Can I do anything to reverse dark circles?

Maybe this routine sounds familiar: You wake up, look in the mirror, and examine the dark, hollowed out skin under your eyes. You look exhausted even though you slept well. And you might also look older than you are.

Dark circles are one of the most common skin complaints, says Dr. Daniel Friedmann, dermatologist and clinical research director at Westlake Dermatology in Austin, Texas. And they are among the most frustrating to deal with.

Eye creams and serums that claim to improve dark circles can be expensive. And most have not undergone “real intensive laboratory or clinical testing,” said Dr. Friedmann, so they are often ineffective.

Because dark circles can have different causes and appear in different shades — such as purple, blue, brown or black — there isn't always a one-size-fits-all solution to get rid of them, said Dr. Friedmann.

But some treatments can help.

Why do you get dark circles anyway?

As you age, the skin around your eyes thins and loses collagen, allowing underlying blood vessels to pass through, causing a bluish discoloration under the eye, said Dr. Friedmann.

At the same time, the skin and muscles under your eyes can loosen, causing bags that cast a dark shadow, said Dr. Friedman.

Dark circles are also genetic — you're more likely to get them if others in your family have them, said Dr. Ivy Lee, a dermatologist in Pasadena, California. And skin color plays a role; people with darker skin may be more prone to developing dark circles due to brownish pigmentation under their eyes, said Dr. Friedmann.

Allergies can temporarily worsen dark circles, as can dehydration, smoking, insufficient sleep or rubbing the eyes, said Dr. Lee.

Can eye creams help?

Despite claims on product packaging or advertisements, there is no scientific evidence that over-the-counter products actually remove dark circles, said Dr. Ronald Moy, a dermatologist and plastic surgeon in Beverly Hills, California. “I don't think any of them work,” he said. “I personally have never seen any improvement.”

However, he has done research on a protein in some skin care products called epidermal growth factor, which stimulates cell growth in the skin, and he said the ingredient has been shown to reduce under-eye bags when applied topically. Dr. Moy said the substance could also lighten dark circles “modestly.”

Dr. Lee said other eye cream and serum ingredients, such as hyaluronic acid, antioxidants or caffeine, can minimize dark circles, but they are only a “quick fix” and won't get rid of them permanently.

For example, she said, products with moisturizing ingredients like hyaluronic acid, ceramides or petroleum jelly, combined with brightening agents like vitamin C and niacinamide, hydrate and plump the skin under the eyes so that the “underlying blood vessels aren't as obvious.”

But any improvements you see will only be temporary. And for the most part, you'll get the same hydrating effects with any moisturizer — it doesn't necessarily have to be specific to dark circles.

Over-the-counter products containing retinol can help improve cell turnover and thicken skin, which can temporarily lighten dark circles, said Dr. Friedmann. Even better, added Dr. Lee adds, prescription topical retinoids may work better than over-the-counter versions.

But dark-circle products can range from tens to hundreds of dollars. And spending more doesn't yield better results. There's typically no difference between drugstore and high-end products, aside from the “fancier packaging,” said Dr. Lee.

Dr. Moy added: “It's hope in a bottle.”

What else works?

Some treatments can brighten dark circles, prevent them from getting worse and sometimes even disappear altogether, depending on the cause, said Dr. Lee.

Lasers. Fractional laser resurfacing (also known as Fraxel) can remove any brownish discoloration by peeling off the pigmented layer of skin, said Dr. Friedmann. Other lasers, such as the Nd:YAG (or neodymium-doped yttrium aluminum garnet) laser, can minimize purple or blue discoloration by targeting the blood vessels, he said. And fractional carbon dioxide lasers can minimize the appearance of dark circles by thickening the skin under the eyes, said Dr. Moy.

Chemical peels. Regular chemical peels, using retinol or glycolic acid, can prevent dark circles from getting worse, said Dr. Lee.

Microneedling. This procedure involves piercing the skin with small needles to create small wounds and stimulate the skin's repair process, stimulating collagen production that can tighten, plump and smooth the texture of the skin under the eyes, said Dr. Lee.

Fillers. Hyaluronic acid fillers can be used (sometimes in combination with lasers) to increase skin volume under the eyes, making dark circles less visible, said Dr. Friedmann. However, fillers can carry certain risks, such as temporary bruising or swelling; rarely have they caused blockages in an artery supplying blood to the retina, which can lead to blindness.

Surgery. Doctors can remove extra fat and skin under the eyes to help dark circles caused by bags under the eyes, said Dr. Moy. But surgery is usually a last resort for patients whose dark circles have not improved with other treatments.

Sometimes a combination of treatments is the best approach, said Dr. Friedmann. You may also need multiple and sometimes frequent procedures to see results.

And it's not always possible to get rid of it completely, especially if your skin is showing signs of aging, said Dr. Friedmann.

He recommended seeking treatment as early as possible, such as in your 20s, rather than waiting until your 40s or later, when you have less collagen to work with.