Under-eye fillers: ignoring the type of dark circle can make it look darker
"People say I always look tired because of my dark circles." "Will under-eye filler make them disappear?" "I've also heard of people looking worse afterward."
These concerns usually come up in this order during under-eye consultations.
To be frank, under-eye filler is an answer for only one of the three types of dark circles. Using filler for the other two can make the area look darker or uneven.
That is why I do not decide on an under-eye procedure before identifying the type. There are many days when my answer is something other than filler.
Why aren't dark circles a single condition?
Some people ask, "Aren't all dark circles the same?" In the clinic, we broadly divide them into three types. First is the pigment-related type: melanin deposited in the skin around the eyes makes it look brown and dark. Causes include rubbing the eyes, ultraviolet exposure and post-inflammatory pigmentation. Second is the vascular type. Under-eye skin is among the thinnest on the body, and vessels and muscle beneath it can show through with a bluish appearance. This tends to look particularly pronounced on tired days. Third is the structural type. Here the problem is a shadow rather than color. Prominent under-eye fat or a hollow tear trough creates contours that cast shadows, making the area look dark. A characteristic is that the darkness becomes lighter when illuminated from the front. Some ask whether a good night's sleep will eliminate it. Lack of sleep can temporarily make vascular dark circles look worse, but if pigment or structure is responsible, sleep alone is unlikely to change it. In practice, more people have a mixture of two or three types. That is why identifying the type is the first step in treatment.
Can I check the type at home?
An accurate diagnosis belongs in the clinic, but there are ways to get an idea. Face a mirror in a bright place and slowly raise your chin. If the darkness lightens noticeably, shadows—that is, structure—are likely contributing substantially. Next, gently pull the under-eye skin downward. If the dark color moves with the skin, pigment may be involved; if a reddish or bluish color shows through the stretched area, vessels may be contributing. It is best to do this without makeup and under lighting close to natural daylight. However, this is only a reference. As mentioned, types are often mixed, and the amount of under-eye fat or thickness of the skin is difficult to assess yourself. Self-checking is intended to help you ask better questions at a consultation, not replace diagnosis.
Which type can benefit from filler?
"So should I have filler or not?" Knowing the type helps reveal the answer. Filler replenishes volume in hollow areas. In structural dark circles mainly caused by a hollow tear trough, improvement in the shadow may therefore be expected. In pigment-related dark circles, however, filler changes the volume while leaving the color unchanged. If pigment is the cause, it is more appropriate to first consider a pigment laser such as PicoWay. The vascular type requires particular caution. Adding filler beneath thin skin may make show-through or unevenness more apparent, and the eye area also demands careful judgment because of its vascular anatomy. Another important point is not to overfill. Under-eye skin is thin, so even small differences in volume readily show at the surface. I therefore prefer to start with a small amount rather than fill everything at once, assess progress around two weeks as swelling settles, and take a staged approach. It may seem slower, but adding insufficient volume is much easier than reversing excessive volume. Saying filler can help or harm is not an exaggeration.
We do not begin a consultation with a procedure already decided
Even when someone comes to LUNN looking for filler in Cheongdam, we do not assume filler will be the conclusion. We first identify the type by gently stretching the skin and changing the lighting angle. Depending on that assessment, we recommend only what is needed among filler, lasers and skin boosters. If pigment is the main cause, we may first consider a pigment laser such as PicoWay; if thin skin makes underlying structures particularly visible, we may consider supporting the condition of the skin itself with a skin booster such as Rejuran. In some cases, I explain that changing the habit of rubbing the eyes and protecting against the sun should come before a procedure. Since I personally handle consultation, treatment and follow-up, decisions about the right combination remain with one doctor throughout. At the consultation, I also explain that any procedure can cause temporary reactions such as bruising or swelling, and that effects and duration vary between individuals.
If dark under-eyes concern you, I recommend first finding out your type before choosing a procedure. Any practice that explains the distinctions can be a good place to start; it need not be LUNN.
Related column: Nasolabial fold filler: is more better? Why a doctor may advise against it Related treatment information: Filler
