Dark Circles Under the Eyes

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Patients with dark circles under their eyes complain that they look tired. The condition is called periorbital hyperpigmentation. Environmental factors that make the condition worse include sunlight exposure, hayfever, lack of sleep, stress, alcohol overuse and smoking.
The condition is classified by appearance as:

• pigmented (brown color)-congenitally darker skin, nevus of Oti or Hori, dermal melanocytosis, side effect of eyedrops, inflammatory induced pigment increase associated with atopic or allergic dermatitis or eyelid rubbing associated with allergies
  
  increased pigmentation from inflammation
• vascular (blue, pink, purple color)-increased blood vessel density
  
  blue color and structural (tear trough) both treated by filler injection
• thin skin making the underlying muscle color visible
  
  thin lower eyelid skin shows muscle under it
• structural (shadows formed by the surface contours such as eyelid bags, eyelid swelling or tear trough visibility associated with aging)
  
  shadows from eyelid bags
• mixture of 2 to 4 of the above classes

structural shadow from malar bags and over pigmented brown lower eyelid skin that is more visible after bags are removed

Nasojugal crease, tear trough deformity, nasojugal groove, bags under eyes, under eye hollowness

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In the young individual the transition between lower eyelid and cheek is imperceptible. The dividing line between these areas in older individuals is the nasojugal crease also called the nasojugal groove (term first used in 1961) or tear trough (term first used in 1969). It is an early sign of aging around the eyes, lending a fatigued and aged appearance to the face. As part of the aging process ligaments that fix facial skin to the underlying facial bones thin and lengthen or stretch, facial bones recede back and facial fat shrinks. This results in the drooping of facial skin and appearance of laugh lines, jowls, nasojugal creases, eyelid bags etc.. The skin within the nasojugal groove or crease becomes thinner and/or darker in color than the slightly lower nose or cheek skin. It can also seem deeper or be more visible if there is protrusion of fat into the lower eyelid. The aging process starts near the nose as the tear trough and progresses outwardly towards the same side ear becoming what is called the palpebromalar groove.


Tear Trough and Palpebromalar Groove Boundaries



Examples of Tear Troughs in Younger Patients Without Protruding Eyelid Fat