Skip to content 
Skin Condition · Kensington, London
Under-Eye Pigmentation and Hollowing: The Three Causes of Dark Circles
Dark circles have three causes that look almost identical: pigment held in the eyelid skin, blue-grey shadowing from vessels showing through skin thinner than anywhere else on the body, and a genuine hollow where the orbital rim and fat pad have receded. Most people have some combination of the three, and each part answers to something different.
- Pigment, shadow and hollow separated
- Assessment before any treatment
- Kensington Church St clinic
- Medically reviewed by Dr Prasad
This page sets out how dark circles, under-eye pigmentation and hollowing are assessed and managed at Faciem, and is reviewed for clinical accuracy.
Last reviewed: 14 September 2026.
Patient information only. Dark circles have several causes that need quite different treatment, and any plan follows a face-to-face consultation with Dr Prasad.
Patients since 2019
Procedures
Satisfaction
On this page:
TL;DR
Dark circles are produced by three separate mechanisms. True pigmentation is melanin in the eyelid skin, usually inherited or left behind by eczema or a contact allergy. Vascular shadowing is the blue-grey tint of veins seen through skin thinner than anywhere else on the body. Structural hollowing is the tear trough deepening as the orbital rim resorbs and the fat pad beneath the lower lid slips downwards. Which one predominates decides what treatment can achieve, so assessment at Faciem Dermatology & Medical Clinic begins by separating the three. Dr Prasad, a GMC-registered doctor, carries out that assessment in person.
- Pigment, shadow and hollow look identical
- Concealer hides all three, treatment does not
- The tear trough is structural, not pigment
About the Condition
What Is Under-Eye Pigmentation and Hollowing?
Under-eye pigmentation and hollowing are two different problems behind the same complaint. Pigmentation is excess melanin held in the eyelid skin itself. Hollowing is loss of volume beneath that skin, where the orbital rim and the fat pad supporting the lower lid recede and cast a shadow. A third cause, vascular shadowing, imitates both.
How to tell pigment, shadow and hollowing apart
True pigmentation is brown, sits within the skin, and holds the same shade whether you are upright or lying flat. Stretching the skin gently does not change it. Vascular shadowing is blue, purple or grey, deepens with tiredness, dehydration and nasal congestion, and often lightens once you lie down and the vessels drain. Structural hollowing is a groove instead of a colour: a defined trough running outwards from the inner corner of the eye, deepest under overhead lighting and much less obvious when the light is diffuse or comes from below. Two checks help at home. Hold a lamp below the face — a shadow that disappears is structural, and colour that persists is pigment. Then look again lying down, which drains the vessels responsible for a blue-grey tint.
Who gets dark circles, and at what age
Periorbital pigmentation runs strongly in families and is considerably more common in South Asian, Middle Eastern, Mediterranean and East Asian skin, often appearing in the teens or twenties, long before any ageing change. Skin tone is recorded on the Fitzpatrick scale, I to VI, at the first appointment, because it changes what the eye area can safely be treated with. Fitzpatrick IV to VI skin is more likely to hold true pigment around the eyes and can be treated, but peel strength is kept lower, contact time shorter and any laser wavelength, fluence and spacing adjusted, with a patch test carried out first — the risk being managed is post-inflammatory pigmentation, which in this skin can be darker and longer-lasting than the shadow that prompted treatment. Vascular shadowing shows up most in fair, thin skin, and in anyone with hay fever, chronic nasal congestion or eczema who rubs the area habitually. Structural hollowing is age-related and usually becomes noticeable from the mid-thirties, although a deep tear trough can be inherited and present since childhood. Weight loss and anything else that reduces facial fat make it more obvious. In children and teenagers the cause is almost always inherited pigmentation or allergy. Most people who reach a clinic have two of the three at once, which is why a single treatment so often disappoints.
What dark circles are often mistaken for
Dark circles are usually blamed on tiredness. Sleep does change how the area looks, but it rarely explains a shadow that has been there for years. Under-eye puffiness is a separate problem: a fluid or fat bulge that casts its own shadow above the tear trough, and treating that as a hollow makes it worse. Puffiness that is marked first thing and settles by midday tends to be fluid, while a bulge present all day is more likely to be fat. Eyelid eczema or a contact allergy to eye cream, mascara or nail varnish leaves the lids dark, slightly scaly and itchy until the trigger is removed. Sun-related hyperpigmentation can extend from the upper cheek onto the lower lid. Thyroid disease and certain medicines also alter the area, so the history matters as much as the examination.
Causes & Contributing Factors
What Causes Dark Circles & Under-Eye Hollowing?
Dark circles are caused by pigment, blood vessels and lost volume acting together in varying proportions. Eyelid skin is the thinnest on the body, so anything beneath it shows through readily, and anything that inflames or rubs it tends to leave a mark. Genetics set the starting point for most people.
Genetics and skin tone
Periorbital pigmentation is frequently inherited and more common in deeper skin tones, where melanocytes around the eyes deposit pigment readily. It often appears in the teens or twenties and has nothing to do with sleep or ageing.
Thin skin over blood vessels
The skin of the lower lid is the thinnest on the body, and the veins beneath it may show through as a blue or grey tint. Tiredness, dehydration and nasal congestion make those vessels more prominent, which is why the area looks worse on some days than others.
Volume loss and bone change
With age the orbital rim resorbs and the fat pad supporting the lower lid shrinks and slides downwards, deepening the tear trough. The resulting groove casts a shadow that reads as a dark circle even where the skin holds no extra pigment at all.
Rubbing, eczema and allergy
Habitual rubbing driven by hay fever, eyelid eczema or a contact allergy to a cosmetic inflames the thin skin and can leave post-inflammatory pigmentation behind. That pigment often outlasts the rash by many months.
Sun exposure and lifestyle
Ultraviolet light darkens eyelid skin as it does anywhere else, and the eye area is routinely missed when sunscreen is applied. Smoking, broken sleep and alcohol worsen vascular shadowing, though they rarely cause dark circles on their own.
Treatments We Offer
How Dark Circles and Under-Eye Hollowing Are Treated at Faciem
Treatment for dark circles follows whichever mechanism is responsible. Pigment answers to topical treatment and cautious resurfacing. A structural hollow answers to replacing volume. Vascular shadowing is the most stubborn of the three and improves least, so an honest account of what each option can achieve comes before anything is booked.
01
Medical-Grade Skincare
Prescription-strength topical treatment reduces melanin production in the eyelid skin and thickens it a little over time, which makes the underlying vessels slightly less visible. Faciem dispenses ZO Skin Health preparations, including vitamin C and retinol, alongside daily sun protection across the whole eye area so pigment is not replaced as fast as it clears.
Best for: true pigmentation and thin, sun-exposed lid skin
Read about Medical-Grade Skincare
02
Tear Trough Filler
Tear trough filler replaces lost volume in the hollow beneath the lower lid so the groove stops casting a shadow. Juvederm Volbella is the product used at Faciem for this area. It is technically demanding, with real risks, and suits a clearly structural hollow — not pigmentation, and not puffiness.
Best for: a defined hollow that disappears under diffuse light
Read about Tear Trough Filler
03
Chemical Peels
A carefully chosen superficial peel can lift established pigment from the lower lid alongside topical treatment. Strength and depth are limited by how thin the skin is here, and the preparation beforehand matters more than it does elsewhere on the face.
Best for: established pigmentation alongside skincare
Read about Chemical Peels
Platelet-rich plasma, prepared from a sample of your own blood, is also used at Faciem to improve lower-lid skin quality. Where puffiness is the problem, filler is not the answer and makes the bulge more obvious. Sequence, suitability and timing are settled at a consultation with Dr Prasad that also covers diet, lifestyle and any skin condition affecting the lids. Results vary between individuals.
When to Seek Medical Advice
When Should You See a Doctor About Dark Circles?
See a doctor about dark circles before buying another eye cream, because the three causes look alike and only one of them responds to a cream. Seek advice sooner if the lids are itchy, swollen or scaly, or if the darkening appeared over weeks.
Worth getting checked
- Darkening that appeared over a few weeks, not gradually across years
- Itchy, flaking or swollen eyelids, which suggest eczema or a contact allergy
- Persistent puffiness, particularly first thing in the morning or with swelling elsewhere
- A dark or raised area affecting one eye only, when the other side is unchanged
Conditions that can look similar
- Eyelid eczema, contact allergy to cosmetics, melasma extending from the upper cheek onto the lower lid, and the wider ageing changes around the eyes can all present as dark circles. Persistent swelling sometimes reflects a thyroid, kidney or allergic cause and nothing cosmetic at all. Any lesion in the area that is changing, bleeding, spreading or failing to settle should be examined in person before cosmetic treatment is considered.
Self-Care & Prevention
What Helps Dark Circles at Home?
Sun protection and leaving the area alone do more for dark circles than most eye creams manage. Eyelid skin is thin, easily inflamed and routinely missed when sunscreen goes on, and habitual rubbing is one of the commonest reasons pigmentation becomes established around the eyes.
Do
- Extend SPF 50 to the eyelids and orbital rim every morning, reapplied every two hours in strong sun
- Start hay fever treatment two to four weeks before your usual season, since congestion drives rubbing and shadowing
- Patch test a new eye product on the inner forearm for five days before it goes near the lids
- Sleep on an extra pillow for two to three weeks if the area is puffier first thing
Avoid
- Rubbing the eye area — a daily habit can darken it within three to six months
- Strong acids, high-strength retinoids and scrubs on the lower lid; stop them five to seven days before any treatment here
- Unregulated skin-lightening creams bought online, which can thin eyelid skin in a matter of weeks
- Judging the area under overhead light only — check it twice, once by a window and once with a lamp held below the face
General guidance only, not individual assessment: what suits the skin around your eyes depends on which cause predominates and on your skin tone.
Why Patients Choose Faciem
Dark Circles Treated for the Cause, Not the Colour
Under-eye treatment fails most often when the wrong mechanism is treated. Filler placed into pigmentation leaves the colour exactly as it was, and skincare applied to a structural hollow does nothing about the shadow it casts.
- Pigment, vascular shadowing and hollowing separated before anything is planned
- Assessed by Dr Prasad, a GMC-registered doctor, in the lighting that reveals each one
- Honest about the vascular component, which improves least of the three
- Puffiness distinguished from hollowing, because filler makes puffiness worse
Experience & Expertise
Why the Under-Eye Area Needs a Medical Assessment
The lower eyelid is the least forgiving area of the face. The skin is a fraction of a millimetre thick, the anatomy varies considerably between people, and the vessels supplying the eye run close to where filler is placed, which is why tear trough treatment carries risks that treatment elsewhere on the face does not. It is also where a wrong diagnosis shows: filler beneath pigmented skin leaves the colour untouched, and filler beneath a puffy lid makes the bulge stand out. Dr Prasad, a GMC-registered doctor with 20 years’ experience, examines the area in more than one light, separates pigment from shadow from hollow, checks for eczema and contact allergy, and is direct about where improvement is likely to be modest.
- Dr Anamica Prasad — MBChB (1999), Dip Dermatology (2001), MRCGP, DFFP, DRCOG · a GMC-registered doctor
- Member of the Joint Council for Cosmetic Practitioners (JCCP), British Medical Laser Association (BMLA), Royal Society of Medicine and the Aesthetic Complications Group
- Clinic operated by Derma Medical UK Ltd, registered with the Care Quality Commission for diagnostic and screening procedures, surgical procedures, and treatment of disease, disorder or injury · CQC Location ID 1-25573003746
- Face-to-face medical consultation and assessment of the eye area in different lighting
- 20 years’ experience in dermatology and facial aesthetics, including the area around the eyes
Patient Reviews
Rated Excellent by Patients on Google
Dark Circles & Under-Eye Hollowing FAQs
Your Questions, Answered
Dark circles attract more myths than almost any other skin complaint. These are the questions that come up before treatment; anything specific to your own eyes is answered at the consultation.
What causes dark circles under the eyes?
Dark circles have three causes, frequently present together. Pigment in the eyelid skin is commonly inherited, or left behind by eczema, allergy or sun exposure. Veins showing through thin lid skin add a blue-grey tint. A hollow tear trough casts a shadow that reads as darkness. Tiredness makes all three look worse without being the cause of any of them.
Can I wear makeup and concealer after under-eye treatment?
Concealer and eye makeup go back on 24 hours after tear trough filler, and 24 to 48 hours after a peel around the eyes, once the skin has stopped feeling tight. Leave the injection points bare for that first day. After that, take eye makeup off with a soft cleanser and no rubbing, since friction is one of the surest ways to darken this skin, and open a fresh mascara rather than returning to the old one.
Does tear trough filler get rid of dark circles?
Tear trough filler treats one of the three causes: a structural hollow. Replacing the lost volume stops the groove casting a shadow, but it does nothing to pigment in the eyelid skin and makes an existing puffy bulge more obvious. This is a demanding area with genuine risks, so dermal filler treatment follows assessment, and the result is maintained over time.
Are dark circles permanent?
That depends on the cause. Shadowing that varies with sleep, salt, alcohol or hay fever usually settles within days. Pigmentation left by eczema or allergy fades over months once the trigger is removed, and consistent topical treatment with sun protection improves it further, though it can return. Structural hollowing does not resolve by itself and deepens slowly with age.
Do eye creams work for dark circles?
Eye creams address one cause. Topical vitamin C, retinol and prescription-strength preparations can lighten genuine pigmentation over months, and daily sun protection stops it being replaced. Nothing applied to the skin lifts a structural hollow or removes a vein beneath it. Anything that stings or flakes tends to darken the area, so an irritating product should be stopped.
How soon can I go back to work or to an event after tear trough filler?
Most people go back to work the same day or the next after tear trough filler. Swelling in the lower lid is most obvious for the first two to three days, and a bruise, where one forms, takes seven to ten days to fade and can be covered with concealer once the first 24 hours have passed. For a wedding or anything photographed, allow two weeks between the appointment and the date, and four weeks if a review to refine the result is planned.
What decides the cost of treating dark circles?
Cost follows the mechanism and the plan it needs. Pigmentation is managed over months, so it is costed by the products a programme uses; our medical-grade skincare page publishes the consultation fee, and each product is quoted individually when you are seen. A structural hollow is treated by volume, priced from the starting figure on our dermal fillers page, while peel prices are published in full. Your own figure is confirmed in writing before anything goes ahead.
Sources & Further Reading
- Dark circles under the eyes — DermNet NZ
- Contact dermatitis patient information leaflet — British Association of Dermatologists
- Skin ageing — DermNet NZ
These are general patient-information sources and do not replace individual assessment. Your own diagnosis and plan are set out at your consultation with Dr Prasad.
Dark Circles & Under-Eye Hollowing in Kensington, London
A Doctor-Led Clinic in the Heart of Kensington
Assessment of dark circles, under-eye pigmentation and hollowing is available at Faciem Dermatology & Medical Clinic on Kensington Church St, London, led by Dr Prasad. The clinic is a few minutes’ walk from High Street Kensington station and around ten from Notting Hill Gate, with Kensington council underground parking close by. Appointments run Monday to Saturday, 10am–7pm. The eye area is examined in person and in more than one light, because a photograph flattens the difference between a shadow and a stain.
Plan Your Visit
- Faciem Dermatology & Medical Clinic
- Phone: +44 20 7131 3539
- 7 Kensington Church St, London W8 4LF, United Kingdom
- Tube: High Street Kensington (few minutes’ walk) · Notting Hill Gate (~10 minutes)
- Parking: Kensington council underground car park nearby
- Open Monday–Saturday, 10am–7pm · Sunday closed
- Consultations bookable online; treatment planned once the cause is clear
- Consultation-first — no treatment without medical assessment
- Serving Kensington, Chelsea, Notting Hill & Central London
Continue Exploring
Related Conditions & Treatments
Aged Eyes
Hooding, lid laxity and fine lines — the wider changes around the eye that develop alongside a deepening tear trough.
Read more →
Hyperpigmentation
How melanin marks form on the rest of the face, why the types differ, and what makes pigment return after treatment.
Read more →
Wrinkles
Crow’s feet at the outer corner and lines beyond the eye area, and why movement lines and fixed creases need different treatment.
Read more →
Faciem Dermatology & Medical Clinic · Kensington
Find Out Which of the Three Causes Is Yours
Book a consultation with Dr Prasad to establish whether pigment, vascular shadowing or a hollow is behind your dark circles, and what is realistically achievable in an area this delicate.
Prefer to talk? +44 20 7131 3539