The skin around the eyes is one of the first areas of the face to show signs of tiredness and ageing. Its structure differs markedly from the rest of the face: the dermis under the eye is up to five times thinner than facial skin and has very little underlying fat, elastin or collagen¹. There are also fewer sebaceous glands, which makes this delicate area prone to dryness and dehydration². Combined with constant blinking (around 10,000 times per day) and expressive muscle movements³, it is no wonder the under‑eye area develops fine lines, dark circles and hollows more quickly than other parts of the face. This guide examines why under‑eye issues develop and explores the full spectrum of rejuvenation options — from home care and skincare to advanced injectables and surgery.
Why do dark circles and hollows appear?
Structural changes: As we age, bony support around the eye recedes and the fat pads that once plumped the cheeks and lower lids descend. In the tear trough — a depression along the medial lower lid just lateral to the lacrimal crest — resorption of bone, thinning of skin over the orbital rim ligaments and descent of the cheek create a noticeable hollow⁴. Orbital fat above and sub‑orbicularis oculi fat below border this hollow, so loss of volume accentuates the shadow⁵. Physicians call this the under‑eye hollow or tear‑trough deformity, and it is often accompanied by dark circles. Dark circles have multiple causes. Loss of soft tissue and bone creates a sunken appearance even when a person is well‑rested⁶. Thin under‑eye skin reveals the network of blood vessels beneath, casting a blue‑grey tint. Ageing, sun exposure and genetics can also lead to hyperpigmentation. According to oculoplastic surgeons, fat loss and descent cast shadows on the lower lid, while pigmentation and vascular congestion contribute to the darkness⁷. Under‑eye bags arise when normal orbital fat herniates forward and can coexist with hollows and dark circles⁸.
Lifestyle factors: Lack of sleep, dehydration, high salt intake and allergies can all lead to puffiness and increased vascularity beneath the eyes. Smoking and chronic sun exposure accelerate collagen breakdown and pigmentation. Poor diet and iron deficiency can exacerbate the appearance of dark circles, while hormonal changes during menstruation or pregnancy may cause temporary fluid retention and swelling.
Genetic and ethnic influences: Genetics influence the distribution of fat and the depth of the orbital bones. People with deep‑set eyes or a family history of under‑eye hollows tend to develop shadows earlier. Ethnic background also contributes: darker skin types are more prone to hyperpigmentation, while lighter skin may show blood vessels more easily.
Home and lifestyle interventions
Before exploring clinical treatments, it is worth addressing reversible factors. Some simple habits can noticeably improve under‑eye appearance:
- Sleep and hydration – Adequate sleep reduces cortisol and fluid retention. Drinking plenty of water helps maintain skin plumpness and circulation.
- Diet – Limiting salty foods and increasing fresh fruit and vegetable intake reduces oedema and supports vascular health. Foods rich in vitamin C and iron support collagen synthesis and oxygen transport.
- Sun protection – Wearing sunglasses and using a broad‑spectrum SPF helps prevent pigmentation and collagen breakdown. Thin under‑eye skin is particularly vulnerable to ultraviolet light¹.
- Allergy management – Treating hay fever or sinus congestion reduces rubbing and vascular congestion. Cold compresses or chilled cucumber slices can temporarily constrict vessels and reduce puffiness.
Skincare and topical treatments
- Hydrating creams and peptides – Because the under‑eye area lacks sebaceous glands², a dedicated eye cream with hyaluronic acid and glycerine can combat dryness. Peptides may encourage collagen production and improve elasticity.
- Retinoids and vitamin C – Low‑strength retinoids can improve fine lines by stimulating collagen synthesis. Vitamin C serums brighten pigmentation and offer antioxidant protection.
- Caffeine and niacinamide – Caffeine constricts blood vessels and reduces swelling, while niacinamide (vitamin B3) lightens hyperpigmentation and strengthens the skin barrier.
- Chemical peels – Mild peels containing glycolic or lactic acid exfoliate the superficial layer, stimulating new cell turnover and improving dark spots. These should only be administered by qualified practitioners because the area is very delicate.
Non‑surgical medical treatments
Injectable fillers: Hyaluronic‑acid (HA) dermal fillers are the most popular option for addressing under‑eye hollows. HA is a sugar molecule that attracts water and adds volume. Fillers are manufactured by bacterial fermentation and cross‑linking to reduce allergic reactions⁹. When injected into the tear trough, they replace lost volume and smooth the lid–cheek junction. The procedure takes minutes and results last around 12 months¹⁰. However, this area is challenging to treat because superficial injections can cause lumps, puffiness, a bluish hue (Tyndall effect) or vascular occlusion. Complications reported in the literature include bruising, swelling, hyperpigmentation, nodules and, rarely, blindness¹¹. Choosing an experienced practitioner and using a blunt cannula reduces risks.
Polynucleotide mesotherapy (Lumi Eyes): A newer alternative uses polynucleotides — long DNA fragments derived from salmon — to stimulate tissue regeneration. These “regenerative fillers” promote fibroblast proliferation, extracellular matrix synthesis and angiogenesis⁴. Clinical trials show that polynucleotide injections improve skin elasticity, hydration and wrinkle depth¹². Unlike HA fillers, which add volume, polynucleotides gradually improve quality by boosting collagen, elastin and microcirculation. Lumi Eyes combines polynucleotides with hyaluronic acid and antioxidants to hydrate, firm and brighten the periocular skin¹³. Benefits include reduced dark circles, smoother fine lines and decreased puffiness¹⁴. Side‑effects are generally mild — temporary bruising, swelling or redness¹⁵ — and there is minimal downtime.
Platelet‑rich plasma (PRP): PRP injections use the patient’s own blood plasma enriched with growth factors to stimulate collagen and elastin. Studies suggest PRP can improve skin thickness and reduce dark circles with a low risk of allergic reactions. Sessions are typically spaced four weeks apart and results emerge gradually over three to six months.
Microneedling and radiofrequency: Microneedling creates microchannels in the skin, triggering collagen production. Radiofrequency devices deliver heat to tighten collagen and improve elasticity. Combining RF with microneedling can reduce fine lines and improve skin texture. As with any energy‑based device, treatment should be performed by a trained clinician.
Laser and light therapies: Fractional lasers, intense pulsed light (IPL) and Nd:YAG lasers target pigmentation and stimulate collagen. These technologies can improve dark spots, vascular congestion and fine lines. Patients with darker skin tones should undergo patch testing to avoid post‑inflammatory hyperpigmentation.
Surgical options
Severe under‑eye bags, hollows or excessive skin may require surgery. Lower blepharoplasty removes or repositions protruding fat and tightens lax skin. Fat grafting can also add volume to the tear trough using the patient’s own adipose tissue⁴. Surgery carries risks of scarring, asymmetry and prolonged swelling, but results are long‑lasting. Consultation with an oculoplastic surgeon will determine suitability.
Choosing the right treatment
The best approach depends on the underlying cause — volume loss, pigmentation, skin laxity or a combination. During consultations at Mesglo Aesthetic Clinic in Marylebone, practitioners conduct a detailed assessment considering skin quality, hollow depth, fat pad size and skin colour¹⁶. They may recommend a staged approach: improving hydration and pigmentation with polynucleotides or peels first, then adding filler for volume if necessary. It is important to set realistic expectations; sometimes treating the mid‑cheek is essential to support the lower lid¹⁷.
Aftercare and maintenance
No matter which procedure is chosen, proper aftercare helps prolong results:
- Avoid vigorous exercise, alcohol and blood‑thinning medications for 24 hours after injectables.
- Use cold compresses and keep the head elevated to minimise swelling.
- Apply gentle sunscreen daily and wear sunglasses to protect the thin skin from UV damage.
- Adopt a consistent skincare routine with hydrating and antioxidant ingredients.
- Follow the practitioner’s instructions and attend review appointments.
Conclusion
Under‑eye rejuvenation is an evolving field with effective options for addressing dark circles, hollows and tired‑looking eyes. From lifestyle adjustments and targeted skincare to advanced injectables like hyaluronic‑acid fillers and polynucleotide treatments, there is a bespoke solution for nearly every concern. The key is to have a thorough assessment by a qualified practitioner who understands the nuances of under‑eye anatomy and ageing. At Mesglo Aesthetic Clinic in Marylebone, our team combine scientific knowledge with artistic judgement to restore a refreshed, youthful appearance while maintaining natural expression and safety.