Dark Circles: The Right Treatment Depends on the Cause

Dark circles are often treated as a single problem. But the reason the under-eye area looks dark varies from person to person, and the right treatment depends on the underlying cause. This article outlines the three most commonly seen types of dark circles in clinical practice and the approach suited to each.

Some dark circles are caused by pigmentation, some by thin skin that reveals the muscle beneath it, and others by protruding under-eye fat that casts a shadow. This is why repeating eye creams or laser procedures without first identifying the cause often fails to deliver satisfying results.

The causes of dark circles fall broadly into three categories — skin, muscle, and fat — and in practice these causes frequently overlap.

Table of Contents

1. Pigmented Dark Circles (Skin Type)

2. Vascular Dark Circles (Muscle Type)

3. Structural Dark Circles (Fat Type)

4. Mixed-Type Dark Circles

5. Dark Circle Types at a Glance

1. Pigmented Dark Circles (Skin Type)

Characteristics

This type occurs when melanin pigment increases in the under-eye skin itself, giving it a brown or dark brown appearance. It is common among ethnicities with darker skin tones, such as in Southeast Asia, and is relatively less common among East Asians, including Koreans. It tends to appear with prolonged sun exposure, frequent eye rubbing, or chronic inflammation such as atopic dermatitis.

Treatment

For this type, the priority is reducing the pigment itself rather than thickening the skin. Sun protection, wearing sunglasses, toning lasers, and pigment lasers are the representative treatments.

2. Vascular Dark Circles (Muscle Type)

This is the most common type among most East Asians, including Koreans.

Cause

In this case, dark circles are less something that has "formed" and more a matter of the muscle beneath thin under-eye skin showing through. The Orbicularis Oculi Muscle (OOM), which is involved in closing the eyes, is naturally red, but when seen through thin skin it is perceived as closer to a dark bluish color. This is also why dark circles deepen when someone is tired: reduced oxygen in the blood makes it appear darker and redder, and this shows through thin skin more directly. Conversely, dark circles lighten when someone is in good condition, for the same reason. Fair skin also tends to be more translucent, which can make dark circles appear more pronounced.

Key to Treatment

For this type, the most important thing is making the skin thicker and healthier. In the past, the main approach was to increase skin elasticity using treatments such as Eye Thermage (RF), radiofrequency treatments, and skin boosters.

More recently, Retuo (Re20) treatment, which directly replenishes ECM (extracellular matrix), has drawn attention as an option. Retuo supplements ECM between the skin and the orbicularis oculi muscle, making the skin firmer, increasing skin thickness, and helping the muscle show through less — contributing to improvement in dark circles. Rather than physically lifting the skin, it can be understood as a concept of replenishing the skin's own structural material.

3. Structural Dark Circles (Fat Type)

This type commonly appears from around age 35 onward.

Cause

As skin elasticity declines with age and the orbital septum weakens, the fat that normally sits below the eyeball is pushed forward. This is commonly known as an under-eye fat bag (eye bag). When the fat protrudes, it casts a shadow beneath it, and the problem is that this can look like dark circles even when the actual skin color is normal.

Treatment

Improving skin elasticity, strengthening the orbital septum, and lifting treatments can be considered first-line options, and in cases of significant fat protrusion, under-eye fat repositioning surgery can be an effective treatment.

4. Mixed-Type Dark Circles

This is the type most commonly seen in actual clinical practice. It refers to cases where multiple causes exist simultaneously — for example, thinned skin combined with some fat protrusion and pigmentation.

In such cases, a single treatment alone is unlikely to bring sufficient improvement. For instance, repeating pigment laser alone on thin skin may lead to lower satisfaction, and conversely, performing only skin boosters when fat protrusion is pronounced is unlikely to bring sufficient improvement either. Therefore, what's needed first is an accurate diagnosis of the cause, and treating the most significant issue first, in order, after identifying the cause leads to a more natural and satisfying result.

5. Dark Circle Classification at a Glance

Dark circles are not a single condition but a result produced by multiple causes. Accurately distinguishing whether the cause is pigmentation, thin skin, or protruding fat is the first step in treatment. In particular, among East Asians including Koreans, the muscle (vascular) type — where thin skin allows the orbicularis oculi muscle to show through — is very common, and in this case, treatment that makes the skin healthy and thick is key to improving satisfaction. Approaches that replenish the ECM between the skin and muscle are drawing attention as a treatment strategy that directly targets this cause.

The effects of any procedure and the recovery course may vary depending on individual skin condition and underlying cause. Please consult a specialist for an accurate diagnosis.