What causes under eye dark circles? I like to break down this problem into three distinct issues, each of which is treated differently.
- Under eye hollowing. This is due to volume loss along the inferior orbital rim. It is most evident in overhead lighting, which accentuates the shadowing caused by the volume deficiency. Under eye hollowing is treated with filler injections.
- Hyperpigmentation. This is due to the eyelid skin having a darker color than the surrounding skin. This is best visualized by taking a photo with a camera flash, which eliminates the shadowing from overhead lights. If the eyelid skin is darker than the surrounding skin, you have hyperpigmentation. This is the hardest type of dark circles to treat and I usually recommend makeup as the best option. Patients with lighter skin types may benefit from laser skin resurfacing but the results are not consistent. I have not seen much success with the use of bleaching creams. Many patients with hyperpigmentation also have hollowing and these patients are great candidates for filler injections. Patients are often amazed at how much better makeup works once there is a smoother (less hollow) surface to apply it. I would love to hear how other providers treat hyperpigmentation.
- Lower eyelid fat herniation. This problem is best treated with lower blepharoplasty surgery to remove the extra puffiness. Mild cases of fat herniation can sometimes be camouflaged with filler injections.
✅ Many patients have more than one of these issues and a combination of treatments often works best.