Dark Circles Under Eyes - The Common Patient Complaint

As every aesthetic practitioner is aware, the skin around the eye is the most delicate of all the parts of the body. It can be up to ten times thinner than the rest of the skin on the face. The eye area can be one of the less forgiving places when it comes to aging which is why treatments around the eye are one of the most requested from aesthetic patients.

One of the main concerns from patients is the appearance of dark circles around the eyes. Dark circles are known to be extremely difficult to treat as there is a very little margin for error. Therefore it is imperative that all treatments in this area are carried out by advanced and experienced practitioners with a thorough understanding of the anatomy of the eye area.

Causes of dark circles

Dark circles can appear under the eye for many reasons. The two main reasons are hyperpigmentation and the anatomy of the area. The skin is very thin in this area with little or no subcutanoeus or fatty tissue which means that the underlying blood vessels can be seen and this gives the dark appearance. Lifestyle can also have an impact.

Anatomy and general aging

When patients are young the junction between the lower eyelid and the cheek blends as there is enough tissue in the area. However, as they start to age this soft tissue breaks down and shows more of the underlying bone. By the time patients reach their thirties dark circle will start to appear. This is due to the loss of soft tissue, thinning skin and hyperpigmentation issues. In the thirties and forties bony changes begin to happen, the eye sockets begin to expand and the mid face starts to collapse. Due to this the appearance of the dark circles worsens. These changes also contribute to the appearance of eye bags. This fat bulge causes an appearance of a dark shadow which also worsens the appearance of the dark circles.


Ethnicity is a huge contributing factor when it comes to hyperpigmentation around the eye. Patients with darker skin are more prone genetically to developing hyperpigmentation around the eye. This condition is harder to treat and takes longer to treat; sun exposure usually plays a big role.

Hyperpigmentation occurs when the cells that contain melanin are damaged or over stimulated. This can cause the body to produce too much melanin. Patients with darker skin are therefore advised to be extra cautious with the amount of sun exposure that they have. Patients with hyperpigmentation in the eye area are likely to need a combination of treatments over a long period of time.


Dark eye circles can be a reflection of a person’s general health. Poor diet, anaemia, late nights and eye rubbing can all contribute to dark circles in the 20’s. Indian –Asian and Hispanic ethnicities often have dark circles in their 20’s, however, it is uncommon for Caucasians. Circulation problems or genetic disorders are commonly found to be the cause of dark circles, but it can also be caused by lifestyle factors such as poor diet, dehydration or chronic fatigue.

Treatment options

Hyaluronic acid dermal fillers

By injecting dermal fillers into the tear trough dark circles can be greatly improved. Fillers restore volume to the flattened areas. Hyaluronic acid is a natural product that is gradually absorbed as it is biodegradable. It is important to use a very light filler in the area as putting a heavy filler in such a delicate area may cause small lumps. The anatomy of this area is extremely delicate and any complications in this area can be extremely damaging. The treatment takes approximately ten to fifteen minutes to complete and the results can be seen immediately.

ZO® Medical Hydrafirm

This crème is designed specifically for the under eye area. It helps to minimise the many signs of aging around the eyes such as puffiness, dark circles and fine lines. Hydrafirm contains caffeine, enzymatic vasodilators and coenzyme A, these have the ability to reduce the appearance of puffiness around the eyes. Natural collagen production is encouraged by the active vitamin A and biomimetic proteins which restores the elasticity of the skin. With continued use of the crème the delicate area around the eye will become thicker and firmer.


Another treatment for this area is PRP. This technique involves the use of stem cells with the idea of regenerating the area. It does not replace volume or lift the area as you would get with dermal fillers, however it does work nicely to provide skin rejuvenation to get rid of dark circles. Smokers are not suitable candidates for this treatment as it is dependent on the blood having growth factors to stimulate.

Fat transfer

Fat transfer is another way of using stem cells in the tear trough. Because the fat is full of stem cells it is able to regenerate the skin and this can help with the dark circles. This procedure has to be done in an operating theatre.


There are many different treatment options for the under eye area. A detailed assessment of this area is essential to determine the correct treatment for the patient.

Dr Ayham Al- Ayoubi: The risk of complications in this area should not be underestimated. To avoid some of these complications the under eye area should only be treated by experienced practitioners who have a thorough understanding of the anatomy of the under eye area.