Dark circles under the eyes can be caused by two things: pigment deposits in the skin or shadows created from fat bulging from the lower eyelid. The treatment for each of these is different.
If pigment deposits are the problem, bleaching agents or skin resurfacing may be the answer. Skin resurfacing can take the form of deep chemical peels or ablative laser (such as CO2 or erbium) treatments.
If fat shadows are the problem, the solution is a lower blepharoplasty in which the fat of the lower eye is addressed. There are multiple approaches to the lower eyelid, including through skin incisions or possibly through incisions on the inside of the lower eyelid. The fat can then be repositioned over the bone of the eye socket (the orbital rim) or removed.
