01Structural
Dermal FillersPlaced in the tear-trough under the Dermal Architecture method; effective for the structural type, less effective for vascular or pigmentary.
Vascular, Pigmentary, or Structural?
Dark Circles
Three different underlying causes. Using the wrong treatment is the most common reason dark-circle treatment fails.
Your Concerns
What Is It?
Dark circles look the same on the surface but have three different underlying causes — vascular (visible blood vessels through thin under-eye skin), pigmentary (excess melanin), and structural (tear-trough hollows that cast shadows). Each responds to different treatments; using the wrong one is the most common reason dark-circle treatment fails. At 23MD, the under-eye area is assessed under the 4D Approach to identify the dominant driver before any plan is recommended. Allergic and lifestyle contributors are also considered.
Recommended Pathway
Treatments for Dark Circles
The treatments our doctors most often recommend for this concern. Your consultation confirms the right combination and sequence for you.
Unsure which pathway suits you?
Not sure which treatment is right for you?
23MD DigitalSkin Expert
Upload a photo and receive a personalised skin assessment with treatment recommendations from our doctor-led protocols.
Analyse My SkinCommon Causes
What Could Be Causing It
Vascular
Thin under-eye skin reveals the bluish tone of underlying vessels.
Pigmentary
Melanin excess in the under-eye area; common in skin of colour and after repeated rubbing.
Structural
Tear-trough hollows produce shadow that reads as darkness even on otherwise unpigmented skin.
Allergic
Chronic allergic congestion causes 'allergic shiners' — venous congestion under the eye.
Lifestyle
Sleep debt, dehydration, and high cortisol exacerbate every type.
FAQs
Your Questions, Answered
The skin under the eye is thinner than anywhere else on the face — sometimes a quarter of the thickness. Whatever is beneath it (vessels, pigment, or shadow from a hollow) shows through more visibly.
Filler is most effective for structural (shadow-cast) dark circles. For purely vascular or pigmentary types, filler alone may not help and can sometimes make the picture look worse. A 4D assessment establishes which type you have before recommending filler.
Often, particularly the pigmentary type. Genetic predisposition doesn't mean it can't be treated — but it does affect expectations of how completely the picture can resolve.
Filler results typically last 9–18 months; regenerative treatments work cumulatively. Lifestyle drivers (sleep, hydration, allergies) need ongoing management.
Yes, with appropriate device selection and clinical judgement. The risk of post-inflammatory pigmentation is the main consideration; treatments are sequenced and graded accordingly.
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Medically reviewed by Dr Suha Kersh, MB BCh BAO LRCP&SI, MRCPsych, GMC-registered since 1992.
