UltraEstetic Aesthetic Clinic

Dark circles are one of the most common aesthetic concerns affecting the periorbital area. While they rarely indicate a serious medical condition, their impact on overall facial appearance is significant — people with visible dark circles are often perceived as tired, aged, or unwell, even when they are in excellent health.

Despite the cosmetic industry promoting hundreds of creams and serums targeting dark circles, the medical reality is that most topical products offer limited results. The reason? Dark circles do not have a single cause, and effective treatment depends on correctly identifying the underlying type and mechanism.

What Are Dark Circles and Why Do They Appear

Dark circles are visible changes in the colour and/or contour of the skin in the infraorbital area (under the eyes). The skin in this region is the thinnest on the entire body — averaging only 0.5 mm in thickness, compared to 2 mm on the rest of the face. This thinness makes any change in the underlying structures immediately visible.

The main causes include:

• Genetic factors — hereditary predisposition is the most common factor. Studies show that individuals with Fitzpatrick skin types III–V (olive or darker complexions) have a higher incidence of periorbital hyperpigmentation. Additionally, the bony structure of the orbit and the distribution of periorbital fat are genetically determined.
• Age-related volume loss — with ageing, the subdermal fat in the infraorbital area gradually resorbs, and the tear trough ligament becomes more pronounced. The result is a visible depression that creates a shadow beneath the eyes, perceived as a "dark circle."
• Superficial vasculature — the capillary network in the periorbital region can become visible through the thin skin, creating a blue-violet appearance. This phenomenon is more noticeable during fatigue, dehydration, or allergen exposure.
• Hyperpigmentation — excessive melanin deposition in the periorbital dermis or epidermis produces a brown discolouration. It can be caused by UV exposure, atopic dermatitis, chronic allergen exposure, or certain medications.
• External and lifestyle factors — sleep deprivation, excessive alcohol consumption, smoking, and diets low in iron or vitamin K can exacerbate the appearance of dark circles, although they are rarely the primary cause.

Types of Dark Circles — Clinical Classification

Identifying the type of dark circle is the essential step before any treatment. In clinical practice, four main types are distinguished:

• Vascular dark circles — characterised by a bluish or violet hue, they tend to worsen in the morning or after nights of insufficient sleep. They are caused by vasculature visible through the thin skin. A simple test: when the skin is stretched, the colour does not disappear completely, and with vitropression (pressing with a transparent object), the tint partially fades.
• Pigmentary dark circles — present as a uniform brown or brownish discolouration. They are more common in individuals with darker skin tones. With vitropression, the colour remains unchanged. They can be aggravated by sun exposure and repeated rubbing of the area.
• Structural dark circles (volume-related) — caused by volume loss in the tear trough area or herniation of periorbital fat (under-eye bags). They do not necessarily involve a colour change but rather a shadow created by the uneven contour. They are the most common type in individuals over 35.
• Mixed dark circles — a combination of two or more types. These represent the majority of cases seen in clinical practice, which is why individualised assessment is essential.

Treatment Options — From Topicals to Medical Procedures

Topical Treatments

Creams containing retinol, vitamin C, vitamin K, kojic acid, or niacinamide can have a modest effect, particularly on superficial pigmentary dark circles. Retinol stimulates cell turnover and may improve dermal thickness over time (6–12 months of consistent use). Vitamin C provides an antioxidant effect and can reduce hyperpigmentation.

The main limitation of topical treatments is that they cannot address structural causes (volume loss) or deep vascular components.

Chemical Peels

Peels using glycolic acid, trichloroacetic acid (TCA), or lactic acid can reduce periorbital hyperpigmentation through controlled exfoliation of the superficial epidermal layers. They are useful for pigmentary dark circles but require multiple sessions and periodic maintenance. They are not indicated for vascular or structural dark circles.

Laser and IPL Treatments

Vascular lasers (Nd:YAG, pulsed dye laser) can reduce the visibility of capillaries in the periorbital area, making them effective for vascular dark circles. Fractional resurfacing lasers can improve skin texture and thickness. IPL (Intense Pulsed Light) can address both the vascular and pigmentary components.

These procedures require a physician with specific experience in the periorbital zone, as the skin around the eyes is extremely delicate.

Hyaluronic Acid Treatment — Volumetric Correction

Injectable hyaluronic acid is currently the most effective and fastest method for correcting structural (volume-related) dark circles. The procedure involves injecting a hyaluronic acid-based filler into the tear trough — the natural depression separating the lower eyelid from the cheekbone.

The main advantages of this method:

• Immediate results — unlike topical treatments that require months of use, volumetric correction provides a visible result immediately after the procedure.
• Reversibility — hyaluronic acid can be dissolved with hyaluronidase if the outcome is unsatisfactory, offering a safety margin that other methods do not provide.
• Longevity — results typically last 12–18 months, depending on the product used and individual metabolism.
• Biocompatibility — hyaluronic acid is a substance naturally present in the body, which significantly reduces the risk of adverse reactions.

For optimal outcomes, under-eye filler treatment for dark circles should be performed by a physician with specific expertise in periorbital anatomy, using products designed for this delicate region — low-density fillers with superior tissue integration properties, such as Teosyal Redensity II or Juvederm Volbella.

Risks and contraindications — although the procedure is considered safe, the periorbital area is one of the most demanding anatomical regions for injection. Risks include persistent oedema, the Tyndall effect (a bluish discolouration caused by overly superficial product placement), asymmetry, or, in rare cases, vascular compromise. For this reason, the physician‘s experience in periorbital anatomy is the decisive factor.

PRP (Platelet-Rich Plasma)

PRP involves collecting the patient‘s blood, centrifuging it to obtain plasma rich in growth factors, and re-injecting it into the periorbital area. It can improve skin quality and reduce hyperpigmentation by stimulating tissue regeneration. Results are gradual (visible after 2–3 sessions) and more subtle than those achieved with hyaluronic acid.

Fat Transfer (Lipofilling)

Autologous fat transfer is a surgical option for severe cases of volume loss. It offers long-lasting results but involves a more invasive procedure and a longer recovery period.

Choosing the Right Method

The correct treatment choice depends on the type of dark circle and the patient‘s expectations:

• Pigmentary dark circles respond best to chemical peels, depigmenting agents, and rigorous sun protection
• Vascular dark circles require vascular laser or IPL treatments
• Structural (volume-related) dark circles are most effectively corrected with hyaluronic acid injection or, in severe cases, fat transfer
• Mixed dark circles often require a combined, personalised approach

Regardless of the method chosen, the initial evaluation should be conducted by a specialist — a dermatologist or aesthetic physician — who can determine the exact type of dark circle and recommend the appropriate protocol.

Maintaining Results

No treatment for dark circles is permanent. To maintain long-term results, the following are recommended:

• Daily sun protection (SPF 30+) to prevent hyperpigmentation
• Adequate hydration and sufficient sleep (7–8 hours per night)
• A skincare routine with active ingredients (retinol, vitamin C, peptides)
• Periodic maintenance sessions for injectable treatments (every 12–18 months) or laser (annually)
• Avoiding smoking and excessive alcohol consumption, both of which accelerate periorbital collagen degradation

This article is for informational purposes only. The information presented does not replace a specialist medical consultation. For a personalised evaluation, consult a dermatologist or aesthetic physician.

Dr Irina Arsene - Clinica UltraEstetic

Tel: 0720 790 098

Str Dr. Zaharia Petrescu 7, Cotroceni, Bucuresti