With thin skin and little subcutaneous fat, the area around the eyes is one of the first places that people notice the signs of aging. There are a lot of ideas floating around regarding under-eye dark circles. Here we review some the recent literature to shine light on the topic.
Sleep: evidence shows sleep is unrelated to dark circles
A recent study from Case Western Medical School published in the journal Clinical & Experimental Dermatology compared the under-eye circles of good and bad sleepers. They found no difference between the groups, consistent with another study of 500 Brazilian women whose under-eye circles also showed no correlation with their sleep. Sleep was important for other aspects of skin health & appearance, however, with poor sleep causing accelerated skin aging, and worse healing (in particular healing UV-induced damage). You can read the article here.
What causes under-eye circles then?
A recent article in the journal Clinics in Plastic Surgery reviews the current thinking on what causes dark circles under the eyes. They identify three major contributors for most people. It should be noted that this article was very procedure-focused and that the authors collect consulting fees from the makers of Juvederm (a major hyaluronic acid filler).
- Hollowing & Shadowing: As we age, the fat under our eyes breaks down. The loss of volume results in more shadows from other parts of the face, which results in the appearance of dark circles. This volume can be improved with the injection of hyaluronic acid fillers.
- Excessive Pigmentation: Certain factors like UV light and estrogen can cause melanocytes in the skin to proliferate, resulting in more pigment and a darker appearance under the eyes. The gold standard treatment of hyperpigmentation of the skin is the prescription drug hydroquinone. It can also be treated with laser treatments that break down pigment.
- Prominent Blood Vessels: Because the skin of the eyes is so thin, it is easy for underlying blood vessels to become visible through the skin, resulting in a dark blue or purple hue under the eye. This can be targeted with laser treatments that break down red blood cells & small blood vessels. These blood vessels also become engorged in several conditions (crying, sleeping without the head elevated). Sleeping with the head elevated and avoiding emotional stress may be helpful.
Full article here.
Caffeine: A popular cosmetic with little evidence base
Many cosmetic companies market caffeine gels for the treatment of dark under-eye circles, and several dermatologists have endorsed this approach. The data behind this recommendation, however, appears to be weak. Recent articles tend to cite a small study from Thailand that showed no statistical difference in the improvement in eye puffiness between base gel & caffeine-containing gel.
Clinical trial can be found here.
Anti-oxidants: Vitamin C has little to no effect on under-eye dark circles
The majority of studies looking at topical anti-oxidant creams (often containing vitamins E & C) are not controlled, making it difficult to study their efficacy. One trial from Japan used vitamin C on one eye and a control gel on the opposite eye. They showed no improvement in under-eye pigmentation, but a small improvement in under-eye erythema (a measure of the blood-vessel component to under-eye circles) with certain vitamin C formulations. Overall, the effect was not dramatic.
Clinical trial can be found here.
What should I do about it then?
Unfortunately, the literature behind over-the-counter cosmeceuticals for dark under-eye circles & puffiness is weak. There is very little data to suggest that these products (caffeine gels, anti-oxidant creams) will do much to help the problem. Some prescription products (hydroxyquinone for hyperpigmentation) and procedures (laser therapy & injectable hyaluronic acid) seem to do a better job. In terms of home care, avoiding expensive under-eye creams and focusing on regular skin care (daily sunscreen use, regular moisturizing) appears to be the best approach – reducing the signs of facial skin aging more generally. Although there is limited evidence to support the practice, sleeping with the head elevated may decrease the congestion of blood vessels under the eyes, and this logical technique is easy to implement.
Daily Dermatology 