2008 Questions from Healthy Living

Garth Fisher M.D.® F.A.C.S.
Board Certified Plastic Surgeon
Beverly Hills, California USA

CellCeuticals® Skin Care Inc
Cofounder and Chairman

Biomedical Skin Treatment Institute®
Founder and Director

1. Why do dark under eye circles occur? What are the best treatments (ingredients/products) to get rid of them?

Dark circles are generally a result of one or a combination of these things:

1. Hereditary dark pigmented skin (dermal melanin deposition)
2. Thinner skin which appears darker as the small veins are more superficial and visible which casts a darker hue.
3. The insertion of the Arcus marginalis (dense tissue) into the bony eye socket
4. Excess bulging fat and tissue laxity of the lower lid which casts a shadow below
5. Descent of the cheek pad from aging and gravity which creates a relative shadow in the tear trough above.
6. Post inflammatory hyperpigmentation (sometimes bruising post traumatic or surgical).

Making the correct diagnosis is critical to providing a treatment! Hereditary pigmentation is sometimes improved with skin bleaching and some laser applications.

The dark circle is sometimes referred to as the "tear trough area" which is just below the lower eyelid and runs from the junction close to the nose to the outer area of the eye margin. Many people refer to this area as the "tear trough area" because if an individual loses tissue volume in this area, tears will collect in this region and flow to the side of the face, rather than flow down the cheek as a child.

Many practitioners are treating this area with dermal fillers to restore the loss of tissue volume and rejuvenate the appearance of this area. Great care must be taken with fillers to avoid lumpiness as the skin is generally very thin and unforgiving. Often fat transplants or grafting can "take" unpredictably resulting in permanent lumps in unpredictable areas. The skill of the injector is more important than the material injected.

Tear trough implants have been utilized for quite some time to help fill out this area but again are often problematic because of the thin skin which may allow edges to be visible.

An "arcus marginalis release" (combined with or without lower blepharoplasty and fat removal) is often helpful for the tear-trough deformity. While some of the fat of the lower lid is removed (lower blepharoplasty), some remaining fat may be advanced into the trough area to provide a nice permanent filling effect.

In patients over 40, sometimes the trough is a combination of excess fat in the upper lid and a descending cheek which causes a "hill-valley-hill" deformity with shadowing. Some of these patients require reduction of fat and elevation of the cheek pad back up with face-lifting techniques such as a cheek, mid face, or upper facelift. Again, the solution must be carefully tailored to the unique source of the patient's problems.

Darkness from post traumatic or post surgical events often is the result of hemosiderin deposition in the cells as the blood in the tissue breaks down. This will gradually improve with time and avoiding sunlight helps the process. Studies have shown that creams with gel containing phytonadione Vitamin K, retinol and vitamins C and E also can reduce dark circles caused in this way.

2. Why does under eye puffiness occur? What are the best treatments (ingredients/products) to minimize puffiness?

Tissue "puffiness" around the eyes can be caused by a variety of factors; age, diet, lack of sleep, allergy, tissue laxity, sun damage, etc. The treatment is most effective when the proper cause is determined. If the anatomic deformity is chronic and is from excessive fat in the tissue around the eyes, blepharoplasty or reduction of fat is a great solution. Don't try this at home! It may be as simple as treating allergies, avoiding too much sunlight, getting necessary sleep, or avoiding products that are inflammatory towards the skin around the eyes.

3. Are there any at-home remedies that you'd recommend for a temporary fix?

An old trick used by decades of beauty contestants is the application of preparation H under the eyes! If that does not sound appealing, the regimens of icing, application of cold spoons or chilled cucumber slices are also effective.

Green tea also is very effective, especially green tea polyphenol which is the ingredient that works its wonders. After sleeping, place wet tea bags over the eyes for 5 to 10 minutes to help minimize puffiness. Also, eye creams that contain caffeine may be helpful. Caffeine, amongst other properties serves as a dehydration agent.

There are a variety of botanicals that have shown varying degrees of effectiveness in antioxidant, dehydration and reparative assistance in skin rejuvenation. Oatmeal baths, Rosemary extract, olive oil, grape seed extract, propolis (extract from bee hives) are all discussed. We know that olive oil and oatmeal are certainly used in products and spring up everywhere. Many of the above listed products are touted to reduce swelling and offer protective epidermal effects.