Cosmetic medicine
Pigment, shadows, vessels, and tear-trough volume loss—multi-cause correction.
Dark circles are not one diagnosis. Thin skin reveals underlying muscle/vessels (bluish hue), allergies cause venous pooling, true pigment deposits melanin, and tear-trough hollowing creates shadowing. The AAD under-eye hollows discusses structural causes.
Treatment must match the cause—fillers alone cannot fix pigment, and lasers alone cannot fix severe hollowing.
Genetics, allergies, chronic eye rubbing, sleep deprivation, aging fat loss, and sun exposure.
Hyaluronic acid fillers for deep tear troughs (advanced technique), vascular lasers for visible vessels, brightening topicals for pigment, and allergy management for allergic shiners. Lower blepharoplasty referral for fat bags.
Improvement depends on cause—structural fillers last months to a year; pigment requires sunscreen discipline.
Fillers help hollow-related shadows but can worsen puffiness if fat herniation is present—examination differentiates.
They may temporarily reduce puffiness by vasoconstriction; they do not erase pigment or structural hollows.
Prominent fat pads or severe skin laxity may need oculoplastic surgery—cosmetic referrals when non-surgical options are insufficient.