How to Treat Undereye Concerns (Causes, Care & In-Clinic Options)

The skin under the eyes is thinner and more delicate than other facial areas, which can make it susceptible to a range of concerns. Common issues include dark circles, puffiness, fine lines, and volume loss. These can arise from a variety of factors such as genetics, ageing, lifestyle, and skin sensitivity.

While there are several at-home options available to help manage mild undereye concerns, some issues may require professional assessment and care. In these cases, a clinician can help determine the most appropriate approach based on individual needs, skin type, and medical history.

This article provides an overview of common undereye concerns, general at-home care strategies, and the types of in-clinic treatment options that are commonly considered.

Understanding the Undereye Area

The skin under the eyes is up to 10 times thinner and more delicate than skin on most other parts of the face. It also has less fat, fewer oil glands, and lower collagen levels. These characteristics reduce the area’s natural support and hydration, making it more prone to visible changes.

As a result, the undereye region can show signs of ageing and fatigue sooner than other facial areas. Because the under-eye skin is thin with limited natural support, it often shows signs of fatigue and ageing earlier than other areas. Over time, collagen and elastin decline, which can make hollows, fine lines, and crepey texture more visible.

Anatomy Basics

Understanding thebasic structure of this area helps explain why certain undereye concerns develop and how they can be addressed.

• Tear Trough: This is a groove that runs from the inner corner of the eye toward the middle of the lower eyelid. It is a common area where hollows can appear as the supporting tissues change with age.
• Orbital Structure: The eye sits within a bony socket called the orbit, which is made of several bones. This structure contains the eye, muscles, nerves, blood vessels, and fat pads. The bony rim helps support the area and protect the eye.
• Fat Pads: There are three main fat pads under the lower eyelid (medial, central, and lateral). These pads normally sit in place behind a thin layer of tissue called the orbital septum. Over time, this tissue can weaken, allowing the fat pads to move forward and become more visible, which may appear as undereye bags.
• Lymphatic Drainage: The lymphatic system helps remove fluid from tissues. Unlike the blood circulation system, it does not have a pump and relies on muscle movement to move fluid. If lymphatic drainage is reduced, fluid can build up under the eyes and cause puffiness.

Common Undereye Concerns Explained

Undereye concerns can present in several different ways. Understanding the specific type of concern you have is important because it helps guide both at-home care and decisions about professional treatment. Below are the most common undereye issues:

Dark Circles & Pigmentation

Dark circles can appear for different reasons, and the appearance often depends on the underlying cause:

• Vascular dark circles: These appear as blue or purple in colour and occur when blood vessels are visible through the thin skin under the eyes. They may become more noticeable when you are tired or congested, as poor circulation can increase their visibility.
• Pigmented dark circles: These appear brown or grey in colour and are caused by increased melanin production. Factors such as sun exposure, inflammation, and frequent rubbing of the eyes can trigger this type of pigmentation. Genetics also play a significant role, as dark circles often run in families.
• Shadow-related dark circles: These are not caused by a change in skin colour, but by shadows created by hollows or volume loss under the eyes. The area may appear darker simply because of how light falls on the skin.

Bags & Puffiness

Undereye bags occur when the tissues and muscles supporting the lower eyelid weaken. Over time, the skin may sag, and the fat around the eyes can shift forward, leading to a visible bulge. Fluid can also collect in the area, contributing to puffiness.

Several factors may contribute to puffiness, including:

• Fluid retention from salty foods or dehydration
• Allergies or sinus congestion
• Thyroid conditions
• Genetic predisposition
• Age-related structural changes

Temporary morning swelling is common and often reduces throughout the day. Persistent bags may indicate changes in the structure or support of the eyelid area.

Hollows & Volume Loss

Hollows, sometimes referred to as tear troughs, are sunken areas beneath the lower eyelid. These can occur when soft tissue between the lower eyelid and cheek loses volume or shifts downward.

Common contributing factors include:

• Age-related bone and soft tissue volume loss
• Rapid weight loss
• Dehydration
• Naturally flat cheekbones
• Changes in supporting ligaments over time

Hollows can also make dark circles appear more pronounced due to shadowing.

Wrinkles & Fine Lines

Fine lines around the eyes are common because the undereye skin is thinner and has fewer oil glands and less collagen than other facial areas. The constant motion from blinking also contributes to repeated creasing, which can become permanent over time.

Collagen and elastin decline gradually over time, and sun exposure can accelerate this process. Fine lines may become more noticeable as skin support reduces and repeated movement causes creasing.

Texture (Crepey Skin)

Crepey texture under the eyes is characterised by thin, wrinkled skin that may appear slightly translucent. This occurs because the undereye area has minimal fat padding, limited oil production, and weaker structural proteins.

Factors that can worsen crepey texture include:

• Sun exposure
• Dehydration
• Smoking or vaping
• Poor nutrition
• Frequent rubbing or harsh skincare products

Unlike expression lines, crepey skin typically affects a broader area and may appear evenly distributed across the undereye region.

The Main Causes of Undereye Concerns

Undereye concerns can arise from a combination of factors, and, in many cases, more than one cause contributes to the appearance of dark circles, puffiness, hollows, or fine lines.

• Genetics & Facial Structure: Genetics play a significant role in undereye appearance. Dark circles often run in families, and certain facial features, such as deep eye sockets, thin under-eye skin, or a pronounced tear trough, can create shadows that appear as dark circles. Structural differences may be present regardless of lifestyle or skincare habits.
• Aging, Volume Loss & Fluid Retention: Age-related changes are common contributors to undereye concerns. The skin under the eyes is already thin and becomes thinner over time. Collagen and elastin production also decrease with age, reducing skin firmness. Fat pads and soft tissue can shift or reduce in volume, and bone structure can change, leading to hollows and shadowing. Aging can also affect fluid drainage, contributing to puffiness.
• Sleep and Lifestyle Factors: Sleep deprivation can cause droopy eyelids, increased redness, puffiness, and darker circles. Even short periods of poor sleep can affect skin hydration and elasticity. Lifestyle factors such as alcohol consumption, smoking or vaping, high salt intake, and dehydration can increase fluid retention and make undereye concerns more visible.
• Allergies and Sinus Issues: Allergies and sinus congestion can affect blood flow around the eyes and cause darkening. Frequent eye rubbing, common in allergic conditions, can also irritate the delicate undereye skin and contribute to visible dark circles.
• Pigmentation and Sun Exposure: Sun exposure can increase melanin production, causing darker pigmentation under the eyes. Sun damage also contributes to collagen breakdown, which can make thin skin appear more transparent and make blood vessels more visible.
• Skincare Habits: Rubbing or pulling the undereye skin can stretch and damage the tissue. Harsh products or incorrect application can cause irritation and inflammation. Because the area has fewer oil glands, it is also more prone to dryness and fine lines.
• Medical or Health Factors: Some medical conditions and medications can affect the undereye area, including thyroid disorders, anaemia, kidney or liver conditions, asthma, and certain medications.

At-Home Undereye Care

Managing undereye concerns at home focuses on supporting skin health, reducing inflammation, and addressing lifestyle factors that can worsen undereye concerns. While these strategies may not fully resolve structural or age-related changes, they may help improve the appearance of the area by supporting overall skin health.

• Sleep and Routine Habits: Research shows that inadequate sleep can contribute to droopy eyelids, redness, swelling, and darker circles. Most adults benefit from 7–8 hours of sleep per night to support skin recovery and reduce fluid buildup. Additionally, sleeping with the head slightly elevated can also help prevent fluid accumulation around the eyes.
• Nutrition & Hydration: Adequate hydration may help reduce the appearance of dark circles by supporting skin hydration and reducing fluid retention. Reducing salt intake may help prevent fluid retention and puffiness, while limiting alcohol and caffeine can reduce dehydration. Dietary factors may also play a role. Foods containing vitamin K, such as leafy greens, can support blood vessel health. Vitamin C–rich foods, including citrus and berries, support collagen production for skin structure.
• Sun Protection: Using sunscreen daily can help protect this area from UV damage. Using SPF 30 or higher is generally recommended, and additional protection, such as UV-blocking sunglasses and wide-brimmed hats, can reduce sun exposure further.
• Eye Care Hygiene: Maintaining good eye hygiene helps reduce irritation and the risk of infection. Always wash hands before touching the eye area, and remove eye makeup thoroughly before bed.
• Cold Compress and Lymphatic Drainage: Applying a cold compress for 5–10 minutes can help reduce temporary puffiness by constricting blood vessels and reducing fluid buildup. Similarly, a gentle lymphatic drainage massage may also assist in moving excess fluid away from the undereye area. This can be done using light pressure and slow movements from the inner eye area toward the temples.
• Allergy Management: Allergies can contribute to undereye darkening and puffiness as nasal congestion can reduce blood flow around the eyes, and repeated eye rubbing can cause irritation and visible darkening. Over-the-counter antihistamines, nasal sprays, or eye drops may help manage allergy-related symptoms. For persistent allergies, discussing long-term options with a healthcare professional may be appropriate.

In-Clinic Treatments for Undereye Concerns

When undereye concerns persist despite at-home care, some individuals may consider in-clinic treatments. These options vary in their purpose, intensity, and recovery time. A consultation with a healthcare professional is essential to determine which approach is appropriate.

Under-eye concerns are rarely caused by one factor alone. In many cases, management planning considers the skin (texture and pigment), fat (hollowing or herniation), and muscle/support structures around the periorbital area. This is why assessment looks at the under-eye region as part of overall facial balance, not a single line or shadow in isolation.

Non-Surgical Options

Energy-Based Options (Where Clinically Appropriate)

Depending on the underlying cause (texture, laxity, or skin quality), practitioners may discuss energy-based options such as DOT laser, AGNES, RF microneedling platforms (including Morpheus or Vivace), or resurfacing lasers as part of a broader plan. Suitability varies, and a consultation is required to determine what is appropriate for the individual.

Laser Skin Resurfacing

Laser skin resurfacing is used to address fine lines and texture by supporting skin renewal and collagen remodelling. Where clinically appropriate, options may include erbium laser resurfacing or fractional (pixel-style) laser approaches. Downtime and suitability vary depending on the intensity and the individual’s skin type

Risks and considerations:

• Redness, swelling, and sensitivity after treatment
• Risk of pigmentation changes, particularly in darker skin types
• Sun protection is essential during recovery
• Downtime and recovery time vary based on treatment intensity

Chemical Peels

Chemical peels involve applying a controlled chemical solution to exfoliate the outer skin layers. This may improve skin texture and brightness in the undereye area. Peels vary in strength, and suitability depends on skin type and sensitivity.

Risks and considerations:

• Redness, irritation, or temporary peeling
• Risk of pigmentation changes
• Sun protection is essential during recovery
• Multiple treatments may be needed for noticeable changes

Microneedling

Microneedling uses small needles to create controlled micro-injuries in the skin. The intended effect is to support the skin’s natural repair process and collagen production. Microneedling may be used to address fine lines and skin texture.

Risks and considerations:

• Temporary redness, swelling, or mild discomfort
• Risk of infection if aftercare is not followed
• Results vary and may require multiple treatments
• Not suitable for some skin conditions or active infections

Surgical Options: Blepharoplasty (Eyelid Surgery)

In some cases, undereye concerns are related to structural changes such as excess skin, tissue, or fat that has shifted over time. When this is the case, surgical options may be considered. These procedures are typically performed by a qualified surgeon and involve a formal assessment of anatomy, medical history, and treatment goals.

In some cases, under-eye appearance is influenced by volume loss and structural support, not only excess skin or fat herniation. Where clinically appropriate, a surgical plan may include techniques such as periorbital fat transfer to restore support and soften hollowing as part of an overall rejuvenation strategy.

Overview

Blepharoplasty is aneyelid surgical procedure that can involve the upper eyelids, lower eyelids, or both. It is intended to address excess skin, tissue, or fat in the eyelid area. Where a surgical pathway is appropriate, Absolute Cosmetic Medicine has access to an accredited theatre environment and suitable procedures may be performed under sedation rather than general anaesthetic, where clinically appropriate. This is discussed during consultation as part of suitability, safety planning, and informed consent.

• Upper Blepharoplasty: During upper blepharoplasty, incisions are typically made within the natural crease of the upper eyelid. This allows the surgeon to access and remove or reposition excess skin and fat. The incision is then closed, and the resulting scar is generally concealed within the natural crease.
• Lower Blepharoplasty: Lower blepharoplasty may involve an incision just below the lower lash line or an incision inside the lower eyelid (transconjunctival approach). Through these incisions, the surgeon can remove or reposition excess fat and may also remove excess skin. The choice of approach depends on the specific anatomy and the nature of the concern.

Duration and Recovery

The duration of the procedure depends on whether the upper lids, lower lids, or both are treated. Upper blepharoplasty can typically take around 45 minutes to one hour, while combined upper and lower procedures may take approximately two hours, depending on the extent of work performed.

As with any surgical procedure, recovery is a biological process. Swelling and bruising are expected, and patients must adhere to strict post-operative care instructions.

Upper eyelid stitches are often removed after about one week, while lower eyelid incisions made inside the eyelid may not require stitches. Recovery time varies between individuals, and it may take several weeks for visible swelling to reduce and several months for complete healing.

Possible Side Effects and Risks

As with any surgical procedure, blepharoplasty carries risks which may include:

• Bleeding or infection
• Dry eyes or irritation
• Changes in eyelid position or eyelid shape
• Scarring or abnormal skin healing
• Sensitivity to light or temporary vision changes
• Rarely, more serious complications such as loss of vision

Recovery Considerations

Recovery may include the following:

• Cold compresses to reduce swelling
• Use of ointments or medications
• Avoiding strenuous activity for a period of time
• Follow-up appointments to monitor healing

Patients should follow their surgeon’s instructions closely and report any unusual symptoms or concerns promptly.

Importance of Professional Consultation & Assessment

As undereye concerns arise from a range of underlying causes, a professional assessment is essential. A qualified practitioner will assess the cause of the concern and determine which treatment approaches are appropriate. Each condition requires a different management strategy, and a thorough assessment helps to avoid unsuitable interventions.

A clinical consultation typically involves:

• Medical history review, including previous treatments, medications, and relevant health factors.
• Facial and skin assessment examining the undereye area and surrounding facial anatomy to identify whether issues are related to hollowing, pigmentation, vascular changes, skin laxity, or tissue protrusion.
• Photographic documentation, such as clinical photographs, may be taken from multiple angles to assist in diagnosis and to track changes over time.
• Treatment planning based on anatomical findings, skin type, and overall facial balance, the practitioner will discuss appropriate options and outline expected outcomes, risks, and recovery considerations.

A consultation is also an opportunity to discuss the limitations of treatments and to confirm whether a proposed option is suitable for the individual’s specific preferences.

Conclusion

The undereye area is delicate, and common concerns such as dark circles, puffiness, and texture changes can be influenced by genetics, ageing, lifestyle, and environmental factors.

While effective care starts at home with adequate sleep, hydration, sun protection, and consistent skincare, persistent or structural issues may require professional assessment. Non-surgical treatments can support improvement, while surgical options such as blepharoplasty may be considered for more significant changes.

A clinical consultation can determine the underlying cause of undereye concerns, assess facial anatomy, and recommend appropriate treatment pathways based on individual needs and risk profile.

To discuss undereye concerns and obtain a tailored assessment,book a cosmetic consultation.

* Dr. Glenn Murray (MED0001196978) (AHPRA Registration MED0001196978) Registered Medical Practitioner, Specialist General Practitioner (specialist registration in general practice). General disclaimer: Patient outcomes can vary due to factors such as genetics, diet, age, exercise, lifestyle, weight, and overall health. It’s essential to understand that all treatments come with inherent risks and may require a recovery period and specific care regimen. Detailed information regarding risks and complications is available here, but it is advisable to conduct thorough research and obtain a second opinion to ensure you are able to make an informed decision. Please note that the information provided is general in nature and does not constitute medical advice or establish a doctor-patient relationship. Please be advised that outcomes vary, from patient to patient, and comprehensive research is crucial before making any decisions.