Dark circles and under-eye hollows
Shadowing beneath the eye is usually structural rather than a pigment problem — the tear trough hollows as the mid-face loses support, and the shadow it casts reads as a dark circle.
The area under the eye has the thinnest skin on the body, around half a millimetre, with almost no subcutaneous fat to buffer it. Three separate things get called dark circles, and they respond to completely different treatment. The most common is structural: the tear trough, the groove running from the inner corner along the orbital rim, deepens as the mid-face loses volume and the ligament tethering skin to bone becomes relatively more prominent. Light falls into that groove and casts a shadow. Nothing is actually darker, which is why brightening does nothing. The second is true pigmentation, more common in deeper skin tones, where melanin sits within the skin and responds to pigment-directed treatment rather than volume. The third is vascular: skin thin enough that the blue-violet of the vessels beneath shows through, worsened by fatigue and dehydration. Most people have some combination of the three. Establishing which one dominates is the entire consultation, because filling a pigment problem achieves nothing and brightening a shadow achieves nothing.
How we treat it
Which treatment is right depends on which mechanism dominates, and that assessment happens before anything is offered. Where the cause is structural, a small volume of hyaluronic acid filler placed deep on the bone restores the support the groove lost. This is one of the most technically demanding placements in aesthetic medicine: the tissue is unforgiving and over-correction is immediately visible, so it is done conservatively and reviewed rather than completed in a single sitting. Where skin quality is the limiting factor, with crepe texture or visible vasculature, PRP or EZ Gel is usually the better answer, using the patient’s own platelets to thicken and improve the tissue over a course rather than adding volume to it. Exosome therapy is used in the same regenerative role. Where pigment is the dominant driver, filler is the wrong tool entirely. In practice many patients are treated with a combination, sequenced across several months.
Medically reviewed by Dr. Sherwin Hariri, MD, Medical Director & Chief Longevity Physician. Last reviewed August 2026.
This page is for information only and is not medical advice. Suitability for any treatment is determined at consultation.
Common questions
Will filler fix dark circles caused by pigmentation?
No. Filler restores volume and removes the shadow cast by a hollow. If the discolouration is melanin sitting in the skin, adding volume beneath it changes nothing visible. This is why assessment matters more than product, and why treating a pigment problem with filler is a common reason people are disappointed by under-eye treatment elsewhere.
How long does tear trough filler last?
Typically nine to eighteen months. The under-eye often outlasts other areas because the tissue moves less, though longevity varies with the product, the depth of placement and individual metabolism. Results are reviewed at two weeks, and a small top-up at that point is routine rather than a sign anything went wrong.
Is under-eye filler safe?
The area carries more risk than most because of the vascular anatomy around the orbit, which is precisely why it should be placed by an experienced injector in a medical setting. Conservative volumes, cannula technique where appropriate and staged treatment all reduce that risk. Swelling and bruising are the common side effects and settle within a fortnight.
What is the downtime?
Most people return to normal activity immediately. Bruising is the main consideration: it occurs in a minority of cases but can last up to two weeks in this area, so treatment is best scheduled with at least that much clearance before an event.
Other concerns
Start with a conversation
