Eye bags and dark circles: why they appear and which treatments actually work

What is the difference between under-eye bags and dark circles?

Although we use both terms constantly, they describe different phenomena. A dark circle is essentially an alteration in the appearance or color of the region beneath the eye: it can look brown, purplish, bluish, grayish, or simply dark.

An under-eye bag, on the other hand, describes a protrusion or increase in volume of the lower eyelid. It can be caused by prominent orbital fat, transient fluid retention, tissue laxity, or a combination of these factors.

And there is a third extremely common situation: the tear trough. In English it is called the tear trough. It is an anatomical depression that begins near the inner corner of the eye and descends toward the infraorbital region. That hollow can create a shadow, and our brain interprets that shadow as a dark circle. Therefore, we can have a dark circle without actually having a significant excess of pigment.

Why do dark circles appear?

There is no single cause of dark circles. In the majority of patients they are multifactorial. Among the main mechanisms we find pigmentation, visible vascularization, thin skin, infraorbital hollowing, anatomical shadows, skin laxity, inflammation, edema, and genetic predisposition.

This is precisely why buying a cream simply because it says 'anti-dark circle eye contour' may work modestly for one person and do absolutely nothing for another. They are trying to treat biologically different problems with the same product.

Are there different types of dark circles?

Yes, and this classification is far more useful than simply talking about 'dark circles.' We can divide them practically into pigmentary dark circles, vascular dark circles, structural dark circles, and mixed dark circles. Most people present some degree of combination, and scientific reviews consistently emphasize that identifying the dominant mechanism is essential for selecting the right treatment.

What is a pigmentary dark circle?

It is one in which there is a real increase in skin pigmentation. It usually has a brown, brownish-gray, or dark brown tone, and there may be a significant genetic predisposition. It can also appear or worsen due to sun exposure, inflammation, dermatitis, repeated rubbing of the eyes, and post-inflammatory hyperpigmentation.

Atopic dermatitis and certain periocular contact dermatitis conditions can promote this pigmentary component. In these patients, indiscriminately filling the tear trough with hyaluronic acid does not eliminate the pigment, because the main problem lies in the skin.

What are vascular dark circles?

The skin of the lower eyelid is extraordinarily thin, which allows structures situated beneath it to become visible by transparency. Vascularization and the orbicularis muscle can contribute to a bluish, purplish, or reddish appearance. The thinner and more translucent the skin, the more visible what lies beneath can be.

That is why some people have had dark circles since they were very young. It does not necessarily mean they sleep poorly: it may simply be their anatomy.

What is a structural dark circle?

Here the problem is not fundamentally about color, but about geometry. When there is a deep tear trough, light casts a shadow beneath the eye, and that shadow visually creates a dark under-eye circle. If we illuminate the face from a different angle, the darkness can diminish considerably.

This small observation helps us understand something: we are not treating a pigment spot, we are treating a change in volume and anatomy. Loss of volume in the infraorbital region and the mid-facial third can accentuate this phenomenon with age.

Why do under-eye bags appear?

To understand under-eye bags, we need to talk about anatomy. Inside the orbit there is fat, and that fat is completely normal: its functions include, among others, protecting and supporting the structures of the eye. In the lower eyelid there are fat compartments contained by support structures.

With aging, changes can occur in the skin, muscle, ligaments, orbital septum, fat, bone, and tissues of the mid-facial third. The result can be that the orbital fat becomes more prominent toward the front: this is what we commonly see as bags beneath the eyes.

So, are bags made of fat?

Very often yes, to a large extent, but not always. A bag can have different components: prominent orbital fat, edema, excess skin, muscular and ligamentous laxity, or a combination. That is why two patients who say 'I want to get rid of my bags' may need completely different treatments.

Why do some people have bags from a young age?

Because aging is not the only cause. Facial anatomy has an important hereditary component. A person can present, from a relatively young age, prominent fat compartments, marked tear troughs, a particular bone structure, or a lid-cheek transition that visually favors the appearance of bags.

That is why we see patients of 25 or 30 years old with evident structural bags, and much older people without them.

Does sleeping little cause dark circles?

It can worsen their appearance, but saying that dark circles appear simply because 'you don't sleep enough' is incorrect. Lack of sleep can make the face look more tired and can favor certain vascular changes or edema.

But if a person has genetic pigmentation, a deep tear trough, very thin skin, or orbital fat protrusion, sleeping eight hours is not going to modify that anatomy. That is why we come across people who say: 'I sleep perfectly and I always look tired.' And they are right.

Why are bags worse in the morning?

When a bag changes considerably in size throughout the day, we should think of an edematous component. During the night we spend hours in a horizontal position, and temporarily more fluid can accumulate in certain facial tissues. That is why some people wake up with puffier eyelids that subsequently improve during the day.

In contrast, a structural bag caused primarily by fat tends to remain much more stable. This difference is very useful.

Do you wake up with eye bags even though you sleep well? Causes, diseases and treatments

Can salt worsen under-eye bags?

In predisposed individuals, a high sodium intake can promote fluid retention. Alcohol, certain medications, allergies, sleep disturbances, and other conditions may also contribute.

But, again, reducing salt does not eliminate an orbital fat hernia. We need to distinguish between fluid retention and anatomy.

Can allergies cause dark circles?

Yes, they can contribute. Congestion, periocular edema, and especially repeatedly rubbing the eyes can promote inflammation and pigmentation. In people with atopic dermatitis or periocular contact dermatitis, post-inflammatory hyperpigmentation may also be present.

That is why, when there is itching, flaking, irritation, tearing, rhinitis, or constant rubbing, before carrying out any cosmetic treatment we should ask ourselves: is there an inflammatory or allergic condition that we need to treat first?

Can dark circles indicate anemia?

This is an extremely common question. A person with anemia may present with pallor, fatigue, shortness of breath, or other symptoms, and the contrast between paler skin and the periocular region can make dark circles more visible. But having dark circles does not automatically mean having anemia.

I do not recommend ordering extensive laboratory panels simply because a person has had a genetic dark circle for twenty years. However, if they appear alongside fatigue, pallor, hair loss, heavy periods, weight loss, or systemic symptoms, then a targeted medical evaluation may indeed be indicated.

How do you get rid of under-eye bags?

That is the big question, and the answer is: first you need to find out what type of bag is present. If oedema predominates, we can act on the factors that promote it. If cutaneous laxity predominates, we can consider treatments aimed at skin quality. If there is volume loss and a groove, we can explore volume-replenishment strategies in selected patients.

But if there is a truly significant protrusion of orbital fat, no cream is going to anatomically eliminate that fat. In these patients, surgery may be the most definitive treatment. A systematic review published in 2026 concludes precisely that surgery is the preferred option when herniated fat and certain lower-eyelid support alterations predominate.

What can eye contour creams actually do?

There is a great deal of marketing in this area. A good eye contour cream can hydrate, temporarily improve texture, reduce the appearance of fine lines caused by dehydration, improve certain pigmentary components, and — depending on its ingredients — produce specific effects on skin quality.

A 30-year review of the literature on topical treatments found benefits with various formulations, although the studies are heterogeneous and treatment should be chosen according to the cause of the dyschromia. But we must understand their limitations.

Can a cream eliminate a fat bag?

No. If there is true orbital fat protrusion, a cream cannot physically push that fat back inside the orbit. It does not matter whether the packaging says "lifting," "surgery-like effect," "puffiness reducer," or "360° rejuvenation."

It may improve the skin overlying the area, but it cannot perform a chemical blepharoplasty.

What about caffeine?

Caffeine appears in numerous eye-contour products. It can produce transient effects on the appearance of certain dark circles or edema, thanks to its vascular and formulative properties.

But it does not modify a deep tear trough, orbital fat protrusion, or a significant excess of skin. That is why it may be useful in certain patients, but we should not expect it to change the anatomy.

Does cold work for puffiness?

It can temporarily reduce edema and the sensation of swelling. That is why a cold compress can improve the appearance of predominantly edematous puffiness. But the effect is temporary.

And, once again, cold does not eliminate orbital fat. A cold spoon can reduce swelling; it cannot remodel the orbit.

What treatments work for dark circles?

It depends on what 'dark' actually means. If there is superficial pigmentation, we can consider — depending on the patient — photoprotection, certain depigmenting agents, carefully selected retinoids, peels, lasers, or specific technologies.

The systematic review on periorbital hyperpigmentation found that topical treatments and peels can be useful when pigment predominates, while certain laser technologies can provide variable improvement in pigmentary and vascular components. But periocular skin is extremely delicate, and that is why I do not recommend indiscriminately applying aggressive depigmenting products around the eye.

Does photoprotection also matter for dark circles?

Yes, especially when there is a pigmentary component. Ultraviolet radiation can promote melanogenesis, photoaging, and pigmentary changes. Photoprotection is therefore part of the strategy in patients with pigmentary dark circles.

We must also remember that in higher phototypes there is a greater risk of post-inflammatory hyperpigmentation. This is especially important when we are considering peels, lasers, or irritating procedures. A specific systematic review in phototypes IV–VI confirms precisely the need to tailor periorbital hyperpigmentation treatments to the individual's phototype.

Can hyaluronic acid remove dark circles?

It can improve certain structural dark circles, particularly when there is volume loss or a tear trough. The goal is not to "lighten the dark circle" but to modify the anatomical transition and the shadow.

By softening the hollow, we can achieve a different distribution of light, making the eye appear less sunken, less tired, and more even. Systematic reviews find that fillers can be especially useful when the dominant problem is volume loss.

So should every tear trough be filled?

No, and this point is critically important. The periocular region is one of the areas where selecting the right patient matters more than simply knowing how to inject.

If there is significant fat herniation, edema, poor structural support, a tendency to retain fluid, or certain anatomical characteristics, adding volume can actually worsen the appearance. That is why a bag is not automatically treated by filling beneath it.

Does hyaluronic acid around the eye carry risks?

Yes, like any medical procedure. It can cause edema, bruising, irregularities, asymmetries, the Tyndall effect, excessive persistence, or aesthetically unnatural results. And, although infrequent, vascular complications from facial fillers can be serious.

That is why treatment of the tear trough should not be trivialized as 'a small injection': it requires anatomical knowledge and a correct indication.

What role do polynucleotides play?

Polynucleotides are increasingly used to improve skin quality, texture, fine lines, and the periocular region. The 2026 systematic review includes polynucleotides among current strategies for the infraorbital region and highlights their interest primarily in aspects related to skin quality and texture.

But we must be very clear: a polynucleotide does not eliminate fat herniation, does not replace a blepharoplasty, and cannot correct a deep structural tear trough on its own. It may have an indication when the target is the skin.

What about PRP or PRF?

Platelet-rich plasma and other autologous preparations have been studied for skin quality, texture, pigmentation, and periocular rejuvenation. Promising results exist, but the evidence is heterogeneous and protocols vary considerably between studies.

The 2026 review includes them within the available arsenal, but once again emphasizes selecting treatment according to the dominant anatomical mechanism. We must not turn 'regenerative' into a synonym for 'works for everything.'

What about lasers?

They can be particularly interesting when we want to address pigmentation, certain vascular components, texture, fine lines, or photoaging. But not all lasers do the same thing.

A systematic review of light-based treatments for periocular hyperpigmentation found different results depending on the technology and the target; fractional lasers such as CO₂ or Er:YSGG may be useful when the additional aim is to improve texture, wrinkles, and skin density. The choice depends on phototype, type of pigmentation, skin quality, depth, risk of hyperpigmentation, and the therapeutic goal.

Can CO₂ laser improve the eye contour?

In correctly selected patients it can improve fine wrinkles, skin texture, certain degrees of superficial laxity and photoageing. The laser produces a controlled thermal injury that initiates processes of repair, remodelling and neocollagenesis.

But we must not attribute to it capabilities it does not have. If the main problem is significant fat protrusion, improving the overlying skin does not eliminate that fat.

What happens when we have both a bag and a tear trough at the same time?

It is extremely common. Imagine a fat prominence and, immediately below it, a hollow. The upper part reflects light; the lower part casts a shadow. The contrast between the two makes the bag appear even larger.

This is why modern lower eyelid rejuvenation does not simply consist of 'removing fat'. We must analyse the orbit, the eyelid, the tear trough, the cheekbone, the volume of the mid-facial third and skin quality together.

When is blepharoplasty the most appropriate treatment?

When there is true orbital fat protrusion, significant laxity, excess skin or certain structural changes of the lower eyelid, lower blepharoplasty may be the most appropriate treatment. It can allow certain fat compartments to be removed, repositioned or redistributed, and the excess skin to be addressed according to the patient's anatomy.

In certain techniques, rather than removing fat excessively, the aim is to reposition it in order to soften the transition between the eyelid and the cheek. This is important because removing too much volume can produce a hollowed appearance.

Does blepharoplasty eliminate dark circles?

Not necessarily. If the darkness is caused primarily by the shadow secondary to the bags, it can improve enormously. But if there is true cutaneous hyperpigmentation, surgery does not automatically eliminate the pigment. Once again, the diagnosis determines the outcome.

How do we know what treatment a person needs?

I prefer to break the problem down into questions: is there pigment? Are there visible vessels? Is there oedema? Is there fat protrusion? Is there a tear trough? Is there volume loss in the mid-facial third? Is there excess skin? What is the skin quality like? Is there a dermatitis? What is the phototype?

This approach aligns with modern reviews, which recommend an evaluation based on anatomy, colour, laxity, fat and tissue quality before selecting a procedure. Only afterwards do we ask: what treatment should we carry out?

Why do some dark-circle treatments look artificial?

Because sometimes there is an attempt to fill a wrong diagnosis. If every dark circle receives hyaluronic acid, every bag receives a machine, every pigmentation receives a laser and every wrinkle receives an injectable, we will end up treating products instead of patients.

The periocular region needs diagnosis before treatment, above all else.

What treatments can be combined?

When several components are present, treatment can be carried out in stages. For example, a patient may need to address pigmentation, skin quality, volume, and laxity in different ways. This does not mean we have to perform five procedures.

It means we must identify which problem is truly responsible for the greatest part of the appearance that concerns the patient, and start there.

When should a bag under the eye not simply be considered cosmetic?

When swelling appears suddenly, only on one side, with pain, significant redness, fever, changes in vision, protrusion of the eye, or difficulty moving the eye, we are not talking about a conventional cosmetic consultation: it requires medical evaluation.

Likewise, persistent periocular oedema may require us to assess, depending on the context, allergies, inflammatory conditions, medications, or systemic disorders.

So what is the best treatment for bags and dark circles?

There isn't one — and that is precisely the most important answer. Pigment requires treatment directed at the pigment; the vascular component needs to be assessed as such; thin or wrinkled skin needs improvement in skin quality; the tear trough requires evaluation of structure and volume; oedema requires discovering why fluid is accumulating; prominent orbital fat may require surgical treatment; and a mixed problem may require a combined strategy.

The most recent systematic review, which analysed 50 studies, reaches exactly this conclusion: there is no universal technique; the best results depend on identifying the anatomy and the mechanism responsible in each individual patient.

What do I want you to remember before buying another eye cream?

That a dark circle is not a diagnosis, and neither is a bag: they are visible signs. Behind them there may be pigmentation, blood vessels, inflammation, oedema, thin skin, volume loss, fat, laxity, or simply an inherited anatomy.

And each of these causes requires a different solution.