far to say that when
you meet with several different doctors, you are going to get a lot of different opinions. So you are going to find a doctor that you
feel comfortable with it and you feel makes sense with your unique situation. Remember, skin type is very important. Same modality that I would use for a lighter
skin type for a person like an Irish blue-eyed person with dark circles is very different
from what I do from let’s say an Indian or Arab skin type, someone who is brown and
then further and even darker skin type like of someone with African origin. So it really has to be customized. So I hope that was helpful, I wish you the
best of luck and thank you for your question.

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