Dark Circles Treatment

What is dark circle treatment?
Tired of seeing those dark, puffy circles under your eyes even after a good night’s sleep? Dark circles can be caused by a variety of eyelid issues, and a proper examination by Dr. Nithya and Dr Sreekar can better help determine how we can help you. Some treatment options may require surgery, while others may require minor procedures or treatment.

Dark circles or under eye bags can be caused by several factors and each one has different ways of correction. We will discuss your diagnosis and treatment options during your consultation in Contura Clinic.

Causes of dark circles include:
Hollowing or volume loss of the lower eyelid, which includes the tear trough area as well. Volume loss often occurs with age. Often the midface and cheek area also undergo volume loss
Prominent lower eyelid fat pockets (bulging fat pockets, eye bags)
Hyperpigmentation of the skin (which can be caused by certain medications or genetic predisposition).
Thin skin allowing the underlying muscle and blood vessels to show.
Underlying allergies or Acne Rosacea

What are the different approaches to dark circle treatment?
Dr. Sreekar specializes in eyelid surgery and Dr Nithya in non-surgical eyelid rejuvenation. During the consultation, Dr. Nithya will determine which procedure, either surgical or non-surgical, will work best for you and your under eye dark circles.
Treating Dark Circles
Cosmetic and Plastic surgeon, Dr. Sreekar will determine the best form of treatment based on the underlying cause. Based on the treatment suggested by both doctors, it is important for the patient to understand that each treatment caters to a specific cause.

Under Eyes Dark Circles Treatment

Prominent fat pads (fat pockets, eye bags)

When lower lid fat pockets are prominent, they can result in bulges in the lower eyelid which can often look like large dark circles. Lower lid blepharoplasty is a surgery that is recommended to remove the excess or prominent fat pockets. A blepharoplasty is a type of eyelid cosmetic surgery, and Dr. Sreekar uses the latest advanced techniques to help refresh your look while providing a natural looking result. Dr. Sreekar uses minimally invasive techniques to help you to heal properly in order to return to your routine normal activities.

When the patient has both prominent fat pads and lower lid hollowing (volume loss), Dr. Sreekar will also perform fat repositioning during the blepharoplasty surgery. By not remove all the excess fat, Dr. Sreekar can mobilize and reposition some of it to help improve areas of volume loss along the infraorbital rim. If patients have significant volume loss around the midface and cheek area, Dr. Sreekar can also perform fat grafting to help improve those areas of volume loss.
Lower eyelid blepharoplasty is also known as eyelid surgery to fix dark circles and remove bags underneath the eyes. Although this procedure is primarily to remove the excess fat beneath the eye, it can improve the dark pigmentation as well.
There are two approaches:

1) Transconjunctival: This scar less technique makes an incision in the lower lid which provides direct access to the fat pockets. Theses fat pockets can either be removed by sculpting or, if Dr. Sreekar thinks so, repositioned. Repositioning (or transposing) helps distribute some of the excess fat into areas that may have volume loss, such the infraorbital rim (ie tear trough area). Chemical peels or laser treatment may be necessary when the patient has excessive wrinkles or mild excess skin.

2) Transcutaneous: In cases where both excess fat and skin need to be directly removed, Dr. Sreekar will use this approach. Here Dr. Sreekar will directly remove excess lower lid skin and excess fat at the same time. He performs this procedure in patients that have moderate to severe extra skin where skin resurfacing (ie laser or chemical peels) will not help much.

Volume loss along the infraorbital rim (tear trough deformity)

Dark circles can result from hollowing or volume loss along the lower eyelid area. The hollowing results in a concavity or a “trough” which appears like a dark area due to the shadowing effect. Filling of the lid-cheek junction and the midface with some form of dermal filler is typically what takes place to treat hyperpigmentation. Fillers can be synthetic such as hyaluronic acid agents or actually acquired from the patients themselves using fat grafting taken from their abdominal fat. Dr. Sreekar will consider fat grafting in selected cases of severe volume loss; otherwise, he prefers using hyaluronic acid fillers since they are very predictable, reversible and performed in the office.

Fillers injected to the lower lids can certainly help improve the volume deficiency people get with aging, and also improve dark circles. Fillers may even help improve the hyperpigmentation that is often present in such cases.
Injectable fillers to the lower lids are performed in the office with the assistance of a topical anesthetic cream. The procedure can take as little as 30 minutes and patients usually go home afterward without any problems. Swelling usually sets in that evening or the following day, and most of the swelling improves by several days in most cases. Dr. Sreekar uses a blunt-tipped cannula for his eyelid injections due to ease of use for patient comfort, safety, and decreases the rate of bruising. Although patients are told that bruising can occur, the rate can be reduced with the use of blunt-tipped cannulas.
Some patients are comfortable during the procedure with just the use of a topical anesthetic.


Treatment may involve the use of professional skin bleaching or brighteners. Hydroquinones work well for short periods of time, often in cases where a daily skin brightener is needed, Dr. Nithya and his staff will provide recommendations for other non-hydroquinone skin brighteners.

Thin Skin

Patients with thin skin may benefit from a combination of treatments if they also have volume loss or excess fat pockets. The thin skin can sometimes allow the underlying blood vessels around the fat pockets to be translucent, hence ‘darkening’ the skin. In such cases, Dr. Nithya may recommend a combination of treatments such as injectable fillers to improve the hollowing along with a chemical peel, or a blepharoplasty surgery to remove the excess fat pockets with a chemical peel. Chemical peels can help tighten the lower lid skin and increase collagen formation. Chemical peels do well in patients with mild skin pigment changes or light wrinkles (rhytids) which may be the result of natural age-related changes.

Allergies or Rosacea

Allergies can result in fluid accumulation around the eyelids, eye bags, and dark circles. It is important to identify this since surgery or fillers or other treatments will further worsen the problem. Rosacea around the cheeks and midface area can also result in dark circles and swelling.

Who are the best candidates for dark circle treatments?

The best candidates for dark circle treatment are individuals who are in relatively good health and have a realistic idea of what the procedure can do for them. Those that have excess fat pockets and/infraorbital rim volume loss can benefit from either surgery or in-office procedures. Most patients can undergo some type of treatment (whether surgery or non-surgery) and see some sort of improvement.

What are the non-surgical treatment options for Dark Circles?
Lasers: Q-Switched ND-Yad and CO2
Chemical peels
Medical treatment
Vitamin C serum
Other customized combinations depending on the individual

Watch Dr. Nithya Raghunath speaking about her treatment methods for Dark Circles at the prestigious IMCAS World Congress in Paris