Under-Eye Dark Circles: How Do Treatments Differ Depending on the Cause?

Key summary. Dark circles have different causes in different people, including pigment, blood vessels, hollowing under the eyes, skin aging, and swelling, and each cause has its own matching treatment. That is why, if you do not know your own type, it is easy to try creams or lasers first and notice no benefit.

01Why do the causes of dark circles differ from person to person?

The skin under the eye is the thinnest on the face and has little fat, so whatever lies beneath it shows through easily, and this is where five patterns diverge. The pigmented type occurs when melanin has actually built up in the skin, caused by melasma, long-term sun exposure, pigmentation left behind by past inflammation, or medications such as birth control pills, while the vascular type occurs when blood vessels under the eye or old blood components (hemosiderin, biliverdin) show through and give a purplish tint. The structural type is neither pigment nor blood vessels but only a shadow created when volume around the eye decreases and the ligament pulls on the fat, carving out a tear trough, and the aging type occurs when the skin itself thins and sags with age, while the edema type occurs when fluid collects under the eye because of salty foods or sleeping position. It is also common for two or three of these five to appear together in one person, and a review paper likewise pointed out that treatment needs to be tailored to each person's anatomical differences.

02How can I tell which type my dark circles are?

The easiest approach uses two things: the direction of the light and gently pulling the skin. If the dark circles look darker when light shines from above and lighter when light shines from the front, they are more likely a shadow cast by a hollow area, that is, the structural type. If the color lightens when you gently pull the skin under the eye with a finger, blood vessels are showing through, and if the color stays the same when you pull, pigment has actually built up. If they are especially bad every morning and more noticeable the day after eating salty food, the edema type may also be mixed in. This is only a rough check you can do at home, and since two or three types often overlap, the exact cause can only be determined by having a clinic examine the area under your eyes directly.

03Which treatments suit the pigmented type and the vascular type?

The two target completely different things. The pigmented type targets melanin that has built up in the skin, while the vascular type targets the blood vessels that show through, so the treatments do not overlap.

These figures were confirmed by directly reading the original papers at 2026-10-05, and skin color also affects which laser is chosen. For lighter skin (Fitzpatrick types 1 to 3), a Q-switched ruby laser or pulsed dye laser is used, and for darker skin (types 4~6), Nd:YAG (1063nm) is used because it is absorbed less by melanin and causes fewer side effects. However, numbers in the table such as "90% improvement" and "40% improvement" are not the result of a large pooled analysis but come from one or two small studies, so it is more appropriate to treat them as a rough reference than to rely on them as they are.

04How is a shadow caused by a hollow under the eye treated?

In this case the problem is not pigment or blood vessels but simply a shadow from lack of volume, so the approach is not to cover the surface with something but to fill in the hollow itself. The most common method is to fill the tear trough with hyaluronic acid (HA) filler, and autologous fat grafting, in which your own fat is harvested and injected back, has the advantage of filling to deeper layers, so there is less concern about the surface becoming uneven. If the bone or the tissue beneath it is considerably hollowed, implants, eyelid surgery, or even surgery that lifts the fascia may be considered, but because surgery has a larger effect, it takes time to recover from and is hard to reverse, so the usual order is to try less invasive methods such as filler first and move on to surgery if that is not enough.

05Are thin skin from aging and morning puffiness different problems?

They are completely different problems. The aging type occurs when collagen and elastic fibers decrease and the skin itself becomes thinner, so treatments that rebuild collagen are used, such as retinoids, peptides, radiofrequency (RF), and fractional CO2 laser. The puffiness (edema) type involves no problem with the skin structure itself, only temporary fluid buildup, so caffeine-containing products can help to some extent. However, if the cause is salty food or sleeping position, a procedure alone will not fully resolve it unless you change those habits. If you treat the two the same way without telling them apart, someone with the aging type may not get the collagen-rebuilding effect they actually need and may only see the puffiness go down temporarily.

06Items to check before a procedure

07Choosing by condition

• The darkness looks different depending on the lighting direction (especially darker when lit from above) → closer to the structural (shadow) type; consider first volume-restoring methods such as fillers or fat grafting
• The color stays the same even when you stretch the skin → closer to the pigment type; consider first whitening ingredients and pigment lasers (such as Q-switched ruby)
• The color fades or looks purplish when you stretch the skin → closer to the vascular type; consider first caffeine and vascular lasers (IPL, pulsed dye laser)
• The skin is thin and lacks elasticity → closer to the aging type; consider first skin-rejuvenating methods such as radiofrequency and fractional lasers
• It is especially bad in the morning and more noticeable the day after salty food → a puffiness type may be mixed in; discuss it at a consultation together with lifestyle adjustments

08Common misconceptions

"One dark circle cream will make them all disappear, regardless of the cause" — This is not true. The structural type, where shadows form because the area under the eye is sunken, is not a pigment problem to begin with, so no matter how much whitening cream you apply, the shadow itself remains. This is why people often say, "I used the cream and it didn't work."

"Dark circles that look dark always mean you are tired or didn't sleep enough" — It is true that lack of sleep can make the puffiness and vascular types look worse, but the structural and pigment types arise from anatomical causes unrelated to sleep. This is why some dark circles do not go away no matter how well you sleep.

09In summary

Dark circles do not arise from a single cause. Pigment, blood vessels, shadows, skin aging, and puffiness can act alone or together, so before deciding on a treatment, the first step is to find out which type yours is closest to. You can get a rough idea with the lighting test or the skin-pulling test at home, but the exact cause can only be determined by having it examined in person at a clinic. Even so, knowing your type before you go will help you get results far more efficiently than trying whatever treatment comes along.

10Frequently Asked Questions

Why do dark circles form?

They cannot be explained by a single cause. Five factors can act separately or together: pigmentation, visible blood vessels, shadows from sunken areas around the eyes, skin aging, and puffiness.

Do dark circle creams work?

It depends on the cause. If pigment or blood vessels are the problem, ingredients such as retinoids, hydroquinone, and caffeine can help, but if the cause is a shadow from a sunken area around the eyes, a cream cannot resolve it at all.

Can fillers get rid of dark circles?

They can help if the cause is a shadow from a sunken area around the eyes. There are reports of clear improvement after hyaluronic acid filler was placed in the tear trough, but if the cause is pigment or blood vessels, filler alone is unlikely to deliver the results you expect.

Which types of dark circles respond to laser treatment?

For the pigmented type, a Q-switched ruby laser is used. For the vascular type, IPL or a pulsed dye laser (585~595nm) is used. The wavelength has to be matched to your skin tone to reduce the risk of side effects, so the same laser is not always used for every case, even within the same type.

Is there a study comparing which dark circle treatment works best?

A meta-analysis published in 2025 (33 studies, 1,320 participants) has been reported to show higher satisfaction with laser and combination treatment, but our editorial team could not obtain and verify the full paper itself [Secondary source: Dermatology Times 2025-03-18 report, original not verified, 2026-10-05]. For that reason, all treatment evidence in this article is based on the 2016 review paper, which we read in full.

11Pre-consultation checklist

• □ I shared the results of the lighting-direction test and the skin-pulling test during the consultation
• □ I was told whether my dark circles are a single type or a mixed type
• □ I confirmed that the type of laser is appropriate for my skin tone (Fitzpatrick type)
• □ I confirmed whether I could try a non-invasive method (such as filler) first
• □ I checked whether the improvement rate I was given comes from a meta-analysis or from an individual small study

12Glossary

• Fitzpatrick type: A classification that divides skin tones into 6 levels based on how the skin reacts to ultraviolet light (burning and degree of pigmentation).
• Q-switched laser: A laser method that delivers high energy in a very short time (nanosecond range) to selectively destroy only a specific pigment such as melanin.
• Selective photothermolysis: The principle by which light of a specific wavelength is absorbed only by the target substance (melanin, hemoglobin, etc.), so that only the target is destroyed without damaging the surrounding tissue.
• Tear trough: A groove-shaped structure that forms at the border between the under-eye area and the cheek where ligaments anchor the fat.

13Sources and verification date

• PMID 27398005 — Verified on 2026-10-05 (full text read). A review paper summarizing 5 underlying mechanisms of dark circles (pigmented, vascular, structural, skin-aging, and edema types) and the treatment options for each type (J Cutan Aesthet Surg, 2016).
• Dermatology Times, "Analyzing Current Procedures for Periorbital Hyperpigmentation" — Verified on 2026-10-05. A news article about a systematic review and meta-analysis (33 studies, 1,320 participants) published in 2025. The editorial team could not directly verify the original paper (Dermatologic Therapy, 2025, DOI 10.1155/dth/9155535) because access was restricted, so it was not reflected in the claims.
• The studies above are materials for understanding the causes and treatment of dark circles, and they do not guarantee any specific clinic, practitioner, or outcome.

14Editorial responsibility and interests

• Written by: Korea Beauty Report Editorial Team
• Editorial responsibility: Korea Beauty Report Editorial Team
• Review scope: The editorial team prepared this content from published research and public data. It was not separately reviewed by a medical professional and does not replace individual diagnosis or treatment.
• Interests: No clinics with a contract or advertising relationship are involved in this article
• First published: 2026-10-05
• Last source check: 2026-10-05

15Change history

• 2026-10-05: Initially written as the first article of the Tier 3 launch. Structured around PMID 27398005 full-text reading, covering 5 cause types and treatments by type.