The Most Common Questions About Under-Eyes Conditions Answered by a Pro

As an oculofacial plastic surgeon, I get all kinds of questions about the under-eye area, and I’m here to tell you that not all under-eye conditions are created equal. Even within the realm of dark circles, for example, there can be many causes, from pigmentation to vascular conditions that are causing a darkening effect below the lash line. As such, it can be helpful to consult with a professional, who can help you to start to understand your own unique needs, so that you don’t spend endless amounts of money on products that aren’t necessarily meant for your specific condition.

However, I also understand that access to care can be tricky (particularly in the middle of a pandemic) and so I’ve set out to answer the most common questions that I get asked about the undereye area. Keep scrolling to read more about them.

What are the most common under-eye conditions?

I often hear from my patients that their under-eye issues make them look perpetually tired. This typically stems from under-eye bags, dark circles, puffiness, crepey skin, and fine lines. Some of these may occur in isolation, but commonly (unfortunately) these tend to present in combination.

What’s the difference between each of those?

It basically breaks down to which layer of the eyelid is involved.

Under-eye bags occur when the normal fat that helps cushion our eyes moves forward into the lower lids, causing them to look fuller. Eye bags usually look the same from day to day. This differs from lower lid puffiness, which does show some fluctuation, due to swelling or fluid retention under the eyes.

Dark circles are the most common issue I help patients navigate on a daily basis. But dark circles can cause confusion because they come in a few different root causes. There is a type caused by an accumulation of melanin pigment in the skin. The vascular type of dark circles results from the visibility of blood vessels and muscle below thin eyelid skin. And still another instigator of dark circles comes in the form of volume loss between the lower eyelid and cheek causes shadowing under the lids.

There are a few tricks to help figure out which factor is at play. Pigment from an accumulation of melanin tends to look brown while blood vessels beneath the skin have more of a purplish hue. The shadows that occur from volume loss often appear worse under overhead lighting. More often than not though, a combination of these factors are co-conspiring to cause dark circles.

Generally speaking, eyelid crepiness—the fragile and crinkly appearance of the eyelid skin—occurs due to a loss of collagen and elastin, proteins in our skin that normally keeps it looking smooth and taut. To boot, the look of crepey eyelid skin can be exacerbated by dryness, because eyelids don’t really have oil glands. In other words: Dry skin is crepey skin.

Can your under-eye condition tell you anything particular about your health?

Under-eye bags are usually just a cosmetic concern and rarely a sign of an underlying medical condition. On the other hand, puffiness can be a telltale sign of allergies, a thyroid disorder, or excessive salt intake. More commonly though, they’re a sign of poor sleep or a bit too much to drink.

There is a specific type of dark circle under the eyes called an “allergic shiner” caused by congestion of the nose and sinuses. These can look a lot like the bruises of a black eye but are actually caused by allergies.

If eyelid dryness and crepiness is severe, it might be a type of eczema, like atopic dermatitis or contact dermatitis. These conditions often cause patches of dry, red, itchy, flaky skin in response to triggers like allergens, changes in temperature, or humidity.

If you suspect you have more than a run-of-the-mill eyelid issue, you should check in with a doctor (even virtually would be helpful) to get a sense of whether your condition is a sign of a health condition.

What are the best ingredients to treat each of these?

The truth is that some of these can be helped with ingredients in our skin care, (and please don’t shoot the messenger, here), but some of these require a visit to a cosmetic specialist to achieve real results.

Treatment of dark circles will depend on the cause. ⁣Makeup can help with all types of dark circles by masking and reflecting light.⁣ Skin brightening ingredients like retinol, vitamin C, kojic acid, licorice extract, and niacinamide can help with pigmented dark circles.⁣ In fact, I formulated my skincare line epi.logic’s Eye Contact ($90) with this concern in mind. Caffeine can help with vascular type dark circles by temporarily restricting blood vessels.⁣ Treatments that plump the skin, like retinoids, chemical peels, laser resurfacing, and micro needling can also help with vascular type dark circles.⁣ However, dark circles related to volume loss often improve with treatments like facial fillers, while surgery or blepharoplasty is the answer to most undereye bags.

To address crepey skin, center sun protection and hydration. The sun is the root cause of skin damage, and when the skin is protected, the eyelid area responds better to hydration. Sun protection and hydration with ingredients like glycerin, hyaluronic acid, and squalane are my favorites for keeping the eye area well moisturized. And light massage with a gentle gua sha or facial roller can decongest puffy eyes temporarily. The fluid will recollect if the underlying cause of swelling isn’t addressed though.

Are any of these caused by lifestyle conditions?

I wouldn’t say any of these are caused by lifestyle conditions but they can certainly be worsened by our choices. For example, I know we may have firsthand familiarity with dark circles looking worse after we’ve had one cocktail too many, not enough sleep—or perhaps both! Sun damage and smoking will also impact our collagen and elastin, making our eyelids vulnerable to developing crepiness.

Hydration may be the biggest misconception here. While being dehydrated will certainly make your dark circles look worse, once you’ve achieved adequate hydration levels, going wild with your water intake isn’t going to do anything to help.

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