Medical Consultation

Pigmentation • Dark Circles

Under-Eye Dark Circles: What It Is and How It Differs from Fine Under-Eye Lines

Written by
The Other Dermatology medical team
Published
2026.08.21

Any darkness under the eyes tends to get called a dark circle, but what is making it dark is not the same in everyone. Pigment that has deepened, vessels showing through thin skin, a shadow cast by the groove called the tear trough — these three lines answer to different things. This page explains how the three separate, and why one procedure does not carry all three at once.

Under-eye hollow treatment model

What is Under-Eye Dark Circles?

In front of the mirror the area under the eyes looks dark, and concealer layered over it does not cover it — this impression is usually what patients mean by dark circles. Medicine handles it under the name periorbital hyperpigmentation. In an online survey that asked 48,000 adults across 34 countries, 14.7% answered that they had periorbital hyperpigmentation. That is the proportion who said so themselves, not the proportion who were diagnosed.

This impression does not come from one cause. The literature proposes a classification by surface appearance — pigmented (brown), vascular (blue, pink, purple) and structural (skin-colored) — and mixed forms, where two or more of these overlap, are part of that classification.

The pigmented type is an increase of melanin in the epidermis or the dermis, and the tone reads as brown to greyish brown. Post-inflammatory hyperpigmentation left behind by atopic dermatitis or allergic contact dermatitis is described as one of the causes. There are also reports that a habit of rubbing the eyes commonly accompanies it — 40.5% among 116 dermatology outpatients in Iran, and 32.5% among 200 patients in India. That is not a proven figure showing that the habit creates the pigment; it is how often the two are observed together.

The vascular type is the one where the area under the eye shows through as bluish or purplish. Thin skin covering the orbicularis oculi muscle, with vessels running close to the surface, is described as one of the common causes.

The structural type is darkness made by shape rather than by pigment. In a study that dissected 48 hemifacial cadavers, an osteocutaneous ligament called the tear trough ligament was consistently identified over the maxilla, and the authors concluded that the prominence of the tear trough has its anatomical origin in this ligament. The darkness in this line is not a change in skin color but a shadow falling into a groove.

Which line is more common depends on the population. In a study that examined 200 patients with periorbital hyperpigmentation attending a dermatology clinic in Singapore, the order was vascular 41.8%, constitutional 38.6%, post-inflammatory hyperpigmentation 12%, and shadow effect 11.4%, with the vascular type predominating among Chinese patients and the constitutional type among Indian and Malay patients. That is the distribution among people who came to a clinic, not a proportion in the general population.

How is it different from Fine Under-Eye Lines?

People who come in because the area under their eyes bothers them often ask about fine under-eye lines in the same breath. Both fall under the same impression — that the under-eye area looks tired — but what has changed is not the same. A fine line is a crease folding in the skin; a dark circle is pigment, vessels showing through, or shadow, or some combination of those.

That is why the axis of the approach splits. A method aimed at wrinkles and elasticity does not lighten pigment, and a method aimed at pigment does not fill in a shadow. One under-eye area can carry fine lines and a dark circle at the same time, so what is making that person's impression right now is separated first.

The distinction is settled in an examination. The literature describes an examination step of gently stretching the eyelid skin and watching how the color changes, but that is a maneuver clinicians use during an examination. No self-assessment method with validated accuracy exists in the literature, and telling the lines apart by eye, on your own, is difficult.

Fine Under-Eye Lines

What the patient sees
Fine creases gather at the eye corners when smiling
What has actually changed
A crease folding in the skin
Axis of approach
Wrinkles and elasticity

Under-Eye Dark Circles

What the patient sees
The area under the eye looks dark even without smiling
What has actually changed
Pigment, vessels showing through, or shadow — one of these or a combination
Axis of approach
Pigment / vessels / structure — different for each line

How is it treated?

Treatment of dark circles branches at the question of what is making the area dark. The three lines sit in different places and work by different mechanisms, so one method does not carry all three at once.

For the pigmented type there is literature on topical agents and on lasers. In a study that compared 4% hydroquinone with 30% salicylic acid over 12 weeks in 50 patients with periorbital hyperpigmentation, most patients in both arms showed mild (10–30%) improvement at the 12-week point. For lasers, a systematic review gathering 10 clinical trials published between 1990 and 2018 reported improvement in pigmented periorbital hyperpigmentation, but the authors themselves wrote that follow-up was usually limited to a few months. The devices, wavelengths and protocols of the included studies differed from one another, so it is not an analysis that separated which device works on which line.

For the vascular type, that review does not answer — its subject was the pigmented form. That the vascular type is established as a distinct line, and that what works on that line and how well is settled in the literature, are two different statements.

The shadow made by the structural type is not reached by methods aimed at pigment or at vessels. Injecting hyaluronic acid into the tear trough to make the groove shallower is covered in the literature, and a systematic review and meta-analysis pooling 31 studies with 2,556 participants has been published. Which technique is better, needle or cannula, is another matter — a separate systematic review of 42 studies concluded that an evidence-based preference cannot currently be established. Injection in this area carries a risk of a different character from a cosmetic outcome. Across filler injection in general, injected material that enters a blood vessel and blocks flow to the eye can affect vision or cause the skin to necrose. Reviews pooling the world literature reported that a substantial share of the cases of vision loss did not recover, and no consistently successful treatment has been identified so far. Hyaluronic acid filler can be dissolved with hyaluronidase, which is reported to leave more room to respond than other materials, but that does not mean the risk is absent. The tear trough is discussed as a site where this risk has to be weighed particularly carefully — a study dissecting 30 hemifacial cadavers found the angular artery running close to the medial end of the tear trough, and that artery was a branch of the ophthalmic artery, which supplies the eye. The authors wrote that several arteries pass through this area, so the risk of arterial injury has to be taken into account. That study did not report cases of blindness, but it shows why this site is handled differently from others. Under-eye filler is a procedure that can only be discussed after this risk has been explained and consent obtained.

This clinic handles dark circles as precise diagnosis by cause, then a different approach for each cause. The pigmentary type is read as a case where melanin pigment has been deposited due to frequent friction or irritation, and is approached with low-irritation toning and regenerative care. Where the thickness and elasticity of the eye-area skin itself is what needs work, Eye Thermage and Eye Virtue are used to build elasticity, and Re2O Fine and Eye Rejuran to restore thinned eye-area tissue. Each device targets a different layer. Which methods this clinic uses for the vascular and structural types, and in what order, is decided in an in-person examination after the thickness of the eye-area skin has been assessed.

Any procedure that puts energy over the eyelid comes with eye protection attached. A 2025 expert consensus on ocular safety in dermatologic laser procedures wrote that eye shields are mandatory for every laser procedure carried out inside the bony orbital rim — because every laser wavelength poses some degree of risk to ocular structures. In a review collecting 21 cases of eye injury from cosmetic facial lasers, the types of damage were iris atrophy, cataract, anterior uveitis, glaucoma, visual field defects, posterior synechiae and pupillary abnormalities, and in 13 of the 21 cases appropriate protection had not been provided or the patient had been asked to remove it. Properly wearing metal shields chosen to fit is presented as the way to reduce this risk. That standard was set for lasers, and whether the same standard applies to radiofrequency devices we were not able to confirm. On the radiofrequency side there is a separate item — studies of radiofrequency treatment classified an implanted pacemaker or defibrillator as an absolute contraindication and excluded such patients from the studies. If you have a cardiac device implanted, it has to be disclosed before treatment.

What to expect and how long it takes

Dark circles are less a change that finishes in one sitting than something handled in stages once the line has been separated. The procedure itself takes approximately 40 minutes to 1 hour including anesthesia. The number of sessions, the interval between them, and when results begin to show differ by line and by the condition of the skin around the eyes, and are explained in an in-person examination.

This is the range the literature gives. In the comparison of topical agents used for the pigmented type, the improvement at 12 weeks was mild (10–30%), and the laser literature has follow-up of usually a few months, so it cannot speak to anything longer than that. Tear trough hyaluronic acid is usually discussed in the literature as lasting 6 to 12 months, and a retrospective study that looked back at 155 patients reported improvement maintained out to the 18-month point. All of these come from different countries and different populations, and individual results vary.

It is closer to the reality to know the common reactions and their timeline as well. In a meta-analysis pooling 31 tear trough hyaluronic acid injection studies with 2,556 participants, swelling and edema were reported in 19.2%, bruising in 18.4%, redness in 7.1% and contour irregularity in 5.3%. That is a reaction roughly one in five people meets. In the same analysis the Tyndall effect was reported in 0.9% — filler placed too superficially showing through under the skin as a blue-grey tint.

Changes that appear well after the procedure rather than right after it are also reported. In a systematic review collecting only the delayed complications of tear trough filler, the mean time to onset of the reported cases was 16.8 months. These were swelling, nodules or lumps, migration, and discoloration, and the latest-appearing kind came at a mean of 52 months. That is a different timescale from the impression of a procedure that is over in a few days.

Pigment can darken again after a laser. Post-inflammatory hyperpigmentation left after a procedure is more of a problem in darker skin tones, and how severe it is varies considerably with the density and energy settings used — that is the direction several studies point in together. It is not something that can be stated as a single number.

If the cause does not match, the result is small. Treating only one of the three lines leaves the others visible, and trying to cover darkness made by a shadow with a pigment procedure gives a small change for the time and recovery it costs. Deciding the type from surface tone alone and starting there spends time and recovery on a method that does not fit, and the distinction is settled in an examination.

Aftercare

The skin around the eyes is among the thinnest on the body. A habit of rubbing the eyes is reported to commonly accompany dark circles, and this clinic likewise reads the pigmentary type in connection with frequent friction or irritation. Cutting down on rubbing that area or washing it hard after a procedure becomes the basis of aftercare.

Sun protection belongs to the conditions for holding a result. In a study of people with periorbital hyperpigmentation, sun exposure of more than 5 hours a day was among the risk factors, and an international survey found that sun-protection knowledge and behavior among people with pigmentary disorders fell short of optimal. That said, blocking ultraviolet light does not mean a dark circle already established will lighten. Specifics such as when to resume washing or makeup differ by the type of procedure, so the post-treatment instructions given at the time apply.

Other conditions that look similar

Atopic dermatitis is commonly observed alongside periorbital hyperpigmentation. In the study of 200 patients in India, 33% of the patients with the post-inflammatory type had atopy, and in the study of 116 patients in Iran, 37.9% had a history of atopy. Pigmentation left behind after inflammation is described as one of the causes. This does not mean atopy always produces dark circles — it means the two are often observed together.

A systemic condition is sometimes behind it. The same two studies reported anemia in 50% and 34.5% respectively, and the study in India reported thyroid dysfunction in 3%. These are not figures that state causation, but treating darkness under the eyes as a skin problem alone and starting with a procedure can delay the diagnosis of an underlying condition. If the darkness has changed suddenly, or other symptoms are present, the cause is looked at first — starting from the skin is not always the right order.

The small bumps that appear in clusters below the eye are a different condition from dark circles, and so is the pigmentary condition that spreads across the center of the face. Their tones can look continuous with one another, so they are often asked about together, and the pages below cover them.

Frequently asked questions

Are all dark circles the same thing?

No. The literature proposes a classification by surface appearance — pigmented (brown), vascular (blue, pink, purple) and structural (skin-colored) — and mixed forms, where two or more of these overlap, are part of that classification. What works differs by line, so separating which one it is comes first.

Can I work out at home which type my dark circles are?

There is no self-assessment method with validated accuracy in the literature. An examination step of gently stretching the eyelid skin and watching how the color changes is described, but that is a maneuver clinicians use during an examination, not a method to try on yourself and reach a verdict with. Something other than the skin is sometimes behind darkness under the eyes, so concluding on your own and putting off a visit can cost you.

Is it because I am not sleeping enough?

Many people feel that way, but it is hard to state as an established cause. A study of 116 dermatology outpatients found no association between sleep quality and the severity of periorbital hyperpigmentation. Sleep problems themselves were common in that group, but they did not track with how dark the circles were.

Does rubbing my eyes often make a difference?

A habit of rubbing the eyes is reported to accompany dark circles often — 40.5% among 116 patients in Iran and 32.5% among 200 patients in India. That is not proof that the habit is the cause, but the frequency with which the two are observed together is not low.

Is under-eye filler safe?

The common reactions are swelling and bruising, reported at 19.2% and 18.4% in a meta-analysis of tear trough injection studies. There is a separate risk of an entirely different character — across filler injection in general, cases in which the injected material entered a blood vessel and affected vision or caused skin necrosis are reported in the world literature, and while the frequency is low, that kind of outcome is hard to reverse. It is a procedure whose risk has to be explained before the decision is made.

Can swelling or a lump appear long after the procedure?

Such cases are reported. In a systematic review collecting the delayed complications of tear trough filler, the mean time to onset of the reported cases was 16.8 months. Even a change that appears a good while after treatment should not be assumed unrelated to it — it is better to have it checked in an examination.

Are there times when it is better not to treat right now?

Yes. If there is active infection or inflammation around the eyes, the area is looked at after that has settled — the contraindication list for microneedling includes local infection such as herpes simplex, moderate or more severe chronic skin disease (eczema, psoriasis), blood disorders or anticoagulant use, and ongoing chemotherapy or radiation therapy. An implanted pacemaker or defibrillator is classified as an absolute contraindication to radiofrequency treatment. During pregnancy and breastfeeding, elective procedures are usually postponed because there are no controlled studies establishing the safety of cosmetic procedures in this period — that means there is no data to check, not that a risk has been confirmed.

This page is general information about a treatment and is not a diagnosis or a recommendation. The right choice differs by skin condition, so treatment is decided after an in-person examination. Individual results vary.

References

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  2. Periorbital Hyperpigmentation: A Comprehensive Review J Clin Aesthet Dermatol 2016;9(1):49-55 (Sarkar R, Ranjan R, Garg S, et al.)
  3. Periorbital Hyperpigmentation: A Study of its Prevalence, Common Causative Factors and its Association with Personal Habits and Other Disorders Indian J Dermatol 2014;59(2):151-157 (Sheth PB, Shah HA, Dave JN)
  4. The Frequency of Periorbital Hyperpigmentation Risk Factors J Cosmet Dermatol 2025;24(2):e70036 (Heidari F, Zadeh ME, Zadeh MHA, Namiranian N)
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  15. Soft-tissue Filler-associated Blindness: A Systematic Review of Case Reports and Case Series Plast Reconstr Surg Glob Open 2019;7(4):e2173 (Chatrath V, Banerjee PS, Goodman GJ, Rahman E)
  16. The Feasibility Determination of Risky Severe Complications of Arterial Vasculature Regarding the Filler Injection Sites at the Tear Trough Plast Reconstr Surg 2018;142(5):1153-1163 (Jitaree B, Phumyoo T, Uruwan S, Sawatwong W, McCormick L, Tansatit T)
  17. Expert Consensus on Ocular Safety During Laser Procedures: A Practical Guide to Eye Safety by a Panel of Dermatologist Laser Surgeons and Ophthalmologists J Cosmet Dermatol 2025;24(7):e70339 (Kesty K, Kesty C, Benson J, et al.)
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