Infraorbital dark circles represent a common, multifactorial challenge and are the result of a variety of factors, including deep facial anatomy and soft tissue changes, as well as contributions from the skin. An understanding of the deep and superficial anatomy is crucial to the management of this complex entity.
Perceptions regarding the degree of a person’s fatigue and age are preferentially based on periorbital aesthetics. Throughout cultures, societal perceptions are similar in that periorbital dark circles contribute to a tired, aged and even sad appearance. Various anatomic factors may contribute to the appearance of periocular dark circles, such as the facial ligamentous architecture, bony structure, mid-face soft tissue (including prominence of the orbicularis oculi muscle and vasculature), and thin eyelid skin with minimal to no subcutaneous tissue.
Infraorbital dark circles are the result of several anatomic features, with contributions from the skin, subcutaneous tissues, orbicularis muscle, and the vasculature and ligamentous architecture of the lower eyelid and cheek. Choice of treatment depends on aetiology and must be individualised. Treatment modalities range from concealment and camouflage, to non-invasive treatments, such as lasers, as well as more invasive treatments, such as volume augmentation and resurfacing, and surgical interventions, such as blepharoplasty.
Across all skin types, the ageing process involves photodamage, fat redistribution, bone shifting, and the loss of connective tissue. Overall, individuals with darker skin are thought to have firmer and smoother skin than individuals with lighter skin of the same age; however, ageing does occur in regards to mottled pigmentation, wrinkles, and skin laxity. A comprehensive knowledge of the structural and functional principles of ethnic and ageing skin is helpful to properly care for the ageing skin.
Tear trough rejuvenation can assist in the dark circles and indentations.