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Dark circles
Pigmented, vascular or hollow: three different things that respond to different treatments.
Dark circles are one of the most frequent reasons for requesting an aesthetic medicine consultation, and also one of the areas where most money is spent without result. The reason is simple: under the same word there are at least three different situations, and the treatment that works on one does nothing for the others.
There are pigmented dark circles, where the skin of the area is genuinely darker due to excess melanin — frequent in darker phototypes and often familial. There are vascular ones, where the bluish or purple colour comes from vessels showing through very thin skin: pigment is not involved, what is seen is what lies beneath. And there are hollow ones, where the problem is not colour but shape — a loss of volume under the eye creates a groove, and the groove produces a shadow.
The distinction is not theoretical: it decides everything. A lightening cream on a vascular dark circle has nothing to act on. A filler on a pigmented one fills a groove that was not there and leaves the colour where it was. And in many people the three components coexist in different proportions, which explains why a single treatment improves things only in part.
There is then a fourth thing often confused with dark circles: under-eye bags, a swelling of the area, which has its own mechanisms and is not corrected like a shadow. Here too, understanding what you are dealing with before choosing is the part that makes the difference between a result and an expense.
The light test: colour or shadow?
There is a simple way to get an idea even before the visit. Look in the mirror with light from the front and then with light from above: if the area clearly lightens with frontal light, much of the problem is a shadow, and therefore a question of volume. If it stays dark in both conditions, the component is colour — pigment or vessels. It does not replace assessment, but it explains why two people with "dark circles" need two different pathways.
How it shows
- Darker skin under the eyes, brown or greyish
- Bluish or purple tint, more evident with thin skin
- A marked groove between the lower eyelid and the cheek
- A tired appearance even after sleeping
- Worsening under overhead light, which accentuates the shadow
- Sometimes associated with swelling of the area (bags)
How we proceed
- 1Consultation: assessment of the prevailing component — pigment, vessels or volume
- 2Examination of skin quality and thickness in the periocular area
- 3Distinction from under-eye bags, which have a different mechanism
- 4Definition of the pathway based on the component, not the generic request
- 5Clear expectations: in this area results are often partial
Available treatments
- First aesthetic medicine visit
- Hyaluronic acid filler
- Biostimulation
- Fractional laser
- Chemical peel
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Frequently asked questions
Do they depend on sleep?+
Partly, and only temporarily. Tiredness can accentuate the colour and swelling of the area, but it creates neither the pigment nor the groove: those with structural dark circles have them after eight hours of sleep too. If sleeping well changes nothing, the problem is not rest — and that is the signal that it is worth understanding which component prevails.
Is filler right for all dark circles?+
No, and it is the most expensive mistake in this area. Filler acts on volume: it makes sense when the shadow comes from a groove, that is from hollowing. On a pigmented dark circle it fills something that was not empty and leaves the colour where it was; on a vascular one, if poorly placed, it can even accentuate the tint. This is why assessment precedes the choice of technique.
Do creams help?+
They can play a role on the pigmented component and on skin quality, which in the periocular area is particularly thin. They do not act on volume and do not change vessels showing through. As with everything else: it depends which of the three components is producing what you see in the mirror.
Can they be eliminated completely?+
Rarely, and it is right to know beforehand. In this area results are often partial, because the components coexist and because periocular skin is the thinnest on the face. A well-planned course can clearly reduce the shadow or the colour, but anyone promising to make them disappear is describing something that is seldom achieved.
Related reading
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