Under the eyes: bags, puffiness, dark circles or hollows, and what helps each

Puffy eyes, eye bags, dark circles or hollow eyes: how to tell them apart

• Puffy eyes, from fluid: worse in the morning and after a salty meal, settling as the day goes on; allergies and short nights add to it.
• Eye bags, from fat: a bulge that changes little through the day, as the tissues holding the fat loosen with age.
• Dark circles: brown ones come from pigment, often run in families and deepen with sun and rubbing; bluish or purple ones come from blood vessels showing through thin skin.
• A hollow: a shadow along the groove that runs down from the inner corner of the eye, the tear trough, worse under overhead light. Young people can have one too, with the shape of the cheekbone.

All four show more here than elsewhere: the skin under the eyes is among the thinnest in the body, with almost no fat beneath it, so the muscle and blood vessels show through and every change looks exaggerated.

Why it shows: the causes of puffiness and dark circles

Most people have more than one of the four, and whichever is strongest decides what may help. A simple clue: stretch the skin gently. A shadow from a hollow fades; pigment stays.

Family traits, rubbing, allergies, eczema around the eyes, short nights and sun all play a part. With age, the deep fat pads of the face shrink and the rim of the eye socket recedes a little, so the groove under the eye lengthens. Dark circles look different across skin tones: in a small study, brown circles and shadows were more common in darker skin and bluish circles in lighter skin.

What helps each one

• Puffiness from fluid: less salt in the evening, treating allergies and enough sleep. Swelling that doesn't settle is a question for a doctor.
• Bags of fat: no cream, facial or radiofrequency removes them, and filler tends to make them look worse. Eyelid surgery, done by a surgeon, is the treatment for them.
• A hollow: a small amount of hyaluronic-acid filler placed deep along the groove, usually in one session. The change shows on the day, under some swelling, and fades over months: one review describes up to about 12 to 15 months in the tear trough. Sometimes support in the cheek comes first, and the groove needs less afterwards.
• Thin, crepey skin and fine lines: polynucleotides and PRP signal the skin to repair over a course; skin boosters hydrate it; Volnewmer radiofrequency firms it gradually, over two to three months.
• Brown circles: steady sun protection, sunglasses and no rubbing; they fade slowly, if at all. Lasers have helped some brown and bluish circles modestly in reviews, with a risk of darker patches on deeper or tanned skin, so a doctor decides whether it is worth it.

Filler under the eyes: when it helps, and when it makes things worse

Filler suits a true hollow when the skin over it is reasonably thick. In a pooled analysis of 31 studies of filler for tear troughs, about nine in ten people were satisfied; swelling and bruising each affected about one in five, lumps about one in twenty and a bluish tint about one in a hundred.

It does not help puffy bags or pigment, and it can make bags look worse. Hyaluronic acid holds water, so too much under the eyes can look puffy, and gel placed too near the surface can show through as a bluish tint. Hyaluronic-acid filler can be dissolved with an enzyme, hyaluronidase; afterwards the original hollow may show again. Rarely, filler blocks a blood vessel, and very rarely that reaches the eye and affects vision, which is why it is placed by a doctor who keeps the enzyme on the shelf.

Polynucleotides or filler under the eyes?

Filler fills; polynucleotides and platelet-rich plasma (PRP) don't. Polynucleotides, purified fish DNA often called salmon DNA, and PRP, made from your own blood, signal the skin to repair, so they suit thin, crepey skin rather than a hollow, and results build over a course. In an under-eye study of polynucleotides, without a comparison group, people rated the area better after the first session, best at three months after two sessions three weeks apart, and still better at six months. Around the eyes, PRP's strongest evidence is for dark circles from pigment, from small studies.

Where the skin is thin and there is also a hollow, the plan may improve the skin first and add a little filler later.

When under-eye changes need a doctor first

See a doctor first if swelling around the eyes doesn't settle, comes on suddenly or affects one eye, or comes with redness, pain or fever; or if your eyelids are puffy or red and your eyes bulge, feel gritty or you see double. Any change in your vision needs urgent care. Dark circles that come with tiredness, breathlessness or pale skin are worth a blood test: in one study of people with dark circles, half had anaemia.

Who you'll see

At our villa at 350 Al Wasl Road, Jumeirah 1, Dr. Daria Banina treats tear troughs and the skin around the eyes, and Dr. Olga Ibrakova's work includes contouring with filler; Kateryna Petliuk, our Head of Non-Invasive Cosmetology, sees thin, dry skin around the eyes. The first visit starts by working out which of the four you have.