What causes the "bags" or "dark circles" under your eyelids???

So many of my friends and patients ask me what causes the dark circles under their eyelids and what can be done to treat them?

Dark circles within the lower eyelids can be caused by several factors and each one has different ways for correction. For instance dark circles can be from any of the following factors:

1)    Hyperpigmentation of the skin (which can be caused by certain medications) and even worsened during pregnancy
2)    Age-related decent of midface of cheek fat which results in a larger deficiency of volume at the lid-cheek junction
3)    Prolapse or herniation of the eyelid fat pockets (bulging fat pockets)
4)    Thin skin allowing the underlying muscle and blood vessels to show
5)    Underlying allergies or rosacea

You should have a complete examination by either a dermatologist or a plastic surgeon to first evaluate the etiology of the “dark circles.”  Treatment depends on what the etiology is and can range from the following regimens:

1)    Filling of the lid-cheek junction and the midface with some form of filler material. I prefer Restylane or fat grafting to this area.  This is done in the office with the assistance of a topical anesthetic. The procedure can take as little as 15 minutes if using Restylane and can go home afterward without any problems.
2)    Lower lid blepharoplasty or eyelid surgery (removal of lower lid skin and/or fat) with the possibility of using a filler material
3)    Skin bleaching or brighteners
4)    Chemical peels or laser treatments
5)    Control of allergies/rosacea

Upper and lower lid swelling from underlying allergies and contact dermatitis.

 

Notice the decent of the midface resulting in a hollowing of the lower lid.  This results in a shadowing effect that appears like dark circles.

 

 Herniation or bulging of lower lid fat pads from age-related changes.