Why do dark circles under the eyes form?
The skin under the eyes is among the thinnest skin on the body. For this reason, the structures beneath the skin, colour changes and shadows are easily noticed in this area. In most people, more than one cause is present at the same time.
| Cause | What it looks like | Note |
|---|---|---|
| Increased pigment | A brown or dark-toned circle | May be linked to genetic tendency, sun and past inflammation around the eyes (for example eczema); more common in darker skin |
| Thin skin and visible blood vessels | A bluish-purple colour | Blood vessels beneath the skin show through the thin skin; may become more visible as the skin thins with age |
| Tear trough hollowing | A hollow under the eye that creates a shadow | Due to volume loss with age, genetic make-up or weight loss; it is actually a shadow, not a colour |
| Puffiness and fat pads (eye bags) | A bulge under the eye with a shadow beneath it | Loosening of the tissues around the eyes with age and fat tissue moving forward; may increase in the morning due to fluid build-up |
In addition, allergies and a blocked nose, frequently rubbing the eyes, lack of sleep, tiredness, smoking and dehydration can also make dark circles more noticeable.
When can it be a sign of a health problem?
Dark circles that have been present for a long time and look similar on both sides are usually harmless. In some cases, however, changes under the eyes can be a sign of another problem.
See a physician without delay in these situations
- Darkening or swelling under the eye that appears on one side only, is new and has no known cause
- Bruising around the eye after a head or facial injury
- Pain, redness, warmth and swelling around the eye (especially with fever)
- Vision problems, double vision, eye pain or the eye bulging forwards
- Widespread swelling (oedema) of the eyelids and body, or symptoms such as foamy urine or shortness of breath
- An itchy, scaly rash around the eyes, or signs of bleeding such as easy bruising or nosebleeds
Also, if there are symptoms such as weakness, paleness and tiring easily, a physician's assessment is appropriate to look into conditions such as anaemia.
What can help in daily life?
- Using a broad-spectrum sunscreen and sunglasses every day can reduce darkening of pigment-related circles.
- If you have an allergy, getting it treated and not rubbing your eyes can help reduce both puffiness and darkening.
- Regular sleep, drinking enough fluids and stopping smoking generally contribute to the appearance of the skin.
- For morning puffiness, a brief cold compress and sleeping with your head slightly raised can give temporary relief.
- Concealer make-up products can temporarily reduce the appearance, whatever the cause.
Treatments a physician may recommend
Treatment is chosen according to the underlying cause of the appearance under the eyes. For this reason, an examination first determines which of pigment, blood vessels, volume loss or puffiness is most prominent.
- Creams: for pigment-related circles, substances such as vitamin A derivatives, vitamin C and azelaic acid may be used on a physician's advice. Because the skin around the eyes is sensitive, there is a risk of irritation; the effect is usually limited and slow.
- Chemical peel and laser: may be considered by a physician for pigment-related circles or to improve skin quality. Treatment around the eyes requires experience; in darker skin there is a risk of marks after the procedure. For details, see our article «Chemical Peel».
- Tear trough filler: if hollowing and shadow are most prominent, supporting the area with hyaluronic acid filler may be considered. This method does not correct discolouration caused by pigment or blood vessels.
- Surgery (blepharoplasty): if there are prominent fat pads and loose skin, eyelid surgery is an option. This operation is assessed and performed by an eyelid surgeon.
Treatment for dark circles is chosen according to the underlying cause. That is why we first need to understand together whether pigment, blood vessels or volume loss is the main issue; tear trough filler belongs only in the hands of a doctor experienced in this area.
Dr. Hamza GemiciMedical Director, DoktorClub · Aesthetic Medicine Physician
Tear trough filler: why is extra care needed?
The area under the eyes is considered one of the higher-risk areas for filler treatments. Because the skin is thin, problems such as irregularity, swelling and the filler showing bluish beneath the skin may occur more often. Long-lasting swelling due to fluid build-up in the area can also develop.
Although very rare, filler entering or compressing a blood vessel can lead to serious consequences such as skin wounds and loss of vision. For this reason, under-eye filler should only be performed by a physician who knows facial anatomy well and is experienced in this area, under conditions where a possible complication can be managed. In people with prominent fat pads, filler can make the appearance worse; other options may be more suitable for them.
For the general risks of filler and emergency symptoms, we recommend reading our articles «Hyaluronic Acid Filler» and «When Is It an Emergency After Filler?».
If you have any change in vision, severe pain or a sudden change in skin colour (whitening, bruising) after filler, this is an emergency; contact the physician who performed the treatment or the nearest emergency department without delay.
Realistic expectations
- Dark circles usually have more than one cause; complete disappearance with a single method is not usually expected.
- Circles caused by blood vessels or genetics may respond to treatment to a more limited extent.
- The effect of filler is temporary, and repeat treatment may be needed over time.
- Sun protection and avoiding triggers help preserve the result, whichever treatment is chosen.
Questions to ask your physician
- What is the underlying cause of the appearance under my eyes: pigment, blood vessels, hollowing or puffiness?
- Could this appearance be related to a health problem, and are any tests needed?
- Which products with a low risk of irritation can I use around my eyes?
- Is tear trough filler suitable in my case, or could it make the appearance worse?
- If filler is done, how would a complication be managed?
- Would a peel or laser for pigment carry a risk of marks for my skin type?
- Is eyelid surgery an option I should consider?
Frequently asked questions
Are dark circles caused by lack of sleep?
Lack of sleep and tiredness can make dark circles more noticeable; however, in most people other causes such as genetic make-up, thin skin, increased pigment and volume loss also play a role. For this reason, sleep habits alone may not always be enough.
Do eye creams get rid of dark circles?
Some creams can reduce the appearance somewhat, especially for pigment-related circles. However, their effects are usually limited and slow; they have little effect on circles caused by blood vessels or on hollowing.
Is under-eye filler suitable for everyone?
No. Tear trough filler is mainly considered when hollowing and shadow are most prominent. It may not be suitable for people with prominent fat pads, thin skin or a tendency to frequent puffiness. A physician decides on suitability after an examination.
Is under-eye filler risky?
The area under the eyes requires more care when it comes to filler. Swelling, irregularity and a bluish appearance may be more common; very rarely, serious complications such as vascular occlusion can occur. For this reason the procedure is not risk-free and should only be performed by an experienced physician.
A new dark mark has appeared under one of my eyes; what should I do?
Darkening or swelling that is on one side only, new and of unknown cause — especially if accompanied by pain, redness, a change in vision or a history of injury — should be assessed by a physician without delay.
Sources
- Infraorbital Dark Circles: A Review of the Pathogenesis, Evaluation and Treatment (Vrcek I, Ozgur O, Nakra T). PMID: 27398005 — Journal of Cutaneous and Aesthetic Surgery, 2016
- Periorbital Hyperpigmentation: A Comprehensive Review (Sarkar R, Ranjan R, Garg S). PMID: 26962392 — Journal of Clinical and Aesthetic Dermatology, 2016
- Delayed Complications following Dermal Filler for Tear Trough Augmentation: A Systematic Review (Trinh LN, McGuigan KC, Gupta A). PMID: 34666405 — Facial Plastic Surgery, 2022
- Dermal Fillers (Soft Tissue Fillers) — U.S. Food and Drug Administration (FDA)
- Eyelid surgery — NHS (United Kingdom)
- Before you have a cosmetic procedure — NHS (United Kingdom)
Medical Aesthetics Expert Board
This article has been reviewed by the DoktorClub Medical Aesthetics Expert Board.
