Treating Dark Under-Eye Circles: Telling Vascular, Pigmented and Structural (Hollow) Types Apart

📅 Updated 11/04/2026·🏷️ Eye aesthetics·✍️ Editorial team — Dr. Vo Thanh Sang

Have you tried every eye cream, cucumber slices and earlier bedtimes, yet the dark circles under your eyes stubbornly persist year after year? Always looking tired, older than your real age, and reaching for concealer every morning is genuinely frustrating. The key thing to understand is this: treating dark under-eye circles does not follow a single formula that works for everyone. Dark circles have several different causes, and each cause calls for its own approach. Using the wrong method may not only fail to clear the discoloration but can also waste your money.

Why Classification Matters Before Treating Dark Under-Eye Circles

The skin under the eyes is the thinnest skin on the body, only a few tenths of a millimetre thick. Precisely because it is so thin, any change beneath it — whether in the blood vessels, pigment, or the underlying fat and bone structure — readily "shows through" to the surface.

In medicine, dark under-eye circles are generally divided into three main groups, and it is not uncommon for one person to share the features of two or even all three groups at once:

Vascular dark circles: related to the blood vessels beneath the skin and to blood pooling.
Pigmented dark circles: caused by melanin accumulating in the skin around the eyes.
Structural (hollow/shadow) dark circles: caused by deep-set eye sockets, fat loss or a tear trough that casts shadows.

Correctly identifying the type of dark circle is the first and most important step, because it determines the entire treatment strategy that follows.

The Three Types of Dark Under-Eye Circles and How to Recognise Them

1. Vascular dark circles

This is the most common type, especially in people with fair skin and thin skin around the eyes. When the skin is thin, the small blood vessels beneath it become visible, producing a bluish-purple or pinkish-violet tone. Allergies, nasal congestion, lack of sleep or stress can cause more blood to pool and make the discoloration more pronounced.

Suggestive signs: the discoloration leans blue, purple or pink; it becomes more obvious when you are tired; when you gently pull the skin downward, the colour usually fades or changes.

2. Pigmented dark circles

This type is more often seen in people with medium to darker skin tones, or those predisposed to increased pigmentation. The cause is melanin deposited in the skin around the eyes, which may stem from genetics, atopic dermatitis, frequent eye rubbing or sun exposure.

Suggestive signs: the discoloration leans brown or greyish-brown; its borders tend to spread more widely, sometimes onto the upper eyelid as well; the colour changes little when the skin is stretched.

3. Structural and hollow dark circles

This is not really a "colour" discoloration but rather a shadow created by the anatomical structure. When the tear trough is deep, the fat under the eye has atrophied, or the eye socket becomes hollow with age, light shining downward creates a shaded area that makes the eyes look dark and sunken.

Suggestive signs: the darkened area is more obvious under light coming from above; when you look into a mirror with your face tilted up, or shine light from below, the shadow lessens considerably; it is often accompanied by a sense of tired, hollow eyes.

Treatment Methods for Dark Under-Eye Circles by Type

Once the type has been correctly identified, treating dark under-eye circles becomes far more clearly directed. Below are the intervention approaches commonly considered, depending on the underlying cause:

For vascular dark circles: foundational care (adequate sleep, managing allergies), creams containing active ingredients that support circulation and thicken the skin; certain lasers or energy-based devices targeting blood vessels may be considered by a physician.
For pigmented dark circles: strict sun protection, skin-brightening actives, combined with pigment lasers or an appropriate treatment course prescribed by a physician; patience is needed, as pigmentation improves slowly.
For structural (hollow) dark circles: filling the tear trough with a dermal filler to eliminate the shadow; in cases caused by excess fat or significant skin laxity, cosmetic surgery of the lower eyelid may be considered.

In practice, many people have mixed-type dark circles, so the treatment plan is usually a personalised combination of several methods. There is no single course that is "right for everyone," and results depend on each person's constitution, age and the degree of the underlying condition.

When is in-depth intervention needed?

If you have followed home care and used cosmetics over a long period without improvement, or if your dark circles are mainly due to hollows and structure, then options such as laser, filler or surgery should be assessed by a specialist physician. Skin analysis, direct examination under light and sometimes additional assessment will help determine the option that is precisely right for you.

Medical Notes: Contraindications and Risks/Complications

Any intervention on the delicate skin around the eyes must be considered carefully. Readers should clearly understand the following points before making a decision:

Contraindications and cautions: women who are pregnant or breastfeeding, people with an active eye infection, bleeding disorders, those taking anticoagulant medication, or those with an autoimmune condition or a tendency to keloid scarring should clearly inform their physician. Some laser methods are not suitable for people with a current suntan or for certain skin types.
Risks of tear-trough filler: bruising, swelling, lumps, the Tyndall effect (a bluish hue) may occur, and rarely but seriously, vascular occlusion if the injection is placed in the wrong layer — this is why the procedure must be performed by a qualified physician in a medical setting.
Risks of laser: prolonged redness, post-inflammatory hyper- or hypopigmentation, particularly in Asian skin, which is prone to increased pigmentation if not properly cared for and protected from the sun.
Risks of lower-eyelid surgery: bruising, swelling, scarring, asymmetry, or excessive hollowing if too much fat is removed.

This is why treating dark under-eye circles should be carried out by a specialist physician, in a hospital or a properly accredited surgical facility — not at a spa or a venue lacking medical conditions. An honest examination will help you understand which methods are suitable and which should be avoided, rather than chasing exaggerated promises.

Closing Thoughts and an Invitation to Consult

Dark circles under the eyes are not a single problem but a combination of different causes: blood vessels, pigment and hollows. Correctly understanding your own type of discoloration is the key to choosing a suitable approach and avoiding wasting time and money on solutions that miss the mark. Actual results always depend on each person's constitution and individual condition, so no general promise can replace a direct examination.

If you would like an accurate assessment of your type of dark circles and advice on a suitable approach, Dr. Vo Thanh Sang, MD (Level I Specialist) — a Level I specialist in plastic and aesthetic surgery in Ho Chi Minh City — is ready to listen and accompany you. Please contact the hotline 079 7479 222 to book an examination and receive gentle, clear advice for your specific case.