Dark Circles & Tired Eyes: What Actually Works for the Under-Eye Area?
“I look tired even when I've slept.”
It is one of the most common concerns we see in clinic.
The difficulty with treating the under-eye area is that dark circles aren't one single problem.
Two people can both complain about tired-looking eyes but have completely different underlying causes, which means they need completely different treatment plans.
What causes dark circles under the eyes?
There are several possibilities.
Hollowing and volume loss
The area underneath the eye naturally changes with age.
Loss of volume and structural support can create a hollow or shadow, making the eye look darker even if the skin itself isn't particularly pigmented.
Thin or crepey skin
The skin around our eyes is naturally thin.
As collagen levels change with age, it can become thinner and more crepey, making underlying structures and blood vessels more visible.
Pigmentation
Some patients genuinely have increased pigmentation around their eyes.
This may be influenced by genetics, skin type, sun exposure and inflammation.
Vascular darkness
Blood vessels beneath thin under-eye skin can contribute to a blue, purple or darker appearance.
Puffiness and eye bags
Sometimes the issue isn't a hollow at all.
Prominent fat pads or fluid retention can create bags beneath the eyes, with shadowing underneath making the area appear darker.
And, frustratingly, many patients have more than one of these things happening simultaneously.
Why eye cream can't fix every dark circle
I absolutely believe in good skincare, but we also need realistic expectations.
An eye cream can improve hydration and may contain ingredients targeting pigmentation, fine lines or skin quality.
It cannot replace significant lost volume or remove an anatomical eye bag.
Equally, an injectable treatment cannot correct every type of pigmentation.
The first step is therefore establishing what we're actually treating.
What are polynucleotides for the under eyes?
Polynucleotides have become an increasingly popular treatment for the eye area.
Rather than using them to create volume in the way we would use traditional dermal filler, we use polynucleotides with the aim of improving skin quality and supporting regenerative processes within the skin.
I particularly consider them where the under-eye skin appears:
Thin
Crepey
Poor in quality
Fine-lined
Tired
They're a useful option for patients who want to improve the quality of the under-eye area without adding significant volume.
What is Sunekos?
Sunekos is another injectable treatment we use for the under-eye area.
It combines hyaluronic acid with amino acids and is designed to support extracellular matrix and skin quality.
Depending on the patient's presentation, we may consider Sunekos, polynucleotides or a treatment plan involving different approaches.
The important thing is that we aren't simply injecting every tired-looking eye with the same product.
What about tear trough filler?
Tear trough filler can be effective in carefully selected patients where genuine hollowing and volume loss are responsible for the tired appearance.
However, it isn't appropriate for everybody.
In patients with significant puffiness, certain anatomy or poor lymphatic drainage, filler can potentially make the area look worse.
This is why I don't believe that every under-eye hollow should automatically be filled.
Sometimes treating the surrounding midface, improving the skin quality or choosing not to inject the tear trough at all produces the better result.
Can Botox treat tired eyes?
Botulinum toxin can soften certain lines around the outer eye, such as crow's feet, but it doesn't treat the underlying causes of most dark circles.
Again, the treatment has to match the concern.
What is the best treatment for dark circles?
There isn't one.
If your problem is skin quality, we might discuss polynucleotides or Sunekos.
If it is true structural hollowing, carefully selected filler may be appropriate.
If it is midface volume loss, supporting the cheek may be more effective than injecting directly beneath the eye.
If it is pigmentation, we need to assess the cause and consider skincare or other appropriate treatments.
And if the issue is significant eye bags, aesthetic injectable treatments may not be the right solution at all.
Why consultation matters with under-eye treatment
The eye area is anatomically complex, and it is one area where I think careful patient selection is particularly important.
Rather than booking a particular treatment because you've seen it on Instagram, come to us with the concern:
“My eyes make me look tired.”
Our job is then to work out why.
At Dr Emma Medispa in Hale and Knutsford, Cheshire, our medical team offers a range of approaches to under-eye concerns, including polynucleotides and Sunekos.
We will always recommend treatment according to your anatomy and skin, and if we don't think an injectable treatment will improve your concern, we will tell you.
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