Under Eye Hollows & Dark Circles

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Neck Ageing & Skin Laxity

Areas of Concern · Periorbital Region

Under Eye Hollows & Dark Circles

Tear Trough Hollowing

Dark Circles

Under-Eye Shadowing

Sunken Appearance

Persistent Tired Look

The area beneath the eyes is one of the earliest and most noticeable places on the face to show change. A hollowed or darkened appearance here is frequently interpreted as fatigue (even in patients who are well rested) because shadow and contour loss in this region directly affect how the eye is read.

Understanding why it is occurring matters, because the causes vary considerably between patients and the treatment that helps one will not necessarily help another.

Assessment & Treatment

This is one of the most structurally complex areas of the face to treat. Accurate assessment before any intervention is not optional, it is what prevents a well-intentioned treatment from producing a result that is difficult to correct.

Tear Trough Treatment
Lower Blepharoplasty
Skin Quality Treatments
Combined Approaches

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Consultations available in Melbourne & Wagga Wagga. Consultation fee is non-redeemable.

Why Under-Eye Hollows & Dark Circles Develop

Facial Ageing Is a Multidimensional Process

The under-eye region is structurally complex and its appearance is influenced by several factors that often coexist. Careful assessment is essential before any treatment is planned – because the causes vary between patients, and the treatment that helps one will not necessarily help another, and may actively worsen the concern.

Tear Trough Hollowing

The tear trough is a natural groove between the lower eyelid and the cheek. When this deepens with age or volume loss, it creates shadowing and a sunken appearance that is easily mistaken for fatigue even when the patient is well rested.

Midface Volume Change

As the cheek flattens or descends, the transition between the lower eyelid and cheek becomes less smooth and thus accentuates the hollow and increases the contrast between the eyelid and the face below it.

Skin Thinness & Transparency

The skin beneath the eye is thinner than almost anywhere else on the face. In some patients this means underlying structures (blood vessels, muscle or orbital fat) become visible through the skin, contributing to a darker or bluish tinge.

Pigmentation

In some patients, the darker appearance is related to pigmentation in the skin itself rather than depth or shadow. This is a meaningfully different cause, requiring a different approach, and one where the response to treatment is less predictable.

Fat Prominence

When lower eyelid fat protrudes forward, it creates fullness that makes the adjacent hollow appear more pronounced by contrast, so that the dark circle is partly a shadow cast by the fullness above it rather than a true hollow.

"The under-eye region is small in area but large in influence. It is one of the main places the face is read for signs of fatigue or age."

Treating it well requires understanding exactly what is causing the change because the right answer for one patient may be the wrong one for another. This is why assessment before treatment in this region is not optional.

How the Assessment Works

What Consultation Evaluates

Because the under-eye region can be affected by hollowing, fat prominence, skin transparency, pigmentation or a combination of these, careful assessment is essential before any treatment is planned. Similar-looking concerns can have quite different underlying causes and the treatment that helps one will not necessarily help the other.

Dr. Sim Lew-Gor evaluates the degree and nature of hollowing, the support and structure of the midface, skin quality and thickness, and whether the darker appearance is primarily shadow-related or pigmentation-related.

"This distinction matters, treatments address volume and shadow but do not change pigmentation, and surgery addresses structural changes that treatments cannot."

Part of the consultation process is identifying patients for whom treatment carries a meaningful risk of worsening the appearance and advising accordingly. Not every patient who presents with dark circles or under-eye hollowing will be a suitable candidate for treatment.

01 – Evaluated

Degree & Nature of Hollowing

The degree and pattern of deeper tissue descent, identifying where structural change is driving the aged or tired impression across the face.

02 – Evaluated

Midface Support & Structure

Where hollowing has developed, where volume has accumulated or descended, and how this redistribution is altering the proportions that once defined a rested appearance.

03 – Evaluated

Fat Prominence

Brow position, upper eyelid heaviness, lower eyelid support, tear trough hollowing and fat prominence, the eye area's contribution to the overall tired impression.

04 – Evaluated

Skin Quality & Thickness

The thickness and condition of the periorbital skin, which influences both the visibility of underlying structures and the suitability of different treatment approaches.

05 – Evaluated

Shadow vs. Pigmentation

Whether the darker appearance is shadow-related (structural) or pigmentation-related (skin-based), a distinction that fundamentally determines which treatments will help and which will not.

06 – Evaluated

Relationship to Lower Eyelid & Midface

The under-eye region assessed in relation to the lower eyelid above and the midface below, ensuring any treatment plan considers the full picture rather than the hollow in isolation.

Establishing what is genuinely needed (and identifying patients for whom treatment is not appropriate) is as important as identifying patients who will benefit. This is established at consultation, based on what is actually present.

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Treatment Options

Surgical & Non-Surgical Pathways

Treatment depends entirely on what the assessment finds. Each option links to a dedicated procedure page with full clinical detail.

Non-Surgical Treatment

In patients with mild hollowing and a good eyelid-to-cheek transition, non-surgical treatments can improve contour, soften shadowing and support the transition between the lower eyelid and cheek.

These approaches can be effective in the right patient, but they are temporary, not suitable for everyone, and have real limits. In patients with significant fat prominence, adding filler to the area can worsen the appearance by increasing overall fullness rather than improving the shadow.

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Surgical Procedures

Where structural changes are more pronounced (fat prominence, significant tissue descent, or a contour irregularity that treatments cannot address) surgical procedures may be considered.

This may involve repositioning or redistributing tissue to improve the eyelid-to-cheek transition, or addressing fat prominence directly. Surgery in this region requires particular precision because the tissues are delicate and small changes are immediately visible.

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A Careful Word About Treatments

The Most Requested and Most Misapplied

Under-eye treatments is one of the most commonly requested non-surgical treatments, and also one of the most commonly misapplied. Not every patient presenting with a dark or hollow appearance beneath the eye is a suitable candidate.

Careful assessment before treatment in this region is not optional. It is what prevents a well-intentioned treatment from producing a result that is difficult to correct.

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"Assessment before treatment in this region is not optional. It is what prevents a well-intentioned treatment from producing a result that is difficult to correct."

When treatment is appropriate

Mild hollowing, good skin quality

Where tear trough hollowing is the primary cause, skin is of adequate thickness, and there is no significant fat prominence, treatment can produce a meaningful and natural improvement.

When treatment is not appropriate

Fat prominence or very thin skin

Where fat prominence is the main issue, treatment adds to the problem rather than solving it. Where skin is very thin, treatment placed in the wrong plane can create a visible bluish discolouration that is difficult to resolve.

What Treatment Can Achieve

Meaningful improvement in the right patient

Reduction in shadowing and the impression of hollowing

Improved contour between the eyelid and cheek

A more rested overall appearance

Structural improvement where structural change is the cause

"Treatment can make a meaningful difference in the right patient, with the right approach, selected on the basis of accurate assessment."

What Treatment Cannot Achieve

Honest limits of this region

Complete elimination of darkness where pigmentation is the primary cause

Uniform or artificial results

Predictable improvement where skin is very thin

Reversal of deep structural change with surface treatment alone

In some patients the degree of improvement achievable is limited by skin thinness, depth of structural change, or the nature of underlying pigmentation. This is established honestly at consultation.

Dr. Sim Lew-Gor - Plastic Surgeon in Melbourne and Wagga Wagga Conducting a Facial Assessment

Planning Your Treatment

Planning the Right Approcach at Consultation

Consultation begins with a full assessment of the under-eye region and its relationship to the midface and lower eyelid. From this, a treatment plan is developed that is specific to what is actually causing the concern in that individual. This may involve non-surgical treatment, surgery, a combination of approaches, or in some cases a recommendation that treatment is not appropriate at this stage.

Not every patient who presents with dark circles or under-eye hollowing will be a suitable candidate for treatment, and establishing that clearly during consultation is as important as identifying patients who will benefit.

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Frequently Asked Questions

Questions most commonly raised about under-eye hollows and dark circles.

Why do I have dark circles even when I am well rested?

Dark circles that persist regardless of sleep are usually caused by structural or skin-related factors rather than fatigue. Tear trough hollowing creates shadow that reads as darkness; thin skin allows underlying structures to show through; and in some patients, pigmentation in the skin itself produces a darker appearance. Identifying which of these is the primary cause determines what treatment, if any, will help.

Are under-eye treatments always appropriate?

No. Under-eye treatments is effective in selected patients but it is not suitable for everyone. Where fat prominence is the main issue, treatment can worsen the appearance. Where skin is very thin, treatment placed in the wrong plane can create a visible bluish discolouration that is difficult to resolve. Careful assessment is essential before any treatment in this region.

Is surgery always required?

No. Many patients with under-eye hollowing are well managed with treatment, particularly where the hollowing is mild and the structural changes are limited. Surgery is considered where structural changes are more significant or where non-surgical treatment would not produce a meaningful improvement. The right approach depends entirely on what the assessment finds.

Can dark circles be completely eliminated?

Not always. Where the darkness is caused primarily by shadow from hollowing, structural correction can produce a significant improvement. Where it is caused by pigmentation, the response to treatment is less predictable and complete elimination is often not achievable. Setting realistic expectations in advance is part of responsible consultation.

Why is this area particularly difficult to treat?

The skin is thinner here than almost anywhere else on the face, the underlying structures are complex, and small changes (in either direction) are immediately visible. This means that both under-treatment and over-treatment have visible consequences. It is also an area where different causes can produce a similar appearance, which is why accurate assessment before treatment matters more here than in most other areas of the face.

Can treatment make the area look worse?

Yes, if the wrong treatment is selected or if technique is poor. This is one of the more consequential areas of the face to treat incorrectly, which is why careful patient selection and precise technique are both essential. Part of the consultation process is identifying patients for whom treatment carries a meaningful risk of worsening the appearance, and advising accordingly.

How long do results last?

This depends on the treatment approach and individual factors. Treatment in the under-eye region typically lasts between twelve and eighteen months, though this varies. Surgical correction provides longer-lasting structural improvement. Ageing continues regardless of treatment, but most patients experience sustained improvement relative to where they started.

When should I consider treatment?

When the concern is persistent, consistent over time, and confirmed on assessment to reflect a cause that is amenable to treatment. There is no fixed threshold, the right time is when the concern is meaningful to the individual and when assessment confirms that a meaningful improvement is achievable for that specific patient.

Areas of Concern

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Eyelid Heaviness & Under-Eye Bags

Eyelid heaviness and under-eye hollows are closely linked – fat prominence in the lower eyelid can directly cause or worsen the shadowing associated with hollowing beneath it.

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Tired or Aged Appearance

Under-eye hollowing and dark circles are one of the most direct structural contributors to a persistently tired impression and often part of a broader pattern of facial change.

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Sagging Jawline & Jowls

Midface descent that contributes to under-eye hollowing often also affects the lower face – understanding both allows for more complete and balanced treatment planning.

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Neck Ageing & Skin Laxity

Facial ageing affects multiple regions simultaneously. Where both the periorbital region and the neck show change, a broader treatment plan may produce a more coherent overall result.

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