Under-Eye Circles: Symptoms, Causes and Treatment

Under-eye circles—those persistent, often frustrating shadows or discolorations beneath the eyes—are among the most common cosmetic concerns for people of all ages and backgrounds. Whether they appear as faint shadows after a sleepless night or as stubborn pigmentation that won’t fade, their presence can affect not only how we look but also how we feel about ourselves. In this comprehensive guide, we explore the symptoms, delve into the causes, and examine the most effective treatments for under-eye circles, drawing on the latest scientific research and clinical insights.

Symptoms of Under-Eye Circles

The appearance of under-eye circles is more than just a matter of looking tired. Recognizing the specific symptoms can help distinguish between occasional shadows and a chronic cosmetic concern requiring targeted care.

Appearance	Texture	Duration	Source(s)
Darkened skin	Thinner skin	Persistent or variable	1, 2
Brown, blue, or purple hue	Laxity/wrinkling	Worsens with fatigue, allergies, or age	1, 2
Swelling or puffiness	Edema	May fluctuate daily	1, 2

Table 1: Key Symptoms

Common Visual Signs

Under-eye circles typically manifest as bilateral (appearing under both eyes) and round patches of darker skin. The color can range from brownish to bluish, purplish, or even nearly black, depending on individual skin tone and the underlying cause. These dark patches often stand in stark contrast to the surrounding skin, making them more noticeable and sometimes difficult to conceal with makeup 1 2.

Changes in Skin Texture

A hallmark of under-eye circles is a change in the skin's texture. The skin under the eyes is already thinner than elsewhere on the face, making any discoloration or vascular changes more apparent. Some individuals may notice increased skin laxity (looseness) or fine lines in conjunction with the darkness, which can exacerbate the shadowing effect 1 2.

Fluctuations and Persistence

While some people notice their under-eye circles primarily after a lack of sleep or during allergy season, for others, the discoloration is a persistent issue. Research shows that the intensity of under-eye circles can vary not only between individuals but also within the same person over different days and times, influenced by factors such as fatigue, hydration, and even seasonal allergies 2.

Additional Symptoms: Swelling and Puffiness

For some, under-eye circles are accompanied by swelling or puffiness—often a result of periorbital edema (fluid retention) or skin laxity. This swelling can cast additional shadows, making the circles appear even darker 1.

Causes of Under-Eye Circles

Understanding why under-eye circles develop is the first step towards effective management. Multiple physiological and environmental factors can contribute, often in combination.

Factor	Mechanism	Typical Presentation	Source(s)
Hyperpigmentation	Increased melanin	Brown/gray circles	1, 2, 4
Vascular changes	Dilated/thicker capillaries	Blue/purple tint	1, 2, 4
Thinner skin	Easier vessel visibility	Enhanced darkness/shadow	2
Skin laxity/edema	Shadowing, puffiness	Swollen, saggy appearance	1, 4

Table 2: Main Causes

Hyperpigmentation

One of the primary causes of under-eye circles is hyperpigmentation—excess melanin production in the skin beneath the eyes. This can result from genetic factors, chronic rubbing, inflammation (such as from allergies or eczema), or sun exposure. Individuals with darker skin tones may be more susceptible due to naturally higher melanin levels, but hyperpigmentation can affect anyone 1 2 4.

• Genetic predisposition: Some people inherit a tendency for pigmentation in the periorbital area.
• Post-inflammatory hyperpigmentation: Chronic rubbing or allergic reactions can trigger increased melanin production 1.

Vascular Factors

The under-eye area contains a dense network of blood vessels. When capillaries in this area become dilated, thickened, or more numerous, they can impart a bluish or purplish hue to the skin above, especially in individuals with fair or thin skin 1 2 4.

• Vascular congestion: Allergies, sinus congestion, or fatigue can cause blood to pool under the eyes.
• Thin skin: Thinner skin allows underlying vessels to show through more prominently 2.

Skin Thickness and Laxity

With age, skin naturally loses collagen and becomes thinner and less elastic. This thinning not only makes underlying blood vessels more visible but also increases the likelihood of shadows forming due to skin laxity or mild swelling 1 2.

• Aging: Loss of fat and collagen in the under-eye area accentuates dark circles.
• Edema: Fluid retention can cause puffiness, casting shadows that further darken the area 1.

Structural and Lifestyle Contributors

The bone structure of the face can also influence the appearance of under-eye circles. Deep-set eyes or prominent tear troughs may naturally cast shadows. Lifestyle factors such as lack of sleep, dehydration, excessive alcohol consumption, and smoking can worsen under-eye darkness by affecting blood flow, skin hydration, and tissue repair 1 5.

Treatment of Under-Eye Circles

Managing under-eye circles requires a tailored approach, as treatments are most effective when matched to the underlying cause. Options range from lifestyle changes and topical creams to advanced medical procedures.

Treatment Type	Best For	Example Approaches	Source(s)
Topical agents	Pigmentation	Creams with vitamin C, retinoids	4
Fillers	Volume loss, skin laxity	Hyaluronic acid injections	3, 4
Laser therapy	Pigment/vascular issues	Q-switched, IPL, fractionated lasers	3, 4
Surgical options	Excess skin/puffiness	Blepharoplasty	4
Adjunctive therapies	Mixed causes	Chemical peels, carboxytherapy, PRP	4, 5

Table 3: Treatment Options

Topical Treatments

For cases where hyperpigmentation is the primary concern, topical creams and serums can offer significant benefits. Ingredients like vitamin C, retinoids, kojic acid, and hydroquinone target melanin production and can lighten dark pigmentation over time 4. However, results may be gradual and require consistent use.

• Creams with antioxidants and brighteners: Help fade pigmentation and improve skin health.
• Caution: Topicals are less effective for vascular or structural causes 4.

Injectable Fillers

When under-eye circles result from volume loss or skin laxity—often due to aging—soft tissue fillers, especially hyaluronic acid (HA) fillers, can restore lost volume and smooth out depressions. This reduces shadowing and can make the area appear brighter and more youthful 3 4.

• HA fillers: Provide immediate improvement with minimal downtime.
• Autologous fat grafting: An alternative for more significant volume loss 4.

Laser and Light-Based Therapies

Laser treatments can address both pigmentary and vascular causes. Q-switched and intense pulsed light (IPL) lasers target excess pigment, while fractionated and vascular lasers can reduce visible blood vessels. These treatments require skilled application to avoid complications in the thin under-eye skin 3 4.

• Lasers: Mild to moderate effectiveness, particularly for mixed causes.
• Fractionated lasers: Stimulate collagen for improved skin texture 3 4.

Surgical Approaches

For pronounced under-eye bags or significant skin laxity, surgical intervention—most commonly lower eyelid blepharoplasty—offers a more permanent solution. This procedure removes excess skin and fat, tightening the area and eliminating shadow-causing puffiness 4.

• Best for: Structural causes, not solely pigmentation 4.

Adjunctive and Emerging Therapies

Chemical peels, carboxytherapy (CO₂ injections), platelet-rich plasma (PRP), and innovative bioactive formulations (such as those derived from mesenchymal stromal cells) are being explored as adjunct or alternative treatments. While evidence is still emerging and no gold-standard therapy exists, these approaches may provide additional benefits, particularly for resistant or mixed-type cases 4 5 6.

• Carboxytherapy: May improve vascular and pigmentary causes, though high-quality evidence is still limited 5.
• MSC-derived products: Early studies suggest potential for periorbital rejuvenation 6.

Lifestyle and Preventive Strategies

Simple lifestyle adjustments can also play a significant role in managing under-eye circles:

• Adequate sleep: Reduces fatigue-related darkness.
• Sun protection: Prevents UV-induced pigmentation.
• Managing allergies: Minimizes vascular congestion and inflammation 1 5.

Conclusion

Under-eye circles are a multifactorial condition, with symptoms and causes ranging from pigmentation and vascular changes to structural factors and lifestyle influences. Effective treatment requires a nuanced understanding of the underlying mechanisms and a tailored approach that may combine topical agents, fillers, laser therapies, surgical options, and lifestyle modifications.

Key points covered:

• Symptoms include darkened, thin, or lax skin, often accompanied by puffiness and variable intensity.
• Causes are multifactorial, encompassing hyperpigmentation, vascular changes, thin skin, structural factors, and lifestyle habits.
• Treatments span topical creams, fillers, lasers, surgery, and adjunctive therapies, with selection guided by the specific cause(s).

Achieving brighter, healthier under-eyes often requires both patience and a personalized plan, ideally developed in partnership with a skilled dermatologist or cosmetic practitioner.