Why Do Dark Circles Form? 4 Causes and Treatment Options
Dark circles are not a single condition but a symptom that appears when several underlying causes overlap. Just because someone else has experienced significant improvement does not mean you will achieve the same result — it is important to analyze the underlying cause and choose a correction suited to your individual situation. The outcome of any treatment varies by individual.
What Are the 4 Causes of Dark Circles?
The causes fall broadly into four categories. First, a shadow cast by a protruding fat pad beneath the eye. Second, fine wrinkles in the skin that create a crepey, darkened appearance. Third, blood vessels beneath the under-eye skin showing through with a bluish tint. Fourth, dark pigmentation of the under-eye skin. The appropriate treatment depends on which cause is dominant.
What Is Transconjunctival Lower Blepharoplasty (Fat Removal)?
This technique makes a small incision inside the eyelid (the conjunctiva) to remove fat, with the advantage of leaving no visible external scar. It aims to improve both the shadow caused by the fat pad and the visibility of blood vessels beneath the skin. After surgery, a paper tape is applied to the skin and removed the following day, and patients are generally told this does not significantly interfere with going out or returning to work — though the course of recovery can vary by individual. That said, in cases with significant skin laxity, fat removal alone has its limits, so when fine wrinkles are also present, combining it with a hydrating injection (Restylane Vital) is often recommended.
How Do Filler Injections and Hydrating Injections Differ?
Filler injections work by using hyaluronic acid to fill in the hollow area beneath the fat pad, and the procedure is relatively quick, taking about 5 minutes. In cases of significant skin laxity, the effect may be limited. Restylane Vital, often referred to as a hydrating injection, uses a stabilized form of hyaluronic acid that can be injected into the dermal layer of the skin. It is generally reported to last around 18 months and can be expected to provide hydration and help soften fine wrinkles, which is why it is often recommended in combination with fat removal.
Can Dark Circles Be Improved Without Surgery?
In addition to filler injections, non-surgical options include PPC injections, Shurink (Ultraformer), Thermage, blue peel, and thread lifting. PPC injections aim to reduce under-eye fat without surgery, but swelling can persist for over a week, and the procedure requires an experienced physician. Ultrasound-based procedures have the limitation of not being usable close to the eyeball, and blue peel (skin resurfacing) requires about a week of recovery. In cases of significant skin laxity, the effectiveness of non-surgical methods may be limited.
What Surgery Should Be Considered for Severe Under-Eye Wrinkles?
Lower eyelid wrinkle removal surgery removes the fat pad while trimming and suturing the loose under-eye skin. Using the same incision, a mid-face lift — aimed at also lifting the sagging cheek and nasolabial fold area — can be performed together, and this combined approach is also offered. For a general overview of facelift procedures, please refer to our Facelift Guide.
Which Treatment Should You Discuss First?
Since dark circles often result from multiple overlapping causes, the first step is to get an examination to determine which of the four — fat, wrinkles, blood vessels, or pigmentation — is the primary cause. Information about the operating physician can be found on our doctor profile page.
Consultation Information
Kim Jongseo Plastic Surgery (Apgujeong, Seoul) · 2F Apgujeong Building, 842 Nonhyeon-ro, Gangnam-gu, Seoul · 02-3416-0070 (after hours 070-4027-0070) · Book a Consultation
This article is provided for informational purposes only. The effects and recovery period of any surgery or procedure may vary by individual. As side effects may occur with any medical procedure, please consult thoroughly with a specialist beforehand.
Procedure Reference Materials
Below is procedure reference material from our previous website (surgery.co.kr). Before-and-after results may vary by individual, and side effects may occur with any medical procedure.
