Dark circles & periocular hyperpigmentation
"Dark circles" is a description, not a diagnosis. Under that one complaint sit at least eight different conditions — and the treatment, and your realistic chance of improvement, depend entirely on which ones you have.
The types of periocular pigmentation
Most dark circles are multifactorial — several of the following at once. Diagnosis is the crucial rate-limiting step; without it, treatment is guesswork.
Acquired causes
- Post-inflammatory hyperpigmentation (PIH) — pigment left behind by eczema, allergy, irritation or rubbing around the eyes.
- Atypical melasma — melasma extending into the periocular region.
- Vascular dark circles — increased blood flow and vessel congestion showing through thin under-eye skin; often worse with allergies and fatigue.
- Allergy & rubbing circles — itching drives rubbing, rubbing drives both inflammation and pigment. Asthma, eczema and hay fever histories matter here, which is why the questionnaire asks.
Genetic causes
- Constitutional hyperpigmentation — inherited pigment affecting the lower and upper lids in a C-shaped pattern.
- Pigmentation demarcation lines (PDLs) — genetically determined lines appearing 1–2.5 cm below the bony orbit.
- Hori naevus and other deep dermal pigment — pigment sitting deep in the dermis, requiring a completely different laser approach.
And one that isn't pigment at all
- Tear trough shadowing — a groove between eyelid and cheek that casts a shadow. No cream or pigment laser will ever fix a shadow; this is a structural problem.
My treatment algorithm: match the cause, then treat
| Cause | Treatment | Realistic outcome |
|---|---|---|
| Pigment-based (PIH, melasma, constitutional) | Pigment correctors + picosecond / dermal toning lasers | Inflammatory (PIH) cases respond well — marked improvement over 6–12 months. Genetic constitutional pigment is honest bad news: only 10–15% respond to pico laser, typically over 4–6 sessions. |
| Vascular / congestion | Skincare + vascular lasers (532 / 595 / 1064 nm — DermaV, Excel V, VBeam) | 2–4 sessions for best results; treatment takes 2–4 minutes with about 5 minutes of recovery, results appearing from 3 weeks. |
| Allergy-related | Treat the allergy first — desensitisation, barrier skincare — then lasers if pigment remains | Stopping the rubbing is half the treatment. |
| Shadow-based (tear trough) | Dermal fillers; Rejuran (polynucleotides) 2–4 sessions, 3–6 weeks apart; hyper-diluted collagen-stimulating injectables 2–3 sessions; nano-fat transfer in selected cases | Fillers give up to ~30% correction — not everyone is a candidate. Fat transfer risks overcorrection in 10–20% of cases. |
Overall success rates — stated honestly
Across all types, improvement ranges from 30% to 80% depending on the pigment type. The best responders are inflammatory (PIH) circles and tear-trough shadowing. The poorest responders are genetic constitutional pigmentation and demarcation lines — these are hard to improve, and I will tell you so before you spend money, not after.
What to avoid
- Microneedling with PRP — a narrow window of genuine application; it often worsens vascular, inflammatory and genetic dark circles.
- BBL / IPL — not my preference in the periocular region.
- Retinol — a very weak pigment inhibitor here, and only safe when there is no irritant dermatitis around the eyes.
- Filler in the wrong candidate — poorly placed filler creates the bluish Tyndall effect; reversible with hyalase, but better avoided by correct diagnosis.
What your report gives you
A breakdown of which of these causes are driving your dark circles — from your photographs, your rubbing/allergy history and your questionnaire — and a matched treatment sequence with honest percentages for each component.
Publications & downloads
Peer-reviewed work underpinning this approach. Downloadable PDFs will be attached here.
Before & after
Before-and-after examples for this condition will appear here. Placeholder
From Instagram & more
Posts, videos and further reading for this condition. Placeholder
— paste post URL here
— paste post URL here
— paste post URL here
Have some questions?
Send a message and it will be answered personally. Form endpoint — to be wired in production