Eye bags and dark eye circles treatment in Malaysia. What are the non-surgical options?
Either consciously or subconsciously, our perceptions regarding a person’s degree of fatigue and age emerge based on the area surrounding the eye (periorbital). Regardless of diverse cultural backgrounds, societal perceptions are similar, in that dark eye circles and eye bags contribute to a tired, aged and even sad appearance.
What causes dark eye circles and eye bags?
Various anatomic factors may contribute to the appearance of periocular dark circles including the facial ligamentous architecture, the bony structure, midface soft tissue including prominence of the orbicularis oculi muscle and vasculature and thin eyelid skin with minimal to no subcutaneous tissue.
Multiple factors may be implicated in congenital and acquired hyperpigmentation of the periorbital skin. Causes may include melasma, nevi, dermal melanocytosis, excessive sun exposure, hormonal changes or a multifactorial aetiology. Inflammation from various conditions including atopy and contact dermatitis may also lead to hyperpigmentation. Medications such as oral contraceptives have been found to increase pigmentation.
Picture insert: Age-related changes involving the osseous, ligamentous and soft tissue anatomy in the ageing eyelid resulting in infraorbital dark circles (adapted from Nakra, 2015)
The underlying facial ligament and bone structure are important in providing a framework to support facial soft tissue and affect the overall appearance of the face. Age-related changes in the midface result in relative orbital rim recession and midfacial and malar bone volume loss, leading to tightening of the orbital and facial retaining ligaments. As facial fat descends and fat volume decreases, the relatively inflexible ligaments result in tethering and associated orbital rim and facial hollowing.
These hollows lead to worsening of shadowing, which can particularly be noted in the tear trough area in the inferomedial orbit. Overhead lighting can worsen the appearance of periorbital dark circles, while direct light may mask the appearance.
Dark eye circles
Age-related anatomic changes of the midface soft tissue include subcutaneous fat atrophy and volume loss, hypertrophy of orbicularis oculi muscle, pseudoherniation of suborbicularis oculi fibroadipose tissue and volume loss in the malar region. These features further accentuate the appearance of dark circles.
The thin and somewhat transparent eyelid skin provides little camouflage to the prominence of the underlying midface soft tissue including the robust subcutaneous vascular network and the orbicularis oculi muscle. This results in a darkened appearance of the skin.
Infraorbital eyelid fluid may accumulate in the infraorbital soft tissue area and further contribute to the darkened and aged appearance in this area. Extravasation of haemoglobin breakdown products such as hemosiderin and biliverdin contributes to visible pigmentation changes in the cutaneous and subcutaneous layers.
What are available treatments for eye bags/dark eye circles?
The first step in managing infraorbital dark circles is to identify the specific constellation of aetiologic factors present so that a customised therapy can be crafted. A spectrum of interventions exist, including non-invasive options such as skincare and lasers to minimally invasive treatments such as soft tissue fillers and microneedling RF.
Arbutin is a botanical extract with a structure very similar to hydroquinone and has demonstrated similar efficaciousness. It works as a competitive antagonist for tyrosinase, which plays a critical role in the pigmentation pathway. Arbutin can help achieve melanocyte stabilisation as a means to decrease the pigment deposition in the periorbital region.
Its decongesting effect fights against edema formation, due to poor lymphatic circulation or high capillary permeability. It inhibits collagen glycation, preventing the loss of elasticity and eyebag formation.
It quickly reduces puffiness and increases skin elasticity (+30% in 1 month) around the fragile eye area. It also lightens dark circles and rejuvenates the look.
Chemical peeling and microdermabrasion is often combined with other interventions or used alone in the treatment of dark circles. This modality is effective in the treatment of dark circles due to both pigment irregularities in the skin as well as contributions from rhytids.
Chemical peeling/microdermabrasion remove melanin from the stratum corneum and epidermis, with deeper peels modulating melanin content in the dermis. Improved skin collagen following chemical peeling/microdermabrasion can also aid in camouflaging the underlying orbicularis and vasculature that can contribute to dark circles.
HIFU is a noninvasive, nonablative rejuvenation technique that uses the concept of ultrasound waves, which penetrate the epidermis and induce vibration of cellular molecules, leading to thermal injury and SMAS. This procedure effectively thickens and shortens the collagen fibers, increases tissue tension because of the elastic properties of collagen, and tightens the skin. HIFU is a nonablative useful treatment for skin lifting in Asian patients including periorbital area.
Microneedling Radiofrequency (RF) devices use energy produced by an electric current (as opposed to a light source as in a laser) to create a thermal effect that results in collagen contraction and neocollagenesis while minimising collateral damage. The use of Microneedling RF devices to achieve tightening of the skin in the periorbital region has been reported.
Picosecond lasers are an effective means of treating dark circles that are primarily due to hyperpigmentary changes in the skin. Given the rapid thermal relaxation time of melanosomes, picosecond lasers are ideal for selectively treating melanosomes while causing minimal trauma to the surrounding structures.
Dermal fillers have become a treatment of choice in many settings to address under-eye contour irregularities that can result in dark shading. Their ease of use and availability make for an effective treatment modality to address volume deficiency in the periorbital region that may result in shadowing in the under-eye region. Profound improvement in infraorbital dark shadows can be achieved using dermal fillers alone.
Hyalual Light/Smart/Booster is an injectable that contains hyaluronic acid as well as succinic acid to deliver redermalization. Redermalization improves skin quality by increasing its regenerative potential.
Hyalual injectables improves the appearance of dark eye circles by addressing the three underlying problems
- Pathological vascularisation. Mechanical activation of regenerative skin function, intensification and restoration of microcirculation
- Dermal Hyperpigmentation. Succinic acid (SA) mechanically blocks tyrosinase enzyme that triggers melanin
- Special Anatomy. Dermal recovery, increase skin thickness, intensification and restoration of microcirculation
Before and after photos are for reference only. Individual results may vary. Photos courtesy of Hyalual