How to Treat Ageing Under the Eyes: A Complete Guide from Skincare to Surgery for Dark Circles

The under-eye area is a paradox. It is both the smallest canvas on the face and, at the same time, the most revealing. This is where late nights, allergies, sun damage and simple genetics all conspire to tell tales you’d rather keep private. The skin here is not only the thinnest on the body but also one of the most structurally complex zones, lying over bone, fat pads, vessels, lymphatics and muscle that are all in constant motion. 

This is why under-eye ageing is such a persistent bugbear for patients and doctors alike.  It is also why there is no single ‘hero’ fix.  The answer, as ever, is layered: understanding the underlying anatomical changes and then applying the correct rung of the treatment ladder - from skincare to surgery - to address them.

The Anatomy and Histology of the Under-Eye

Before we get carried away with serums, lasers and clever injectables, it’s worth pausing to look under the bonnet.  The under-eye area only truly makes sense when you appreciate the architecture beneath it: skin, muscle, fat pads, bone and blood vessels all packed into the tiniest stretch of real estate on the face.  Ageing here is a cascade of structural changes across these layers, so unless you understand the mechanics, treatments risk being a sticking-plaster rather than a solution.

Let’s begin beneath the surface. The eyelid skin is around 0.5 mm thick, compared with up to 2 mm elsewhere on the face. Here it contains fewer sebaceous glands and less dermal collagen, making it drier, thinner and far more vulnerable to environmental and chronological ageing.

Immediately below the skin sits the orbicularis oculi muscle, responsible for blinking and squinting (both of which happen thousands of times a day). Beneath the muscle are delicate fat compartments (the medial, central and lateral orbital fat pads) which give youthful fullness. Supporting this framework is the orbital septum (a fibrous membrane), which weakens with age and allows fat to herniate forward, creating puffiness or ‘eye bags’.

Bone also plays its part. The infraorbital rim (I.e. lower part of the eye socket) remodels and resorbs with age, which accentuates the groove between the infraorbital fat and the cheek fat, known as the ‘tear trough’ hollow and lengthens the junction between the eyelid and the cheek (rather nimaginatively named the ‘lid–cheek junction’). Lymphatic drainage in the area is sluggish at the best of times; with age it slows further, contributing to puffiness and fluid retention.

At a more microscopic level (Histologically), collagen and elastin fibres become more fragmented with age, fibroblast (the collagen and elastin producing cells) activity slows, and melanocytes (pigmentation cells) misbehave, producing pigment irregularities. The end result: crepey texture, lines, hollowness and pigmentation that together creates that unmistakable look of fatigue, even when the rest of you feels perfectly well-rested

The Stepladder Approach to Treatment

Treating the under-eye well requires an escalation strategy. We start with skincare (pretty much for everyone), progress to regenerative therapies, move on to injectables when necessary and reserve surgery for structural changes that nothing else can fix.

Step One: Skincare and Lifestyle

Targeted Topicals

The under-eye is not the place for blunt instruments.  The skin is around a quarter of the thickness of that on the cheeks, meaning active ingredients that work beautifully elsewhere can tip into irritation, redness or dermatitis when used here.  Potent retinoids, for example, are excellent collagen stimulators but can cause peeling and inflammation if applied to this delicate area.  Similarly, high concentrations of vitamin C in its purest form (ascorbic acid) can be destabilising, leading to stinging and erythema (redness) rather than the brightening effect you actually want.  That doesn’t mean we avoid these categories of ingredients altogether - it simply means they must be delivered in gentler, stabilised forms that respect the unique histology of the eyelid skin. Protecting against UV with a high-quality SPF (such as All Day Long SPF 50 ) is also non-negotiable as UV is one of the most important factors causing acceleration of dermal thinning and pigmentation.

This is the philosophy behind my Stellar Eye Cream, which uses next-generation actives chosen specifically for efficacy without irritation.  A granactive retinoid (an equivalent to retinaldehyde but at lower concentrations than I use in my Good Night [LINK] cream) stimulates collagen and elastin production but bypasses the harshness of traditional retinoids, making it safe for fragile under-eye skin.  Tetrahexyldecyl ascorbate, a lipid-soluble and highly stable form of vitamin C, penetrates the skin extremely effectively to reduce pigmentation and stimulate collagen without the instability (and irritation risk) of ascorbic acid.  It works synergistically with vitamin E, which neutralises free radicals and, when paired with vitamin C, has been shown to enhance brightening of pigmentation while protecting skin cellss from oxidative stress.  Peptides add further support by signalling fibroblasts to upregulate collagen and elastin production, gradually firming the thin dermis of the undereye skin.  For puffiness, caffeine and escin act in tandem: caffeine constricts capillaries to reduce vascular congestion, while escin, a saponin derived from horse chestnut, improves microcirculation and lymphatic drainage, easing the tendency to fluid retention.

The result is a multi-pronged formula designed to strengthen, brighten and decongest, all while being tolerable for the most temperamental of under-eyes.

General Skin Health

Even the best creams or injectables can only go so far if lifestyle is working against you.  The under-eye area is acutely responsive to systemic changes in hydration, circulation and inflammation, which is why seemingly minor habits (an extra glass of wine, a restless night, that late-night ramen brimming with salt and MSG) announce themselves so dramatically the following morning as puffiness, dullness or deepening shadows. 

Sleep is the first and most underestimated lever.  During deep (REM) sleep, the body’s repair mechanisms are at their most active: collagen synthesis is upregulated, cellular turnover is accelerated and cortisol (the stress hormone that breaks down collagen) falls.  Poor or fragmented sleep disrupts these processes, leaving skin thinner, duller and less resilient.  Moreover, lying flat or stomach-down can impair lymphatic drainage around the eyes, causing morning swelling.  Optimising sleep hygiene (a cool, dark room; a consistent bedtime; avoiding blue light from screens for at least an hour before sleep) supports both quality and duration of sleep.  For patients with stubborn under-eye swelling, even something as simple as an extra pillow to elevate the head slightly can help overnight drainage.  Supplements such as magnesium glycinate or low-dose melatonin (only available on prescription in the UK) can be helpful adjuncts for those who struggle with onset insomnia, though these should be used judiciously and ideally with medical advice.

Diet is the next crucial pillar. High sodium intake causes water retention in the extracellular space, most visible in delicate tissues like the under-eyes.  This isn’t just table salt: hidden sodium in processed foods, soy sauce, crisps and condiments all contribute, as does monosodium glutamate (MSG), which can provoke transient water retention in sensitive individuals.  The result is morning puffiness that stubbornly resists even the strongest eye cream.  Balancing this with a potassium-rich diet (bananas, leafy greens, avocado) can help the body regulate fluid more effectively.

Sugar, meanwhile, fuels glycation, a biochemical process in which sugar molecules bind to proteins like collagen and elastin, stiffening and weakening them.  Around the eyes, where collagen is already in short supply, the impact is magnified.  Reducing refined sugars and focusing on complex carbohydrates with a low glycaemic index (such as oats, pulses and wholegrains) helps preserve skin elasticity.

On the flip side, a diet abundant in antioxidants supports microvascular health and combats the oxidative stress that contributes to pigmentary dark circles. Vitamin C-rich foods (kiwi, citrus, peppers) help stabilise fragile capillaries, while anthocyanins in berries improve circulation.  Omega-3 fatty acids, found in oily fish, walnuts and flaxseeds, reduce systemic inflammation and improve the lipid barrier of the skin, enhancing resilience against environmental stressors.

Hydration deserves its own mention. The periorbital skin is particularly vulnerable to transepidermal water loss, and systemic dehydration makes this instantly visible as dullness and fine crêping.  Aim for steady hydration throughout the day rather than sudden gulps before bed (which only encourage fluid retention overnight).

Ultimately, good skin health around the eyes is less about rigid restriction than about balance: reducing excesses that stress the vasculature and lymphatics, while ensuring a steady supply of the micronutrients and hydration that this fragile tissue depends upon. 

Step Two: Skin Treatments for dark circles and undereye skin

The first category of in-clinic options work directly on the skin itself, targeting pigmentation, crepiness and dermal quality.

Mesotherapy

Treatments like Bright Eyes  deliver customised cocktails of vitamins, antioxidants and hyaluronic acid microdroplets directly into the superficial dermis.  This helps to hydrate, brighten and support the tissue at a microscopic level, improving skin tone and reducing dullness.  It’s especially useful in younger patients with early changes who want something preventative rather than corrective.  Usually a course of treatments would be recommended for best results.

Exosomes

Exosomes (tiny extracellular vesicles packed with growth factors and signalling molecules) represent one of the most promising new regenerative tools.  In the UK, they cannot be injected but can be applied via microneedling channels after controlled injury.  Once delivered, they can help to calm inflammation, accelerate healing and stimulate collagen synthesis.  In practice, pairing exosomes with gentle fractional laser (for example UltraClear) or microneedling creates a regenerative ‘boost’ that enhances results vs the treatments alone and reduces downtime.

Dermal Fillers

For hollowing and shadowing caused by volume loss, dermal fillers remain the most effective tool for volume replacement.  The key with Tear Trough Filler is subtlety: tiny microdroplets of a soft, low-hydration hyaluronic acid filler such as Teosyal Redensity 2, placed deeply against bone, restore smoothness without the risk of lumpiness or the bluish Tyndall effect.  Importantly, midface support with slightly thicker fillers such as Juvederm Voluma often does as much to correct the appearance of the tear trough than under-eye filler itself, by re-lifting the lid–cheek junction.  A nuanced approach balancing direct tear trough placement with adjacent support tends to give the most natural results.

Step Three: Bio-Stimulatory Injectables For the undereye area

Injectables that stimulate tissue rather than simply filling it are a vital rung on the ladder for undereye treatments, particularly where thin, crepey undereye skin is the main issue for patients.

Polynucleotides (PNs)

Polynucleotides such as Plinest Eyes  are DNA fragments that work at a cellular level, binding water molecules and stimulating fibroblasts to produce collagen and elastin.  They also exert anti-inflammatory effects, making them an excellent choice for fragile, crepey skin where dermal resilience has been lost.  Over a course of 3 treatments, they should improve elasticity, hydration and overall skin quality.  Usually results take about 3-6 months to fully show but there is good evidence for their use.

Platelet-Rich Plasma (PRP)

PRP  uses the patient’s own growth factors, to stimulate repair and regeneration.  PRP is concentrated from a small blood sample which is then centrifuged to isolate the ‘platelet-rich” portion which is then reinjected into the skin.  When injected into the under-eye, it has been shown to improve texture and pigment irregularities.  Again, a course of treatments is usually needed.  Often tts effects are subtler than PNs but can be valuable in patients preferring fully autologous therapies.

Step Four: Energy-Based Devices (Lasers & RF)

For patients with fine lines, crepey texture, or laxity that creams and injectables alone can’t resolve, energy-based treatments come into play.

Fractional Lasers for the undereyes

Lasers such as UltraClear  and CO2 laser (e.g. Fraxel] resurface the epidermis while stimulating new dermal collagen, tackling pigment and fine lines in tandem.  Using specialist settings for around the eyes, these treatments work by creating microscopic columns of skin ablation interspersed with intact skin.  This then provokes healing and renewal causing the skin to thicken and tighten.  Particularly in patients with pigmentation plus crepey undereye texture, lasers remain the gold standard.  As mentioned above, they can be used with other complementary treatments, for example PRP, exosomes or polynucleotides for the best result.

Radiofrequency Microneedling for undereye skin

Fractional radiofrequency devices like Morpheus8 use microneedles to deliver radiofrequency heat into the dermis, causing existing collagen to contract and stimulate new collagen and elastin production.  The result is firmer, smoother skin.  Precision is vital in this area: used too aggressively, RF can damage under-eye fat pads, leaving hollowing that is difficult to correct.  At shallow depths and conservative energy settings, it is highly effective for dermal tightening and can again be combined with polynucleotides or exosomes for synergistic effect.

Step Five: Blepharoplasty Surgery

For patients with true fat prolapse, redundant skin, or significant laxity, surgery remains the definitive fix. Lower lid blepharoplasty (which involves removing or repositioning herniated fat, tightening the orbital septum and trimming excess skin) produces results that no injectable can match.  Recovery is longer, but for the right candidate, the outcome is transformative and will last.

Quick Guide: Matching Treatments to Underlying Issues

A tailored consultation should always identify the dominant anatomical culprit.  Treating dark circles with filler when the issue is pigment, or zapping puffiness with laser when the problem is herniated fat, is a recipe for disappointment so accurate diagnosis of the underlying issue is key for optimal outcomes.

Final Thoughts

Under-eye ageing is not one problem but many, layered on top of each other: thinning skin, pigment, vascular show-through, fat changes, bone resorption.  The best results come from respecting that complexity and choosing the right rung of the ladder (and treatment combinations) for each individual.

The goal is never to erase character as life leaves its signature in the skin, and rightly so.  But the tiredness, the heaviness, the sense of perpetual exhaustion that under-eye changes can project?  That, can be improved.  Book in for a consultation with us to understand which treatment combinations would work best for you.

References

Lampridou, S., Constantoudis, S., Vasios, G. et al. (2024) ‘The Effectiveness of Polynucleotides in Esthetic Medicine: A Systematic Review’, Journal of Cosmetic Dermatology. Available at: https://pubmed.ncbi.nlm.nih.gov/39645667/

Lee, K. W. A., Mucha, P. and Budzisz, E. (2024) ‘Polynucleotides in Aesthetic Medicine: A Review of Current Applications’, MDPI (Open Access). Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11311621/ 

Shauly, O., et al. (2023) ‘Radiofrequency Microneedling: Technology, Devices, and Clinical Evidence’, PMC (Frontiers / open access). Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11181949/ 

Lin, F., et al. (2025) ‘Therapeutic Effectiveness of Microneedling Radiofrequency (MNRF) for Periocular Wrinkles’, Journal of Cosmetic Dermatology. (online pre-publication). Available at: https://onlinelibrary.wiley.com/doi/10.1111/jocd.16645  

Cheng, H., et al. (2022) ‘Synergistic Effect of Microneedle-Delivered Extracellular Vesicles and Monopolar RF for Eye Area Rejuvenation’, Frontiers in Medicine. Available at: https://www.frontiersin.org/articles/10.3389/fmed.2022.900784/full