Doctors say it's at the top of the list of complaints along with thinning hair and acne.

But dark circles have many causes and many treatments. And no matter what the cause, not protecting them from the sun makes them even worse.

Deena Haynes, 57, is tired of looking at the dark circles under her eyes.

'You just want to feel good about yourself and I think if you feel good about yourself on the outside, you're going to feel good about yourself on the inside,' said Haynes.

This is the first time she is attempting to do anything about them.

She's turned to Dr. Elizabeth McBurney, an LSUHSC and Tulane Dermatologist in Slidell, for help.

'Deena, what are you allergic to?' asked Dr. McBurney as she prepared Haynes for her first treatment.

Dr. McBurney is using the CO2 fractionated laser on Haynes. Using a sedative and a nerve block injection, the ablative laser will burn away a layer of the skin. When new skin grows back it will be thicker and smoother.

Metal shields protect Haynes' eyes during the procedure and in minutes, it was done.

'By tomorrow, this is going to get redder and it'll be more swollen and she'll have about five to seven days of what I call down time she won't be in any pain, but she's not going to look good,' explained Dr. McBurney.

Haynes has the kind of dark circles where the skin is so fair from genetics and thin from years of sun that you can see through it to the blue purplish hue from the network of veins. New York dermatologist Dr. Arielle N. B. Kauvar has used the Vbeam pulsed dye laser for dark circles when the cause is fine blood vessels. But she agrees with Dr. McBurney that, for most people, the best results for under eye circles and dark, wrinkly eyelid skin, is to thicken the skin with the CO2 fractional laser that Haynes is having.

Another treatment to camouflage the veins is to inject fillers to thicken the grooves or concave areas, the same hyaluronic acid fillers used in the lips and smile lines. They last in the eye area for about a year.

'That's the basis of using fillers to lift the skin and increase the distance from the surface to the blood vessels so that you don't see through the blood vessels very well,' said New Orleans Dermatologist Dr. Mary Lupo.

Filler can also stimulate your own collagen to grow again. But doctors warn that it's a very technical procedure. There are safety issues and if not done right, the filler can show through the thin skin. So go to someone with experience.

There are also products with caffeine in them, such as Teamine Eye Complex and RevaleSkin Eye Therapy, that temporarily constrict the vessels, so the color is not as obvious. One of the over-the-counter products Neocutis Lumiere was tested for the FDA by Dr. Lupo.

'Lumiere has the growth factors and why that works is it thickens the skin so you have an improvement of the texture of the skin as well as you don't see the show through,' Dr. Lupo explained.

She's also says Vitamin C products, such as Vivifying Serum C and Renew by The Face Company, tone down dark circles.

But there are many other causes of dark circles. In young people it is more often allergies.

'Because the venous (veins) congestion from sinus problems and allergies causes a back up of the blood in the venous system and that bluish purple hue in that thinner skin, that literally shows through,' Dr. Lupo said.

For that, treat the allergies and its swelling. And remember, rubbing your eyes darkens the skin pigment, which brings us to another cause, hereditary pigment.

'Darker skinned people tend to be more prone to get them because they have more pigment in their skin. So they are very common in African-Americans and Hispanics and dark-skinned Caucasian patients,' said Metairie Dermatologist Dr. Patricia Farris who is the Chairwoman of Media Relations for the American Society for Dermatologic Surgery.

'It's more common in people of Mediterranean background and also Asians, you will see it in too,' added Dr. McBurney.

For pigment, doctors can start with a simpler treatment such as prescription retinoids. Those are the number one wrinkle fighters such as Retin A, Tazorac and Renova, which has emollients in it so it is less drying for that delicate skin. Prescription Tri-Luma can be used in the short term because it has a skin bleaching ingredient along with the retinoid. Lasers and chemical peels can also be used.

For other causes surgery is needed. Dr. Kamran Khoobehi does a variety of procedures, from removing the fat that has herniated through the muscle or even injecting or repositioning the fat to make the area smooth. He also lifts the cheek pad if it has fallen creating a deep hollow. Doctors warn removing too much fat could make a deeper hollow that is unattractive.

'That's why it's important to make a correct diagnosis,' said LSUHSC and Metairie Plastic Surgeon Dr. Kamran Khoobehi.

'Lower lid eyelid surgery is an office procedure done under local anesthesia so you can be on your feet a few hours later the recovery depends on bruising. Some people bruise and they have to hid out for a week or so with sun glasses. Other people don't have any bruising and the next day they are moving around pretty well,' said Dermatologic Surgeon Dr. William Coleman, who is the Editor-in-Chief of the Journal of Dermatologic Surgery.

Dr. Coleman says that certain lasers can even tighten the skin enough to push the fat back in its place. Creams will not work if fat is the problem.

But in the meantime, remember that no matter what your age, you're not alone.

'Dark circles under the eyes are one of the most common complaints we hear about. We hear this almost every day,' said Dr. Coleman.

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