Hi!,

Thank you for the query.

I can understand your problem very well. Dark circles has always been a very frustrating condition for we all dermatologist. It has been a topic of discussion in nearly all the conferences. The results has been variable.

Its good that you have given a very detailed medical history of your self.

Your haemoglobin has been good and even your sleeping habits .These were important factors in dealing with dark circles. Well, hereditary factor, any chronic illness, stress and sun exposure have been other factors responsible for dark circles.

You have also tried nearly every cream, right from tretinon to desonide, and even glycolic acid chemical peels; leaving only few options.

Thin skin under the eyes and wrinkles aggravate the problem of dark circles. Because of the fine lines around the eyes the skin becomes more crumpled, thus leading to more pigmentation.

You have not mentioned whether you have sunken eyeballs or tear drop sign below the eyes. In such cases or even otherwise also, the latest is the use of injectable fillers and botox. Botox(injections) is basically a remedy for dynamic lines(wrinkles) on the face. If it is given carefully below the eyes it can reduce the lines below the eyes.And thus it would slightly reduce the appearance of darkness.
Similarly ,we can use filler substance (collagen filler) just below the eyes to give it a fuller look. There are other injectable preparations available which if given below the eyes can help in hydrating the skin underneath .It has been seen that less hydrated skin underneath the eyes can again increase dark circles.

In fact the tretinoine which you have been using also helps to reduce the fine lines along with pigmentation. So kindly continue using it at night only.

In the day to come, its mandatory to use a good spf sunscreen at-least three time a day. Even if you are in front of the computer do use a sunscreen .

There is another cream which is used is hydroquonone cream(2-3%) which can help reducing pigmentation .This again should be used at night .

Last but not the least is the use of specific lasers like Q-switched Nd:yag laser which specifically act on melanocytes (pigment cells) can also be tried. This would require multiple sessions .I've used this laser for nearly 10 years with variable results.

Any of the treatment you would go for, would not be a one time treatment. Once you get the result you need to maintain it also. So you would require touch ups now and then.

So, kindly consult a good dermatologist who has experience in latest treatment and lasers. Please avoid treatments from a beauty parlor .

I hope this answers your query ,If you have any further questions ,kindly write back to us .I'll be happy to follow them up.

Regards,

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Hi!,

Thank you for follow up.

A good dermatologist who can do the listed procedures would be Dr. XXXXXXX VED MURTHI. (if I am not wrong, she is associated with apollo hospital).

Yes, botox and filers are safe, but depends upon the safe hands of the doctors as well. Lasers are used specifically under the eyes and they are safe too. And as I tell my patients, "it's not just the machine ,but the man behind the machine which is equally important".
Whether you require it or not is under the discretion of the treating doctor only.

We have been using hydroquinone for a very long time and have not come across cancer due to its use.

But yes, hydroquione in some patient can cause 'Ochronosis', which is nothing but a ironical situation - where in this cream causes deposition of pigment rather than reducing it. But it's not very common.
Use hydroquinone in the night only and a sunscreen in the day.

Since I am not a dietitian, I can only suggest you to eat healthy food, drink at-least 8-10 glasses of water daily and take good 7 hour sleep in the night.
Eating lots of salads and XXXXXXX leafy vegetables helps a lot.

I hope this answers your query.

Wish you good health.

Regards,

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