Under-Eye Concerns – Which Treatment Is Actually for You
Dark circles, hollowing, visible veins, and pigmentation all look similar from the outside but are clinically distinct concerns requiring different treatments. Dr Chia maps each one to the right solution.
The under-eye area generates more consultation questions than almost any other part of the face.
And more confusion.
Patients come in describing “dark circles” when what they have is hollowing. They come in asking for filler when what their skin needs is quality treatment. They’ve tried brightening eye creams for visible veins that no topical product will touch. They’ve had tear trough filler for pigmentation that filler was never going to address.
The under-eye area looks like one problem from the outside. Clinically, it’s four distinct ones - and they respond to four different treatments.
Concern 1: Hollowing and Shadowing From Volume Loss
What it looks like: a groove or hollow beneath the eye, a shadow that makes you look tired regardless of how much sleep you’ve had, a sunken quality to the under-eye zone.
What’s causing it: the fat beneath the tear trough has thinned and descended, creating a structural deficit that casts a shadow.
What addresses it: tear trough filler - hyaluronic acid placed carefully along the orbital groove to restore volume and lift the tissue. This is the treatment for structural hollowing. Placed well, with appropriate product selection, the shadow softens and the tired appearance improves significantly.
What doesn’t address it: skinboosters, lasers, topical products. None of these restore structural volume.
Concern 2: Skin Quality - Thinness, Crepiness, Dullness
What it looks like: under-eye skin that looks aged, thin, slightly translucent, or lacks the firmness it once had. Fine lines in the lower eyelid. A general quality deterioration that makes the area look tired even without a visible hollow.
What’s causing it: the periorbital skin - already the thinnest on the face - has lost collagen, elastin, and extracellular matrix support. The tissue is structurally depleted.
What addresses it: ECM Eye skinboosters, which directly supplies extracellular matrix proteins to the periorbital tissue. Polynucleotides, which stimulate cellular regeneration in the skin. Hyaluronic Acid skinboosters, which restore dermal hydration to the zone.
What doesn’t address it: tear trough filler adds volume but doesn’t improve skin quality. The tissue may look slightly fuller but the crepiness and thinness remain.
Concern 3: Visible Veins
What it looks like: bluish or greenish lines visible beneath the lower eyelid, sometimes branching, contributing to a shadowed or tired appearance around the eye.
What’s causing it: the periorbital skin has thinned enough that the vessels running beneath it have become visible through the surface. Volume loss in the surrounding area reduces the structural buffer further.
What addresses it: long pulse Nd:YAG 1064nm laser, which targets the vessel directly - causing it to coagulate and be gradually reabsorbed by the body. Two to three sessions typically produce meaningful improvement.
What doesn’t address it: filler, skinboosters, topical products. None of these reduce vessel visibility. Improving skin quality around the treated area - through ECM Eye skinboosters or polynucleotides - reduces the thinning that makes vessels visible and helps maintain results longer.
Concern 4: Pigmentation and True Dark Circles
What it looks like: brownish or greyish discolouration in the under-eye area that persists regardless of sleep, hydration, or skincare. More prominent in certain skin types. May be present from a young age.
What’s causing it: melanin deposition in the periorbital skin - often hormonally influenced, sun-aggravated, and in some cases genetic. This is true pigmentation, distinct from the shadow cast by hollowing or the blue tinge of visible vessels.
What addresses it: targeted pigmentation treatment - specific laser wavelengths for periorbital pigmentation, combined with diligent sun protection and sometimes topical depigmenting agents. This is a separate category of treatment from volume, quality, or vascular concerns.
What doesn’t address it: tear trough filler will not improve pigmentation. Vascular laser is not the right wavelength for melanin. Getting this distinction right before treatment begins is what prevents the frustration of addressing the wrong problem.
Why Assessment Comes First
Many patients have more than one of these concerns simultaneously - hollowing and skin quality issues, or visible veins and pigmentation, or all four in varying degrees.
The treatment plan in these cases is a sequence, not a single intervention. Understanding which concern is dominant, which needs to be addressed first to create the best conditions for what follows, and what the realistic timeline looks like - that’s what a thorough under-eye assessment at Journey Aesthetics establishes before anything is recommended.
The under-eye area rewards patience and precision more than almost anywhere else on the face. Getting the diagnosis right is the most important step.
Dr Chia Min Shan is the Medical Director of Journey Aesthetics Medical Clinic in Katong, Singapore. She specialises in skin quality, facial aesthetics, and natural-looking results using treatments including botulinum toxin, dermal fillers, skinboosters, polynucleotides, Ultherapy Prime, Volnewmer, Fotona 4D, and Corage 2.0. Every treatment plan she creates is built around a thorough consultation - because understanding what a patient actually wants is where good aesthetic medicine begins.