Q: I have fat deposits and dark circles under my eyes, which I think are hereditary because both of my parents have them. Knowing that, what, if anything, can you do to improve these?

There are 4 things that cause dark under eye circles:

1) the fat deposits or thickened muscles cast shadows on the infra-orbital rim, 2) as we age there is loss of tissue along the orbital rim which makes it hollow and more susceptible to a shadow, 3) as we age, the skin becomes very thin along the naso-jugal groove to the point were it is so thin that we can see the dark color of the muscles beneath, and 4) there may be pigment in the lower lid skin.

To improve #1, the fat deposits can be removed. Most physicians would not recommend debulking thickened muscles, but injections with Botox or Dysport can help soften bulky muscles that are casting shadows. For #2 in some patients, the fat can be transfered and sutured into place along the hollow rim to recreate it’s volume. Alternatively, a filler can be injected along the hollow rim improve the contour from the eyelid to the cheek. Hyaluronic acid is the safest since it can be dissolved should there be an irregularity. Number 3 can be improved with laser skin resurfacing. There are a variety lasers, but I believe that a CO2 laser does the best job of stimulating new collagen to make the skin thicker so that it becomes more opaque and therefore underlying muscle is not as visible. Finally #4 is the most difficult to treat. If pigment is superficial it can easily be stripped off with the laser, but if it is very deep, the lasers may not be able to reach it. A topical fade cream such as hydroquinone or a bleaching cream such as the new Elure may be of benefit.

—Julie Woodward, MD
Durham, NC