Treatments for Under Eye Dark Circles : Comparing Surgical and Non Surgical options

Under-eye dark circles are one of the most common (and frustrating) aesthetic concerns. They can make you look tired, older, or stressed, even when you feel perfectly fine. The tricky part? “Dark circles” don’t have just one cause, which means there isn’t a single treatment that works for everyone.

In this blog, we’ll break down why dark circles happen and explain both non-surgical and surgical treatment options, so you can understand what approach may be best for you.

Why Do Under-Eye Dark Circles Happen?

Dark circles are usually caused by one (or a combination) of the following:

1. Pigmentation

Brown or gray discoloration caused by melanin, genetics, sun exposure, or chronic rubbing of the eyes.

2. Thin Skin & Visible Blood Vessels

The skin under the eyes is very thin. When it becomes thinner with age, underlying blood vessels show through, creating a bluish or purplish tone.

3. Volume Loss & Hollowness

Loss of fat under the eyes (tear trough deformity) creates shadows that look like dark circles—even if the skin color itself hasn’t changed.

4. Prolapsed Fat & Eye Bags

Bulging fat pads can create contrast between puffy and hollow areas, exaggerating shadows.

Because these causes are different, treatment must be tailored, not one-size-fits-all.

Non-Surgical Treatments for Under-Eye Dark Circles

Non-surgical treatments are ideal for mild to moderate concerns, or for patients who want minimal downtime.

1. Injectable Fillers : Hyaluronic Acid

• Best for hollowness and shadowing

• Hyaluronic acid fillers restore lost volume and smooth the under-eye contour

• Results are immediate and natural when performed precisely

• Typically lasts 6–12 months

Best for: Structural dark circles caused by volume loss
Not ideal for: Severe pigmentation or large eye bags

2. Injectable Fillers : Baby Collagen

Baby collagen injections, such as Humallagen®, are an advanced regenerative option for under-eye dark circles caused by thin, fragile skin and visible blood vessels.

Unlike hyaluronic acid fillers, baby collagen does not add volume. Instead, it works by improving the quality and thickness of the skin itself, creating a naturally brighter and smoother under-eye appearance.

How Baby Collagen Helps Under-Eye Dark Circles

• Increases dermal thickness in the delicate under-eye area

• Reduces translucency, making dark blood vessels less visible

• Improves fine lines and crepey texture

• Enhances skin elasticity and firmness

Because the under-eye skin is extremely thin, this treatment is especially valuable where fillers may be too heavy or risky.

3. Skin Boosters & Regenerative Injections

Examples include PN/PDRN, collagen stimulators, or hydration-focused injectables.

• Improve skin thickness, elasticity, and translucency

• Reduce the visibility of blood vessels

• Gradual, natural improvement over time

Best for: Thin, crepey under-eye skin
Bonus: Very natural, refreshed look

4. Laser & Energy-Based Treatments

• Target pigmentation and skin quality

• Can improve brown discoloration and fine texture

• Often combined with injectables for better results

Best for: Pigment-related dark circles
Requires: Multiple sessions and sun protection

5. Medical Skincare

• Brightening agents, retinoids, and antioxidants

• Supports in-clinic treatments but rarely sufficient alone

Best as: Maintenance or prevention

Surgical Treatments for Under-Eye Dark Circles

Surgical options are recommended when dark circles are caused by significant anatomical changes.

1. Lower Blepharoplasty (Under-Eye Surgery)

Transconjunctival Blepharoplasty (No Skin Incision)

• Removes or repositions excess fat through the inside of the eyelid

• No visible scar

• Often combined with fat repositioning

External (Skin Incision) Blepharoplasty

• Removes excess skin and tightens the lower eyelid

• Suitable when skin laxity is prominent

Best for: Eye bags, fat prolapse, advanced aging
Results: Long-lasting and structural correction

2. Fat Repositioning

Instead of removing fat, the surgeon redistributes it to fill hollow areas.

• Smooths the transition from lower eyelid to cheek

• Reduces shadows without a “sunken” look

Best for: Combination of eye bags + hollowness

Advanced Techniques

Midface Lift

Lift up mid-face sagging while treating under-eye bags simultaneously. Shorten the mid-face for a youthful impression

A midface lift addresses under-eye dark circles by lifting the cheek fat pads that naturally descend with age.

As the midface drops, it:

• Deepens the tear trough

• Increases shadowing under the eyes

• Creates a harsh contrast between the lower eyelid and cheek

Rather than treating the under-eye alone, a midface lift restores youthful support from below, which is often the missing key in severe or recurrent dark circles.

How a Midface Lift Helps Under-Eye Dark Circles

• Elevates descended cheek fat to support the lower eyelid

• Softens the tear trough and lid–cheek junction

• Reduces shadowing without adding volume

• Improves overall facial balance and youthfulness

Surgical Approach

• Often performed through hidden incisions (lower eyelid or temple)

• Can be combined with:

  • Lower blepharoplasty

  • Fat repositioning

  • Facelift procedures

Best for:

• Advanced under-eye hollowness

• Recurrent dark circles after fillers

• Sagging cheeks contributing to eye aging

• Patients seeking long-lasting, natural structural correction

Results:

• Long-term improvement

• More natural than repeated fillers in advanced cases

• Under-eye area appears brighter, smoother, and better supported

Final Thoughts

Under-eye dark circles are rarely just an “eye problem.” In many cases, they reflect midface aging and structural descent, which is why combining under-eye surgery with a midface lift can create the most natural and durable results.

A tailored approach, based on anatomy, skin quality, and aging pattern, is essential for achieving a refreshed look that still feels like you.

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Clinic Locations

📍  Ginza Clinic

12F Ginza ONE, 1-8-19 Ginza, Chuo-ku, Tokyo, Japan

☎  050-3196-4834

🚇  Access:

🚶‍♀️ A 4-minute walk from  Ginza Station  on the Tokyo Metro Ginza Line.

🚶‍♀️ A 1-minute walk from  Exit 7 of Ginza-itchome Station  on the Tokyo Metro Yurakucho Line.

🚶‍♀️ A 3-minute walk from  Exit 3 of Kyobashi Station  on the Tokyo Metro Ginza Line.

🚶‍♀️ An 8-minute walk from the  Kyobashi Exit of JR Yurakucho Station .

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📍  Omotesando Clinic

Minami-Aoyama 511 Building 2F, 5-11-10 Minami-Aoyama, Minato-ku, Tokyo, Japan

☎  050-1807-1593

🚇  Access:

🚶‍♀️ A 5-minute walk from  Exit B1 of Omotesando Station  on the Tokyo Metro Ginza Line, Hanzomon Line, and Chiyoda Line.

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Consultation Hours:  10:00–19:00  Closed:  Irregular holidays

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About BIANCA Clinic

At BIANCA, we redefine beauty care by offering a holistic approach that transcends traditional cosmetic surgery and dermatology. 20 specialized doctors in different fields including plastic surgery, dermatology, internal medicine, regenerative medicine, gynecology will carefully listen to your needs and help you to enhance your beauty and wellness from the inside out. We are committed to creating personalized treatment plans with precision and care, and ensuring you experience the true spirit of Japanese omotenashi and hospitality.