It’s one of the most common beauty frustrations: you look in the mirror and see tired, shadowed eyes—no matter how much you sleep. But what’s actually causing that worn-out look? Is it true “dark circles,” or are under-eye hollows to blame? Understanding the difference is key to finding the right solution and avoiding disappointment. Treatments at Cosmetic Injectables Center Medspa are performed by certified expert injectors under the on-site supervision of Dr. Sherly Soleiman, MD, a board-certified aesthetic physician and national trainer.
What’s the Real Difference Between Under-Eye Hollows and Dark Circles?
While they often appear together, under-eye hollows and dark circles are distinct concerns. Hollows are depressions or grooves beneath the eyes, usually caused by bone and soft tissue loss as we age or by genetics. These create shadows that mimic darkness, especially in certain lighting. Dark circles, on the other hand, refer to actual discoloration—brown, blue, or purple—resulting from excess pigment, visible blood vessels, or thin skin.
Here’s where most people get it wrong: treating hollows with creams or dark circles with fillers rarely works unless the underlying cause is addressed. That’s why a careful assessment is essential.
Why Do Under-Eye Hollows and Dark Circles Happen?
Multiple factors contribute to these concerns:
- Volume Loss & Bone Changes: Age-related loss of fat and bone, especially around the orbital rim, leads to hollows and shadowing.
- Thin Skin: The eyelid skin is the thinnest on the body, making blood vessels and muscles more visible.
- Pigmentation: Genetics, sun exposure, and inflammation can increase melanin or hemosiderin, causing brown or blue discoloration.
- Fluid Accumulation: Allergies, lack of sleep, or even anatomy can cause puffiness and worsen darkness.
- Ethnic & Genetic Factors: Some people inherit deeper hollows or more pigment, especially in certain ethnic groups.
According to a 2016 foundational review in the Journal of Cutaneous and Aesthetic Surgery, these issues are often multifactorial, requiring a tailored approach for each patient.
How Are Under-Eye Hollows and Dark Circles Evaluated?
A thorough evaluation is the first step. Providers assess bone structure, fat pads, skin thickness, and pigmentation. A recent PMC article on lower eyelid assessment recommends segmenting the area into medial, central, and lateral zones and using lighting to distinguish shadow from pigment. This helps determine whether volume restoration, pigment correction, or both are needed.
Under-Eye Hollows vs. Dark Circles: Quick Comparison Table
| Feature | Under-Eye Hollows | Dark Circles |
|---|---|---|
| Definition | Depressions or grooves beneath the eyes, creating shadows | Discoloration under the eyes (brown, blue, or purple hue) |
| Main Cause | Volume loss in fat, bone, or soft tissue; genetics | Increased pigment, visible blood vessels, thin skin |
| Appearance | Sunken look, shadowing, especially in certain lighting | Uniform or patchy darkness, may look brown or bluish |
| Common Triggers | Aging, genetics, bone structure, weight loss | Genetics, sun exposure, allergies, inflammation, fatigue |
| Best Treatments | Hyaluronic acid fillers (e.g., Restylane Eyelight), fat transfer | Lasers (Nd:YAG, IPL), topicals (niacinamide, arbutin), chemical peels |
| Treatment Goal | Restore lost volume, reduce shadow | Reduce pigment, improve skin quality, target vessels |
| Prognosis | Results last 9–12 months (fillers); longer with surgery | Improvement varies; maintenance often needed |
| Who’s Most Affected | Older adults, those with deep-set eyes or maxillary retrusion | All ages; more common in certain ethnicities or with allergies |
| Can They Coexist? | Yes, often appear together | Yes, often appear together |
Note: A professional assessment is essential to determine which condition—or combination—is present and to guide the safest, most effective treatment plan.
Evidence-Based Treatments: What Really Works?
Injectables
Dermal Fillers: Hyaluronic acid based fillers are designed to restore lost volume and soften shadows beneath the eyes. Restylane Eyelight and Juvederm are FDA-approved specifically for under-eye hollows.
- Mechanism: Fills depressions by attracting water and supporting tissue.
- Indications: Under-eye hollows, tear troughs, shadowing from volume loss.
- FDA Status: FDA-approved for infraorbital hollows.
- Effectiveness & Longevity: 87.4% responder rate at 3 months; results typically last 9–12 months.
- Candidacy / Contraindications: Best for those with true hollows, not excess skin or pigment; not for those with active skin infections or certain autoimmune conditions.
- Risks & Urgent Care Cues: Swelling, bruising, rare vascular occlusion (seek immediate care for vision changes).
- Recovery Time: Minimal; most swelling resolves in days.
- Comparative or Combination Role: Often combined with lasers or topicals for optimal results.
- Inline Evidence: 2023 FDA pivotal trial for Restylane Eyelight
Lasers (Q-switched Nd:YAG, CO2, IPL)
Lasers target pigment and vascular causes of dark circles, and can improve skin texture.
- Mechanism: Selectively breaks down melanin or hemoglobin, stimulates collagen.
- Indications: Brown or blue discoloration, visible vessels, fine lines.
- FDA Status: FDA-cleared for skin rejuvenation; off-label for periorbital use.
- Effectiveness & Longevity: >40% improvement in pigmentation; results last months to years.
- Candidacy / Contraindications: Suitable for most skin types; caution in very dark skin due to hyperpigmentation risk.
- Risks & Urgent Care Cues: Temporary redness, rare pigment changes; persistent darkening needs prompt evaluation.
- Recovery Time: Minimal to moderate, depending on laser type.
- Comparative or Combination Role: Works best when combined with fillers for both pigment and volume.
- Inline Evidence: 2020 comparative study on lasers and fillers
Topical Formulations (Niacinamide, Arbutin, Tranexamic Acid)
Advanced serums can reduce mild pigmentation and improve skin quality.
- Mechanism: Inhibit melanin production, reduce inflammation, improve barrier.
- Indications: Mild dark circles, early pigment changes, sensitive skin.
- FDA Status: Cosmetic; not FDA-approved as drugs.
- Effectiveness & Longevity: Up to 48% reduction in pigmentation after 6 weeks; effects last with continued use.
- Candidacy / Contraindications: Safe for all skin types; not for those with allergies to ingredients.
- Risks & Urgent Care Cues: Rare irritation; discontinue if rash occurs.
- Recovery Time: None.
- Comparative or Combination Role: Often used with lasers or fillers for enhanced results.
- Inline Evidence: 2025 clinical efficacy of novel topical formulation
Regenerative Injections (Nanofat, PRP, SVF)
Regenerative therapies use your own cells to improve skin quality and reduce darkness.
- Mechanism: Delivers growth factors and stem cells to stimulate repair and collagen.
- Indications: Wrinkles, mild darkness, tissue thinning.
- FDA Status: Off-label for under-eye use.
- Effectiveness & Longevity: 100% satisfaction in combination therapies; effects can last a year or more.
- Candidacy / Contraindications: Suitable for those seeking natural options; not for those with bleeding disorders.
- Risks & Urgent Care Cues: Minor redness or swelling; infection is rare but requires prompt care.
- Recovery Time: Minimal; mild swelling may last a few days.
- Comparative or Combination Role: Most effective when combined with lasers or fillers.
- Inline Evidence: 2024 randomized clinical trial on nanofat combinations
Chemical Peels (TCA, Lactic Acid)
Peels can lighten pigment and improve texture in the under-eye area.
- Mechanism: Exfoliates top skin layers, reduces melanin.
- Indications: Brown discoloration, fine lines, uneven tone.
- FDA Status: Cosmetic; not FDA-approved as drugs.
- Effectiveness & Longevity: >90% improvement in lighter skin types; results last months.
- Candidacy / Contraindications: Best for lighter skin; higher risk of scarring in darker skin.
- Risks & Urgent Care Cues: Irritation, rare scarring; persistent redness needs evaluation.
- Recovery Time: 3–7 days for mild peels.
- Comparative or Combination Role: Often combined with lasers or surgery.
- Inline Evidence: 2005 foundational study on periorbital hyperpigmentation
Surgery (Blepharoplasty)
Surgical correction is reserved for excess skin, fat, or severe hollows.
- Mechanism: Removes or repositions fat, tightens skin and ligaments.
- Indications: Severe bags, loose skin, deep hollows.
- FDA Status: Surgical procedure; not FDA-regulated as a device.
- Effectiveness & Longevity: Long-lasting; high satisfaction when combined with other treatments.
- Candidacy / Contraindications: Suitable for significant structural issues; not for those with poor healing.
- Risks & Urgent Care Cues: Bruising, swelling, rare hollowing; vision changes require immediate care.
- Recovery Time: 1–2 weeks.
- Comparative or Combination Role: Often paired with peels or lasers for best results.
- Inline Evidence: 2016 foundational review on pathogenesis and treatments
Recent Advances in Under-Eye Treatments
The science is moving fast. According to a 2025 systematic review and meta-analysis on POH treatments, lasers and combination therapies deliver the highest satisfaction and effectiveness, with mild side effects. New topical serums can reduce pigmentation by nearly 48% in just six weeks, and FDA-approved fillers like Restylane Eyelight show high responder rates and satisfaction. Combination therapies—such as nanofat with PRP or lasers—are emerging as the gold standard for complex cases.
Why Choose Cosmetic Injectables Center Medspa?
At Cosmetic Injectables Center Medspa, every under-eye treatment is tailored to your unique anatomy and concerns. Our certified injectors use the latest evidence-based techniques and only FDA-approved products when available. With Dr. Sherly Soleiman’s on-site supervision and a commitment to safety, you’ll receive a comprehensive assessment and a plan designed for natural, refreshed results—never overdone or risky shortcuts.
References
- 2025 Systematic Review and Meta-Analysis on POH Treatments. Lasers and combination therapies are most effective and satisfactory for periorbital hyperpigmentation, with mild side effects. https://onlinelibrary.wiley.com/doi/full/10.1155/dth/9155535
- 2025 Clinical Efficacy of Novel Topical Formulation. Achieved 47.94% reduction in under-eye hyperpigmentation after 6 weeks, safe with no adverse effects. https://pmc.ncbi.nlm.nih.gov/articles/PMC12235579/
- 2024 Randomized Clinical Trial on Nanofat Combinations. Combined treatments (nanofat + PRP/SVF/laser) superior to nanofat alone, with 100% patient satisfaction and significant improvements in darkness and tissue repair. https://pmc.ncbi.nlm.nih.gov/articles/PMC11187812/
- 2016 Foundational Review on Pathogenesis and Treatments. Details multifactorial etiology, histological melanosis, and multimodal management including fillers, lasers, and surgery. https://pmc.ncbi.nlm.nih.gov/articles/PMC4924417/
- 2020 Comparative Study on Lasers and Fillers. All modalities effective depending on cause, with 82% excellent improvement ratings and minimal complications. https://pubmed.ncbi.nlm.nih.gov/33272039/
- 2023 FDA Summary for Restylane Eyelight. 87.4% responder rate for infraorbital hollows, with transient side effects; approved for under-eye volume restoration. https://www.accessdata.fda.gov/cdrh_docs/pdf4/P040024S135B.pdf
- 2025 FDA Executive Summary on Dermal Fillers. Discusses risks like vascular occlusion and imaging interference; includes under-eye approvals with increasing procedure reports. https://www.fda.gov/media/188185/download
- Recent PMC Article on Lower Eyelid Framework. Stepwise assessment for HA fillers, emphasizing midcheek volumization; survey shows high concern for hollows and dark circles. https://pmc.ncbi.nlm.nih.gov/articles/PMC11177555/
- 2005 Foundational Study on Periorbital Hyperpigmentation. Multimodal treatments like peels, lasers, and surgery; histological focus on melanin deposits. https://www.sciencedirect.com/science/article/abs/pii/S1090820X0500467X
Frequently Asked Questions
How do I know if I have under-eye hollows or dark circles?
A professional assessment can distinguish between volume loss (hollows) and pigmentation or vascular issues (dark circles), guiding the right treatment.
Are fillers safe for under-eye hollows?
When performed by certified injectors, FDA-approved fillers are generally safe, but rare risks like vascular occlusion exist. Always choose an experienced provider.
Can creams really help dark circles?
Topical serums with proven ingredients can reduce mild pigmentation, but deeper hollows or severe discoloration often need more advanced treatments.
What’s the downtime for laser treatments under the eyes?
Most laser treatments have minimal downtime—typically a few days of redness or swelling, depending on the device and settings used.
How long do under-eye fillers last?
Most under-eye fillers last 9–12 months, though results can vary based on product type, metabolism, and lifestyle. Some patients may see benefits for up to 18 months with proper care.
Is under eye filler painful?
Most patients describe under-eye filler as mildly uncomfortable rather than painful. Topical numbing and gentle techniques help minimize discomfort during the procedure.
How to increase volume under eyes?
Volume under the eyes can be restored with hyaluronic acid fillers, fat transfer, or regenerative injections. A personalized consultation will determine the safest, most effective approach for your needs.