Can under-eye hollows and dark circles be improved with procedures?

Dark circles are broadly divided into three types: pigment type, vascular type, and structural type (hollows), and the approach differs completely depending on the type. A simple method is to gently pull the under-eye skin. If the brown darkness remains even when pulled, it is the pigment type; if a red or blue tint shows through, it is the vascular type; if the darkness fades when pulled or when illuminated with frontal light, it is closer to the structural type caused by shadows.

In reality, two or three types are often mixed, and the order and combination of procedures are determined based on which factor is dominant. Differential diagnosis through a consultation is more accurate than self-judgment.

For thin and highly mobile under-eyes, a Skin Booster that helps the skin's own moisture, elasticity, and regeneration is considered first, rather than creating volume.

REJURAN®, which contains polynucleotide (PN) derived from salmon DNA, is widely used for regeneration management of the thin skin around the eyes, to the extent that a separate formulation for the eye area exists. It is typically administered in 3 sessions at 1-month intervals.

Re2O® Fine, which contains acellular dermal matrix (hADM), is a Skin Booster with fine particles that replenishes collagen and is used to improve the elasticity and texture of the skin around the eyes.

JUVELOOK, which induces collagen production, can also be helpful as an adjunct in cases where the skin is thin and blood vessels are visible. However, regardless of the agent, the area around the eyes is anatomically sensitive, so it is important that the formulation choice and injection depth follow the judgment of a specialist.

The Tyndall effect is a phenomenon in which, when hyaluronic acid filler is injected close to the skin surface (too superficial a layer), light scatters off the filler particles, causing the skin to appear bluish. The under-eye area is known to be a representative site where the Tyndall effect is more likely to occur than other areas because the skin is particularly thin.

The key to prevention is avoiding superficial injection and over-injection. If it has already occurred, the affected filler can be dissolved using hyaluronidase, and if necessary, it can be corrected by re-injecting it into a deeper layer. The ability to reverse it is an advantage of HA fillers, but receiving precise treatment from an experienced dermatologist from the start is the best prevention.

Fat repositioning surgery is considered when under-eye fat protrusion is pronounced and the hollow (depression) below it is deep, so that non-surgical methods such as dermal filler or Skin Booster have limited improvement. Fat repositioning is a surgical approach that moves protruding orbital fat to the hollow area to fundamentally flatten the step-off, and is suitable when both protrusion and hollowing are severe.

Conversely, if the main concern is hollowing or skin issues (pigmentation, thinness) without protrusion, non-surgical treatments such as dermal filler, Skin Booster, and laser are considered first rather than surgery. Since the causes of under-eye concerns vary greatly from person to person, we recommend first consulting with a board-certified dermatologist to determine whether the condition can be improved with non-surgical treatments or if a surgical approach is needed.