Dark circles are due to a variety of factors. There is no one, single cure and sometimes, a combination of treatments is required. Understanding the different causes will help you be aware of the varied treatments.
Firstly, the problem can be in the skin around the eyes, which is more darkly pigmented than the surrounding skin. This is commonly seen in dark skin where on stretching the eyelid skin taut, you can see a darker pigment in the skin itself. Secondly, some people have creepy, crinkly skin around the eyes, which traps light and makes it appear darker.
The most common cause, however, is due to the congestion of blood vessels. This can either be in a thin network of vessels that lies beneath the eyelid skin or in the eyebag fat itself. Eyebags also create a bulge just below the eyes, which casts a shadow, making the dark skin look worse and delineating the junction between the eyebags and the cheeks.
Whenever I examine patients with dark eye circles, I am struck by how many of them have eyebags with some degree of vascular congestion, which makes the eyelid appear bluish, purplish or sometimes greenish. This explains why the lack of sleep makes them more prominent – it is the buildup of decongested or deoxygenated blood in the eyebag vessels. It may also explain why, after two kids, and I am sure many sleepless nights, your eye circles look worse.
Some individuals have a combination of all of these reasons and each has to be treated separately. When eyebags are responsible for the dark rings, then it is only logical to remove them surgically. I prefer an approach that involves a cut in the back of the eyelid, as this allows the fat to be removed without damaging the skin and muscle. There is also no external scar. I then use a laser to remove the greenish veins around the eyes.
If there is pigment in the skin or the presence of fine red vessels that make the eye rings look purplish or reddish, I use Intense Pulsed Light (IPL) to reduce this. I sometimes combine this with the Cooltouch laser if there is creepy skin.
This helps to stimulate collagen production and make the eyelid skin more taut. Microdermabrasion also seems to have a positive effect on smoothening the creepy skin. If the pigment around the eyes is very dark and prominent, then I recommend the use of a pigment laser to burn it away. The only problem is that there is considerable downtime and some post-laser pigmentation which may take several months to subside.
Thankfully, it always does subside. I also recommend antioxidant creams, anti-pigment creams and medically approved anti-wrinkle creams to help smoothen and lighten the eyelid skin. I also warn patients that it may take several months before they can see results.