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The darkness of the infra-orbital areas, colloquially known as “dark circles,” is a widespread facial skin issue in the general population. Therefore, many primary care patients also have this problem.

For most, the condition is purely an aesthetic concern, not a medical one. Less commonly, dark circles are a consequence of genetic predisposition or an underlying illness, such as anemia (iron deficiency) or thyroid function disorders.

Although cosmetic or body-image issues do not harm physical health, they can negatively affect mental and emotional well-being.

Adequate treatment increases the patient’s quality of life and overall satisfaction with care. So, mastering the treatment techniques is an asset for any general practitioner.

For further information on this topic, you may be interested to learn more about the HealthCert Professional Diploma program in Aesthetic Medicine.

Overview

Dark circles harm the aesthetic appeal of an individual. As a result, people look tired, older, and sad. There are no conclusive findings about the causes of dark circles. So, the focus of all therapies is on relieving the symptoms (shadowing and darkness).

Modern aesthetic medicine offers some efficient minimally invasive treatments. With additional training, most GPs can successfully add these to their list of services.

Potential causes of dark under-eye circles

Researchers believe that potential causes of infra-orbital darkness include:

• Excessive pigmentation
• The shape of the nasojugal groove (tear through)
• Infra-orbital skin laxity
• Infra-orbital fat herniation
• Translucent (thin) skin over the orbicularis oculi muscle

Treatment options for dark under-eye circles

The usually available treatment options for dark circles at the primary care level are:

• Topicals,
• Platelet-Rich Plasma (PRP) injections,
• Hyaluronic Acid (HA) fillers,
• Polynucleotide (PN) fillers, and
• Laser Skin Resurfacing.

Other treatments, such as autologous fat transplantation and the removal of infra-orbital fat pads, are unfit for primary care conditions.

Some treatments, such as topicals, will work well only for excessive pigmentation. Others, such as HA fillers, can cover almost all potential causes.

The best method is to examine the patient and identify the likely cause. Then, inform them about all options with their limitations, advantages, and cost.

Quality management of expectations is essential. Doctors should ensure the patients understand the following:

• The likely therapy outcome,
• The time necessary to achieve maximum results, and
• Potential complications.

Topical treatment of dark circles requires patience and persistence. It usually includes skin-lightening and depigmenting agents, such as hydroquinone and albumin. Other potentially beneficial topicals include:

• Corticosteroids,
• Vitamin E,
• Vitamin C,
• Azelaic acid, and
• Kojic acid

PRP injections also have a role in dark circles treatment. More so in the treatment of Periorbital hyperpigmentation. According to some studies, PRP contains an epidermal growth factor that may inhibit melanin production.

Hyaluronic acid injections are a comprehensive treatment for infra-orbital darkness. Tear throughs, infra-orbital fat herniation, and thin and saggy skin are all HA fillers indications.

The soft tissue augmentation with HA fillers is well-tolerated in the infra-orbital region. It results in significant improvement of dark circles.

However, doctors need to choose an appropriate injection technique and HA filler when treating particular causes of dark circles. The considerations for fillers are:

• Hyaluronic acid concentration,
• Swelling ratio,
• Rheology, and
• Particle size

Intradermal PN fillers can improve thin and saggy skin-related dark circles. They boost the metabolic activity of fibroblast cells, increase collagen production, and strengthen the skin’s regenerative ability.

Various laser treatments can improve the pigmentation in the infra-orbital area and minimize the appearance of fine lines and prominent veins.

Qualifications and facility requirements

All general practitioners with sufficient knowledge of facial anatomy, injectable techniques, and additional training in aesthetic medicine can perform these treatments in a primary care setting.

– Dr Rosmy De Barros

Read another article like this one: Providing radiofrequency in primary care

References:

• Vrcek I, Ozgur O, Nakra T. Infraorbital Dark Circles: A Review of the Pathogenesis, Evaluation, and Treatment. J Cutan Aesthet Surg. 2016 Apr-Jun; 9(2):65-72. Doi: 10.4103/0974-2077.184046. PMID: 27398005; PMCID: PMC4924417.
• Park KY, Kwon HJ, Youn CS, Seo SJ, Kim MN. Treatments of Infra-Orbital Dark Circles by Various Etiologies. Ann Dermatol. 2018 Oct; 30(5):522-528. Doi: 10.5021/ad.2018.30.5.522. Epub 2018 Aug 28. PMID: 33911473; PMCID: PMC7992473.
• Agarwal M. Treatment of Dark Circles with the New 15 mg/ml Hyaluronic Acid Filler with Lidocaine. Indian Dermatol Online J. 2019 Jul-Aug; 10(4):471-472. Doi: 10.4103/idoj.IDOJ_381_18. PMID: 31334075; PMCID: PMC6615388.
• Mehran P, Zartab H, Rajabi A, Pazhoohi N, Firooz A. Assessment of the efficacy of platelet-rich plasma (PRP) on infraorbital dark circles and crow’s feet wrinkles. J Cosmet Dermatol. 2014; 13(1):72-78. doi:10.1111/jocd.12072