Under-Eye Concerns

Under-eye concerns are the most commonly misidentified thing we assess, and a wrong identification costs more here than anywhere else. What people call dark circles, tear troughs or looking tired turns out, on examination, to be at least five separate things, often two or three at once. The skin here is thin and mobile, and mistakes show, so the first step is working out which of them you have.

What "tired eyes" usually turns out to be

True hollowing is a loss of support beneath the skin. The tear trough deepens into a groove running from the inner corner of the eye towards the cheek, and its shadow looks dark even where the skin has no extra pigment. Pigmented darkness is a brown or grey tint in the skin itself. It often runs in families, is more common in deeper skin tones, and barely changes whichever way you tilt your face. Vascular darkness is the blue or purple cast of blood vessels showing through skin thin enough to be translucent. Crepey texture is fine, crinkled skin that is short of water and collagen, not volume. Fluid puffiness is usually worst on waking and settles as the morning goes on. These look alike across a desk, but each responds to different treatment.

Why identification comes before anything else

You can do a rough test at home. Tilt your head back and look up towards a light. A hollow softens as the shadow fills, while true pigment stays where it was. Then gently pinch a little skin at the outer corner and watch how quickly it settles. Skin that crinkles and returns slowly points to skin quality, not volume. That distinction decides the treatment pathway, and sometimes shows there is no suitable treatment.

What tends to make it worse

Poor sleep, salt, alcohol and allergy all show here first, because this is the thinnest skin on the face, over tissue that holds fluid readily. Hay fever and habitual eye rubbing drive both puffiness and pigmentation, and rubbing is one of the few habits that visibly worsens the area by itself. Sun exposure darkens pigmented circles as it darkens pigment anywhere. That includes daylight through a car's side window, which over a Hampshire spring of driving adds up to more than most people realise. A stripped barrier makes crepiness worse, heavy eye creams can leave small white milia, and dragging the skin to remove make-up is best avoided.

The realistic pathways, and what each is not for

Where the concern is skin quality, thin and crepey but not hollow, polynucleotides are the option most often discussed. They may support hydration, elasticity and repair over a short course, and they do not add volume. Small raised bumps for a day or two afterwards are usual, and feel odd more than sore. Where the darkness is pigment, the work is pigment management: daily sun protection and medical-grade skincare. It is slow and does nothing for a shadow. Where the hollow is structural, tear trough filler is sometimes discussed and always approached cautiously, because the area tolerates very little product and holds water. Vascular darkness responds poorly to most of these options. Injectables do not treat fluid puffiness or a prolapsed fat pad. The under-eye is the area where we decline treatment most often.

What a consultation looks at

Your practitioner assesses the area in more than one light and position: at rest, looking upwards and smiling. As the light moves, a hollow, a shadow and a pigmented patch become easier to tell apart. Your history matters as much. You will be asked how long it has been there, whether a parent has the same, whether it is worse on waking or by evening, and about your allergy and thyroid history, sleep and skincare. Skin quality, laxity and the position of the cheek below are assessed too, because the under-eye rarely changes independently of what sits beneath it. Consultations run at our Bedhampton clinic near Havant, serving Portsmouth, Waterlooville and Denmead, and at our Winchester clinic on Jewry Street from 8 December 2026.

When it belongs with your GP

Not everything around the eye is cosmetic. Swelling that comes on suddenly, affects one side only, or comes with pain, redness or any change in vision needs same-day medical attention, not a clinic appointment. Puffiness with fatigue, weight change or feeling the cold can point to a thyroid or kidney problem. Persistent itching and swelling is often allergy or eczema, which should be treated first. An eyelid that has begun to droop by itself, or a new lump or mole on the lid margin, should be seen by your GP.

For most people the best start is a skin consultation, where the cause is identified before anything is planned. Results vary between individuals. Sometimes the most useful outcome is being told that sleep, sun protection and a good concealer will do more for you than anything we could inject.

Frequently asked questions