The world-renowned Dr. Dhir shares with a Vanichi reader the latest procedures to get even skin tone. Dear Dr. Dhir, I am a woman in my mid forties of South Pacific descent. I have always had very young and clear skin. I still have very little aging. My problem with my skin is in the last two years I have developed hyper pigmentation and dark eye circles. I have tried many high end skin care regimens that do help a little. I would love to forgo makeup on the weekends without feeling self-conscious. What are the latest procedures for this type of pigmentation? Sincerely, Eliza THE ANSWER Dear Eliza- You are not alone in your sentiments regarding the struggle in treating and dealing with hyperpigmentation and dark circles under the eyes. This is one of the most common issues I deal with when consulting with patients beginning in their mid-thirties and mid-forties. Before outlining the options available to satisfy each patient’s goals and expectations, I spend time with each one of my patients describing the possible causes. By treating the root cause, you are more likely to successfully treat them. First, medical causes to consider include allergies, nasal congestion, pregnancy, thyroid problems, chronic sinusitis, eczema and dehydration. This condition can also be due to genetics, tobacco, caffeine, alcohol, or sun damage. Lastly, it is important to discuss the normal facial aging process. As we age, our face undergoes two distinct progressions. The first is skin thinning, or volume loss. The second is that gravity pulls our facial skin downward. This is important to understand when discussing the lower eyelid region. As the skin thins and gravity pulls the cheek skin downwards, the lower eyelid region begins to hollow and dark shadowing ensues. In addition, the underlying muscle and veins can also show through the now thinner skin making the dark circles appear worse. The treatment options include the following: Non-Surgical: Topical creams – Bleaching creams, over-the counter creams. Best for circles caused by true skin pigmentation issues such as sun damage, melasma from pregnancy or scarring. IPL – Photofacials. When skin thinning allows for the blood vessels to show through the skin and this causes the dark circles, laser therapy can help greatly reduce your dark circles. Chemical peel or laser resurfacing. Again, this is best used for true skin pigmentation issues. Volume Augmentation with Fillers. Most commonly, dark circles are from the aging process. To rejuvenate the lower eyelid region, fillers can be injected in the office with minimal discomfort to return volume and improve the hollowness and shadowing. These include Restylane, Juvaderm, Belatero. I recommend Restylane Silk or Juvaderm for this region. Surgical: Lower eyelid rejuvenation with tightening of the lower lid can help gain a youthful result and remove excessive skin and fat. Fat transfer from the abdomen or thighs allows for fat injections to the midface, cheek and lower eyelid region to rejuvenate the volume loss and improve the dark hollows. I recommend consulting with a board certified facial plastic surgeon and dermatologist to communicate all your goals and to discuss all your options. I wish you the best of luck and hope I helped you feel more comfortable. ABOUT DR. DHIR | Dr. Dhir is a double board certified facial plastic & reconstructive surgeon trained at the prestigious Mt. Sinai Hospital in New York City. He currently practices in Beverly Hills and continues to teach the art of Facial Plastic Surgery as an Assistant Clinical Professor at UCLA –Harbor. His interests include cosmetic and “better- breathing” functional rhinoplasty, revision rhinoplasty, natural face lifting techniques, volumizing filler implants, botox, fillers, blepharoplasty and custom cheek and jaw implants. Above all else, Dr. Dhir takes pride in his patient relationships and makes himself available throughout the healing process to garner the best possible results and care. Click here to visit Dr. Dhir online.