Dark circles and bags under the eyes

Dark Circles and Under-Eye Bags

To date, there are few studies on dark circles. We know little about them except that they are a very common aesthetic problem, difficult and often unsuccessful to remove. For many people, they are a significant issue because they are pronounced and hard to conceal, affecting both emotional well-being and professional life. Looking in the mirror in the morning can be a painful routine as people try to hide dark circles with layers of makeup or glasses. Dark rings can sometimes be concealed, but under-eye puffiness is much harder to cover.

Dark circles are often mistakenly confused with under-eye bags. These are two different conditions that can occur together later in life. Thanks to modern treatments and technologies, many types of dark circles can now be effectively reduced. Different types of dark circles require different approaches, and multiple causes are often combined. Without identifying the type and cause, treatment results may be poor.

Are Dark Circles and Under-Eye Bags Different?

Yes. They differ in cause, appearance, and treatment:

• Dark circles appear in younger people.

• Under-eye bags usually start after the age of 35.

• Over time, due to degenerative changes, under-eye bags often combine with dark circles.

• Later, it can be difficult to distinguish between the two. Some authors consider them the same problem.

What Are Dark Circles?

Dark circles are an aesthetic problem caused by multiple, often combined factors. They are usually characterized by dark pigmentation, puffiness, or discoloration under the eyes. They primarily develop due to poor circulation, slow metabolism, skin structure, and pigmentation, influenced by genetics and both internal and external factors. Dark circles make the face appear tired.

What Are Under-Eye Bags?

Under-eye bags arise from degenerative changes due to aging, often caused by facial sagging or fat protrusion from the eye socket. Sometimes both causes are combined. Loss of connective tissue support allows fat from the eye socket to protrude, and the skin under the eyes becomes loose, forming excess skin and wrinkles. Pigmentation may also occur. With aging, the face loses support, making the underlying fat more visible and giving the appearance of under-eye bags.

How Do Dark Circles Form?

True dark circles are caused by poor circulation and lymphatic drainage, leading to blood pooling under the eyes. Increased hydrostatic pressure can cause blood to leak into tissues, where it breaks down, producing pigmented or colored dark circles—similar to a long-lasting bruise.

Some people experience only congestion without blood leakage, leading to puffiness. Over time, puffiness may combine with skin discoloration. In individuals with neurodermatitis, rubbing the area due to itching contributes to pigmentation. Sun exposure also darkens the skin.

Other Causes of Dark Circles

• Allergies, often with neurodermatitis

• Heart or kidney disease affecting function

• Thin skin revealing bluish muscles underneath

• Visible blood vessels near or under the eyes

• Sun damage causing brownish discoloration

• Genetics

• Hypothyroidism

• Fat protrusion from the eye socket contributing to puffiness

• Skin thinning with age revealing underlying structures

• Slower metabolism and impaired nutrient/waste exchange with aging

Classification of Dark Circles

There is no universally accepted classification. Simplified:

True Dark Circles:

• Pigmented (dark)

• Congestive (puffy)

• Combined

False Dark Circles:

• Caused by external factors such as sun exposure, rubbing, or cosmetics

Does Lack of Sleep Affect Dark Circles?

Sleep seems to affect congestive dark circles more than pigmented ones. However, effects are variable between individuals.

Can Dark Circles Be Permanently Removed?

In most cases, significant improvement is possible, but 100% permanent removal is not guaranteed. Results vary individually and can last from 4–6 months to several years, depending on the type of dark circle. Proper assessment of the type and cause is essential before choosing a treatment. Sometimes tests are needed to rule out allergies, heart, kidney, or thyroid issues.

What Influences Treatment Success?

• Family history of dark circles

• Type of dark circle

• Duration

• Presence of pigmentation

• Severity of dark circles

• Number of contributing factors

• Skin quality under the eyes

• Possibility to address triggers

• Presence of under-eye bags

• Comorbid conditions: allergies, thyroid, heart, kidney

Do Creams Help?

• Creams have limited effect for some types.

• Creams with vitamins A, C, and K may help pigmented and congestive dark circles.

• Other supportive measures:

  • Cold compresses for congestive circles

  • Massage from inner to outer eye corner (helps both congestive and pigmented circles)

  • Sun protection

  • Avoid rubbing the eyes

Is Surgery a Solution?

Surgery is not a direct solution for dark circles. It removes excess fat or skin under the eyes, tightening the area, but does not address the cause (circulation, pigmentation). Surgery is mostly recommended for pronounced under-eye bags combined with dark circles.

Goals of Treatment

• Improve circulation and lymphatic drainage

• Reduce pigmentation

• Stimulate new collagen for thicker skin

• Tighten under-eye skin

• Address underlying conditions (heart, kidney, thyroid, allergies)

Treatment must be individualized based on type and cause. Longer-standing dark circles require more time and treatment. No single method treats all causes, so a combination of approaches is recommended. Most people respond well; some less so. Maintenance treatments 1–2 times a year are advised.

Treatments

Carboxytherapy

• Addresses most causes, especially circulation and collagen production

• Not painful; may cause temporary swelling (minutes to 1 day)

• Usually 5 sessions, spaced 10–30 days apart

• Maintenance: 1–2 sessions per year

Hyaluronic Acid Injections

• Fill and thicken skin to cover pigmentation and stimulate collagen

• 1–2 sessions; results visible immediately or within days

• Effects last 3–12 months; maintenance every 1–2 years

• Minor bruising possible

Radiofrequency

• Strengthens circulation, lymph drainage, and collagen production

• 3 sessions; results visible over months and improve up to 12 months

• Helps reduce under-eye fat and tighten skin

Fractional Radiofrequency

• Creates microscopic skin injuries replaced by new tissue

• 1–3 sessions; results appear after a few months, lasting improvement

• Temporary redness; minimal downtime

Fractional Ablative Erbium Laser

• Microscopic skin injury promotes new tissue growth over 12 months

• 2–3 sessions; initial results visible after months

• Recovery: 2–5 days

• Reduces pigmentation and thickens skin

Fractional Ablative CO2 Laser

• Similar to erbium laser

• 1–2 sessions; recovery 2–7 days

• Improves skin structure and tightens under-eye area

Fractional Non-Ablative Laser

• Thermal effect, not mechanical

• 1–3 sessions; reduces pigmentation and thickens skin

• Redness for 2–3 days; minimal downtime

Erbium Laser

• Mechanically removes skin layers, reducing pigmentation and wrinkles

• 1–2 sessions; recovery 7–10 days

Q-Switch Laser

• Targets pigmentation

• 2–5 sessions; recovery 3–5 days

Other Options

• Own blood (PRP)

• Autologous fat

• Lab-grown autologous cells