The author provides an insightful paper on the aetiological factors involved in dark circles and explores the treatment options. An emphasis is placed on the importance of undertaking a thorough patient consultation and history to establish causative factor(s), as well as the use of standardised photographic lighting for capturing accurate before and after photographs. The author reinforces the importance of differentiating periorbital oedema from soft tissue ageing with references for further reading around this anatomical area. Treatment modalities may be customised, depending upon the anatomical combination of problems that the patient presents with.
A selection of surgical techniques and approaches are recommended, including lower lid blepharoplasty with transconjunctival approach, as well as surgical repositioning of retroseptal fat. Correction with hyaluronic acid dermal fillers to the tear trough, and palpebromalar groove is suggested for suitable patients, as well as potentially the deep cheek fat, though it is not explicit which fat compartment this refers to. The author recommends Q-switched alexandrite and ruby lasers for treating signs of pigmentation and loose skin and Erbium and CO2 in experienced hands, whereas radiofrequency may be considered for tightening and thickening skin. Needle-based therapy, chemical peels and topical treatments are briefly discussed. An interesting paper for aesthetic nurses, supported by excellent clinical educational images.