The under-eye area is one of the first places to show signs of ageing, fatigue, and stress. If you’ve ever looked in the mirror and wondered why your eyes look tired, even after a good night’s sleep then you’re not alone. However, not all under-eye concerns are the same. One of the biggest mistakes people make is assuming that all under-eye issues can be treated in the same way. In reality, the correct treatment depends entirely on the underlying cause.
In this guide, I’ll break down the key types of under-eye concerns tear troughs, hollowness, eye bags, loose skin, and dark circles and explain the most effective treatments for each.
Why Accurate Diagnosis for Under Eye Concerns Matters
Before choosing any treatment, it’s essential to understand what’s actually causing the issue. The under-eye area is delicate and complex, and using the wrong treatment can often make things worse rather than better.
Broadly speaking, under-eye concerns fall into four main categories:
- Volume loss (hollowness or tear troughs)
- Fat protrusion (eye bags)
- Skin laxity (loose or crepey skin)
- Skin quality issues (dark circles, pigmentation, poor circulation)
Each of these requires a different approach.
Tear Troughs: The Sunken Groove Under the Eye
A tear trough is an anatomical depression that runs from the inner corner of the eye down towards the cheek. This groove can create a shadow, making the under-eye area appear dark and tired.
Key Characteristics:
- A defined hollow or groove
- Shadowing that mimics dark circles
- Often more noticeable in certain lighting
- May be genetic or age-related
Tear troughs are not caused by pigmentation, they’re actually caused by structure and shadowing.
Best Treatment:
Tear troughs are, the most common under eye concerns are typically treated with dermal fillers, such as Juvederm Volbella or Restylane Refyne. These fillers restore lost volume and smooth the transition between the lower eyelid and the cheek.
When done correctly, this treatment can:
- Reduce shadowing
- Brighten the under-eye area
- Create a more refreshed appearance
Under-Eye Hollowness Concern: Volume Loss
Hollowness is similar to tear troughs but tends to be more widespread. Instead of a defined groove, the entire under-eye area appears sunken.
Key Characteristics:
- A general “sunken” or gaunt look
- Loss of volume in the midface and under-eye
- Can make the face look tired or aged
This condition is usually caused by:
- Age-related fat loss
- Bone resorption
- Genetic factors
Best Treatment:
Like tear troughs, hollowness is best treated with dermal fillers but I also consider Fat Injection Lipo Filling Transfer to restore lost volume.
However, treatment often needs to extend beyond the under-eye area. In many cases, supporting the mid-cheek is crucial for achieving a natural result.
Under-Eye Bags: Puffiness and Fat Protrusion Under Eye Concerns
Under-eye bags are often confused with hollowness, but they are actually the opposite problem.
Instead of volume loss, bags are caused by fat pads pushing forward due to weakened supporting structures.
Key Characteristics:
- Puffiness or bulging under the eyes
- More noticeable in the morning
- May worsen with age
- Can coexist with hollowness
Why Fillers Don’t Work Here:
Using filler on under-eye bags can make the area look heavier and puffier, as it adds volume to an already full area.
Best Treatment:
The most effective treatment for true under-eye bags is lower blepharoplasty (eyelid surgery).
This procedure:
- Removes or repositions fat pads
- Tightens the area
- Can also address excess skin
For many patients, surgery is the only long-term solution for significant eye bags.
Loose or Crepey Under-Eye Skin
Loose skin under the eyes is another common under eye concerns, particularly as we age. This is caused by a decline in collagen and elastin, which are responsible for keeping the skin hydrated, firm and elastic.
Key Characteristics of these Under Eye Concerns:
- Thin, wrinkled, or “crepey” texture
- Skin that looks loose or sagging
- Fine lines that worsen with movement
- In severe cases, can form “festoons” (lower cheek bags)
Why Filler Isn’t Ideal:
Adding filler to loose skin can sometimes make it appear more puffy or unnatural, especially if the skin lacks structure.
Best Treatments:
Loose skin is best treated with skin-tightening and regenerative treatments, such as:
- Polynucleotides (a gold-standard regenerative injectable)
- Laser treatments (either Resurfacing CO2 lasers or stimulating Broad Band IPL)
- Radiofrequency skin tightening
- Skin boosters
What Are Polynucleotides?
Polynucleotides are advanced injectable treatments made from DNA fragments (commonly derived from salmon or trout). They work by stimulating your body’s natural repair processes.
They:
- Activate fibroblasts
- Boost collagen and elastin production
- Improve skin thickness and elasticity
Unlike fillers, they don’t add volume but rather improve skin quality from within.
Dark Circles: More Than Just One Cause
Dark circles are often misunderstood because they can have multiple causes, including:
- Shadowing from tear troughs
- Thin skin revealing blood vessels
- Poor circulation
- Pigmentation
Treatment Options:
The best treatment depends on the cause:
- Structural shadows I would use dermal fillers
- Thin skin & poor circulation I would consider polynucleotides, exosomes
- Pigmentation I look into targeted skincare and treatments
Advanced Treatments:
- Nano fat transfer: naturally uses your body’s own stem cell from your own fat to improve skin quality
- Exosomes: innovative approach to promote cellular repair and regeneration
- Improve microcirculation and skin brightness
The Role of Skincare in Under-Eye Health
While treatments can deliver dramatic improvements, daily skincare plays a crucial supporting role.
Think of skincare as maintenance, a way to help prolong and enhance the results of in-clinic treatments and future protection.
Key Ingredients to Look For:
Demani Skincare Refine Eye Serum containing Retinol:
- Refine Eye Serum stimulates collagen production
- Improves skin texture over time
Hyaluronic Acid Moisturiser (Demani Skincare: Quench):
- Quench from Demani Skincare hydrates and plumps the skin
- Reduces the appearance of fine lines
- Helps soften shadows temporarily
Targeted Eye Products:
Medical-grade eye serums like those found in Demani Skincare can help maintain skin quality and hydration, especially when used consistently.
Why a Combination Approach Often Works Best
In many cases, under-eye concerns are not caused by just one issue. For example:
- You may have hollowness + loose skin
- Or bags + skin laxity
- Or tear troughs + dark circles
This is why the best results often come from a combination approach, such as:
Skincare for maintenance
Fillers for volume loss
Surgery for fat protrusion
Skin boosters for skin quality
Key Takeaway: The Right Treatment Makes All the Difference
One of the most important things to understand is this:
- Using fillers for eye bags or loose skin can make them worse
- Choosing surgery for simple hollowness is often unnecessary
- Treating the wrong issue leads to poor results
A tailored, expert-led approach is essential.
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