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Under-eye dark circles and hollows: causes and medical aesthetic options
Darkness under the eyes does not have a single cause: increased pigment in the skin, blood vessels showing through thin skin, or the shadow created by volume loss can all lead to this appearance. Which option is suitable depends on the cause; because the under-eye area is very delicate, the decision is made at the examination.
23 October 2026 · About a 5-minute read
Why does the under-eye area look dark or hollow?
The skin under the eyes is among the thinnest skin on the face. As a result, even small changes in the underlying structures are visible from the outside. In scientific reviews, the causes of under-eye darkness are generally grouped as follows[1][2]:
- Increased pigment (periorbital hyperpigmentation): A brownish darkening of the skin. Genetic predisposition, or pigmentation that develops after allergic or irritant inflammation of the skin, may play a part.
- Visible blood vessels: A bluish-purple colour caused by the underlying vessels showing through thin skin.
- Structural causes: Volume loss with age, the groove between the lower eyelid and the cheek (the tear trough) and skin laxity create a shadow as light falls on the area.
- Oedema: Fluid build-up around the eyes can contribute to puffiness and a darker appearance.
In most people, more than one of these causes is present at the same time. Reviews emphasise that the first aim of treatment is to identify the underlying cause[1].
Lifestyle and other factors
Allergic or irritant inflammation of the skin can pave the way for increased pigment around the eyes[1]. Lack of sleep and tiredness can make puffiness and colour changes around the eyes look more noticeable. If you have allergic symptoms, having them assessed by the relevant doctor also matters for the appearance of the under-eye area. If there is swelling or a change in colour around the eyes that starts suddenly or is clearly one-sided, you should see a doctor before any aesthetic assessment.
Medical aesthetic options
Once the cause of the under-eye darkness and hollowness has been assessed at the examination, the following options may be considered. The doctor decides which one is suitable.
- Under-eye mesotherapy: A treatment given to the skin under the eyes with fine needles. It is usually planned as 5 sessions, 2–3 weeks apart; a session takes 20–30 minutes on average.
- Polynucleotides: Polynucleotides derived from salmon DNA are applied under and around the eyes in 2 sessions, 2–3 weeks apart. In a randomised split-face study around the eyes, polynucleotide and hyaluronic acid treatments showed similar overall improvement scores, and no serious side effects were reported[5]. A recent review notes that polynucleotides are used mainly for skin quality and fine lines[6].
- Filler for suitable patients: Hyaluronic acid filler may be considered in patients with marked volume loss and a visible tear trough. Systematic reviews report that fillers are among the prominent options for darkness caused by volume loss[2][3]. However, not every under-eye area is suitable for filler; if the skin is very thin or lax, or if there are prominent fat pads under the eyes, filler may not be suitable and other options are discussed[2][6].
For darkness that is mainly due to pigment, different skin-focused approaches may be considered; this decision is also made at the examination.
Why is the under-eye area so delicate?
The under-eye area calls for care because of its thin skin, dense network of blood vessels and closeness to the eye. Redness, swelling and bruising may appear after treatments; these are usually temporary. With under-eye fillers, late swelling, small lumps (nodules), movement of the filler or changes in colour have been reported, although rarely[4]. Hyaluronic acid fillers can be dissolved with the enzyme hyaluronidase if needed.
How long filler stays depends on the product, the area and the person; in a review of under-eye fillers, the reported duration of effect ranged from 8 to 12 months[3]. The follow-up takes place within 1 month.
Treatment is not carried out during pregnancy or breastfeeding. If you take blood thinners, mention this at the examination; do not stop your medication without consulting your doctor. It is recommended that you come on the day of treatment without make-up on the area.
Frequently asked questions
Are dark circles under the eyes caused only by lack of sleep?
No. Lack of sleep can make them more noticeable, but there are other causes too, such as increased pigment, blood vessels showing through thin skin and volume loss. In most people, more than one cause is present at the same time.
Is filler always used under the eyes?
No. Filler is considered for suitable patients with marked volume loss and a visible tear trough. Skin structure, fat pads and lower eyelid support are assessed at the examination; for some patients, filler is not suitable.
How many sessions of under-eye mesotherapy are needed?
It is usually planned as 5 sessions, 2–3 weeks apart. The number of sessions and the interval are determined for each person at the examination.
References
- Sarkar R, Ranjan R, Garg S, et al. Periorbital Hyperpigmentation: A Comprehensive Review. J Clin Aesthet Dermatol. 2016. PMID 26962392
- Michelle L, Pouldar Foulad D, Ekelem C, et al. Treatments of Periorbital Hyperpigmentation: A Systematic Review. Dermatol Surg. 2021. PMID 32740208
- Trinh LN, Grond SE, Gupta A. Dermal Fillers for Tear Trough Rejuvenation: A Systematic Review. Facial Plast Surg. 2022. PMID 34192769
- Trinh LN, McGuigan KC, Gupta A. Delayed Complications following Dermal Filler for Tear Trough Augmentation: A Systematic Review. Facial Plast Surg. 2022. PMID 34666405
- Lee YJ, Kim HT, Lee YJ, et al. Comparison of the effects of polynucleotide and hyaluronic acid fillers on periocular rejuvenation: a randomized, double-blind, split-face trial. J Dermatolog Treat. 2022. PMID 32248707
- Beer J, Boghosian T, Sherif R, et al. What's New With Under Eye Treatment: A Multispecialty Systematic Review of Recent Under Eye Treatments. Dermatol Surg. 2026. PMID 41615388
Further reading
This article is for general information and does not replace a medical examination. Which treatment is suitable for you is decided by your doctor at the examination.