Periorbital Hyperpigmentation

(Darkness around the eyes)

“Beauty is how you feel inside, and it reflects in your eyes. It is not something physical.”

Sophia Loren

Overview

Periorbital hyperpigmentation —  or undereye darkness or dark circles is a common finding in otherwise healthy individuals. Its importance rises mainly from its cosmetic implications on a person’s appearance. This is usually a bilateral condition around the eyes, but sometimes extending to the upper nose and glabella. It might be present on the upper, lower or both eyelids. It is common in both men and women, but it’s more common among those of darker complexion. 

What causes periorbital hyperpigmentation?

  • Familial/Genetic causes- Usually starting at a younger age with variable expression in different family members. Starting in the lower lids, but continuing to surround the eye with aging.
  • Post-inflammatory hyperpigmentation- Secondary to atopic or contact dermatitis.
  • Periorbital edema- Due to systemic and local causes. Edema is usually worse in the morning or after having a salty snack. To differentiate this from normal orbital fat pads, this stays when a person looks downward, and do not change much when looking upward.
  • Excessive subcutaneous vascularity- Usually involving the entire lower lid with a violaceous appearance due to prominent blood vessels covered by a thin layer of skin. It’s more in the inner aspect of the eyelid and usually worsening during menstruation.
  • Thin/translucent lower eyelid.
  • Shadowing secondary to prominent tear trough- This is an aging process change, most noticeable in the infero-medial orbital rim.
  • Lifestyle factors- Excessive sun exposure, lack of sleep, alcohol overuse, and smoking.
  • Medications- a good example would be Glaucoma eyedrops.
  • Hormonal causes

How to treat Periorbital hyperpigmentation?

It really depends on the cause of the hyperpegmintation, but similar to the regular skin hyperpigmentation. This is a persistent and relapsing condition and frequently requires lifetime management.

  • Topical treatment- With depigmenting agents such as Hydroquinone or tretinoin, Kojic acid, Azelaic acid, topical retinoid acid, or vitamin C.
  • Fillers– Hyaluronic acid gel can be used as a filler especially when the depression of the tear trough area is the main cause of the periorbital hyperpigmentation. Results are immediate, and post-procedure satisfaction is high. 
  • Plasma injections (PRP)- This is a great choice for periorbital hyperpigmentation treatment. Recently PRP was used to treat undereye darkness, wrinkles, and tear trough abnormalities. Injection of 1.0-1.5 of PRP under each eye has shown to significantly improve the infraorbital color homogeneity. One treatment commonly shows wonderful results but 2-3 treatments might be needed.
  • PDO threads- PDO threads are strong monofilament threads that enhance the production of collagen and add volume over the course of 4-6 weeks while dissolving under the skin. The very specific type of threads has been designed to be safely placed in the hollow area under the eyes! These threads not only improve the darkness but also improve the appearance of wrinkles and fill the lost volume.
  • Lasers- Laser has been recently used to treat infraorbital hyperpigmentation where the target would be the pigment or vascularity. This usually requires multiple treatments 3-5 treatments, and is best when combined with depigmenting agents containing tretinoin and hydroquinone . Laser is also helpful when skin laxity or age related changes are the main cause of the pigmentation.
  • Chemical Peels- These can use alone or in combination with topical bleaching agents. 
  • More invasive treatments-  Such as autologous fat transplantation, Surgery, Blepharoplasty are also available and can be considered if other more conservative methods show to be ineffective.

So which treatment is best for me?

After a thorough history and examination; our physician will discuss a treatment plan that would be the best for your condition. Call our office to schedule your consultation today.

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