Dark Circles and Hollows Under the Eyes: Causes and Treatment Options
Content owner/Author: Specialist Dr. Utkan Kızıltaç — Dermatology Specialist
Last medical review and update: September 10, 2026
What are dark circles under the eyes?
Dark circles under the eyes are not caused by a single factor. Increased pigmentation, visible blood vessels due to thin skin, shadowing caused by anatomical depressions, puffiness, and changes in skin quality can all play a role, individually or in combination.
What is under-eye hollowness?
The anatomical groove between the lower eyelid and the cheek is called the tear trough. It can be present at a young age or become more pronounced with age as mid-face support decreases. The shadow created by this hollowness can create a dark appearance even without a true increase in pigment.
Is insomnia the only cause?
No. Insomnia can accentuate existing features, but it's not the sole cause of persistent dark circles.
How is it evaluated?
Pigmentation, vascular visibility, depressions, puffiness, mid-face volume, skin quality, edema tendency, and concomitant eczema or contact dermatitis are all evaluated together.
When might fillers be beneficial?
Hyaluronic acid fillers can particularly reduce shadowing caused by hollowness. They do not directly treat pigment or vascular discoloration.
Who might not be a suitable candidate for fillers?
Direct under-eye filler injections may not be suitable for those with significant puffiness, advanced skin laxity, persistent edema, or lymphatic drainage problems.
How is pigment-induced dark discoloration treated?
Sun protection, appropriate topical treatments, selected chemical peels, and laser/light therapies can be considered. Darker skin types require more careful planning due to the risk of increased pigmentation after inflammation.
What can be done about under-eye bags?
For significant fat deposits and excess skin, fillers are not always the right option. In selected patients, surgical blepharoplasty may be more suitable.
Dermatologist's Note
The most important point in treating dark circles under the eyes is to determine whether what the patient perceives as "dark circles" is due to pigmentation, visible blood vessels, anatomical shadowing, or a combination of these.
Scientific Resources
1. Trinh LN, Grond SE, Gupta A. Dermal Fillers for Tear Trough Rejuvenation: A Systematic Review. Facial Plast Surg. 2022;38(3):228–239. PMID: 34192769. https://pubmed.ncbi.nlm.nih.gov/34192769/
Michelle L, Pouldar Foulad D, Ekelem C, Saedi N, Atanaskova Mesinkovska N. Treatments of Periorbital Hyperpigmentation: A Systematic Review. Dermatol Surg. 2021;47(1):70-74. PMID: 32740208. DOI: 10.1097/DSS.0000000000002484. https://pubmed.ncbi.nlm.nih.gov/32740208/
3. Park M, et al. Treatments for periorbital hyperpigmentation in Fitzpatrick skin types IV–VI: a systematic review. Arch Dermatol Res. 2024;316(8):552. PMID: 39172264. https://pubmed.ncbi.nlm.nih.gov/39172264/
4. Nalcı Baytaroğlu H, Hoşal MB. Complications of Periorbital Cosmetic Hyaluronic Acid Filler Injections: A Major Review. Turk J Ophthalmol. 2025;55(5):276–286. PMID: 40963300. https://pubmed.ncbi.nlm.nih.gov/40963300/
Dermatology Examination and Appointment
You can get information about dermatological evaluation and appointments for under-eye dark circles and hollowness.
On this page
- What are dark circles under the eyes?
- What is under-eye hollowness?
- Is insomnia the only cause?
- How is it evaluated?
- When might fillers be beneficial?
- Who might not be a suitable candidate for fillers?
- How is pigment-induced dark discoloration treated?
- What can be done about under-eye bags?
- Dermatologist's Note
- Scientific Resources