Under-eyes (hollowness and dark circles) - hollowness versus pigment versus visible blood vessels? (Photos)

Question

47-year-old male, Indian skin (Fitzpatrick IV–V), prone to dark marks after any inflammation. Concern: dark circles and a hollow, tired look under both eyes, present for years. - Thinking of JuvelookLenisna sessions under the eyes - On semaglutide, still losing weight. - Also on finasteride. - Daily routine: azelaic acid 15% each morning, plus SPF. Questions: 1. From the photos, how much of this is hollowness versus pigment versus visible blood vessels? 2. On darker skin, which treatments work for the pigment part without causing more marks? 3. For the hollowness: fat transfer, hyaluronic filler, or get Juvelook and wait for it to settle? Does ongoing weight loss change that? Photos: cropped only, no retouching or filters. June and October were taken on different phones and in different lighting.

Edwin Kwon, MD, FACS · Answer

Dark circles are usually a mix of three things, and each responds to a different treatment, so it helps to sort them out before choosing anything. Hollowness is a shadow problem: the tear trough and the junction between the lower lid and cheek sink in, and that shadow reads as darkness, especially under overhead light. Pigment is true brown discoloration in the skin, which is common in Fitzpatrick IV to V skin and stays the same no matter how the light hits it. Visible vessels give a bluish or purple tone that shows more where the lower lid skin is thin. A simple check is to face even light and then tilt your chin up toward it; whatever darkness fades is mostly shadow, and what stays is pigment or vessels. For the pigment on darker skin, staying consistent with gentle topicals and sun protection is the safest approach, and aggressive lasers or peels carry a real risk of new dark marks. For the hollowness, fat transfer can soften the trough and blend the lid into the cheek with a longer-lasting result than filler, while collagen stimulators work gradually and are less predictable in this thin area. Because you're still losing weight on semaglutide, it makes sense to wait until your weight is stable, since facial volume and transferred fat both change with weight. I'd encourage you to schedule a consultation once your weight levels off so your under-eyes can be examined in person and a plan can be built around whichever of these factors matters most for you.

Randal Haworth, MD, FACS · Answer

Under-eye darkness usually has three overlapping sources: a tear trough hollow that casts a shadow, pigment in the skin, and thin lower-lid skin that lets vessels and muscle show through. Photos taken on different phones and in different light cannot reliably separate them. Pigment on darker skin is best handled by a dermatologist experienced with Fitzpatrick IV to V skin, since aggressive treatment can leave more marks. For the hollow, fat transfer adds soft volume, but part of the graft may not persist, and grafted fat tends to behave like the fat it came from, so it is generally wiser to wait until your weight is stable. Filler is temporary and adjustable. An in-person exam with a board-certified surgeon who does periorbital fat grafting regularly will show which layer matters most.

Under-eyes (hollowness and dark circles) - hollowness versus pigment versus visible blood vessels? (Photos)

Answers (2)

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