The undereye area contains complicated anatomy that can be frustrating to deal with. There are multiple issues in the undereye area that can cause concern.

There can be “bags” under the eyes that are caused by excessive volume in the area. This volume can be in the form of lower eyelid fat- if this is the case, the undereye bags do not change day to day and are always present. The treatment for this is lower eyelid cosmetic surgery to remove this excess fat and smooth out the area where the lower lids meet the cheeks. This condition is called lower eyelid fat pseudoherniation (the connective tissue holding the fat in place has loosened, causing the fat that normally lives around the eye to bulge in this area). 

Lower eyelid bags that change day to day can be the cause of excess fluid. This type of swelling can be from not getting enough sleep or from an allergy to something in the environment. Sometimes this area will also get swollen with sinus infections. This type of swelling is best treated by addressing the underlying cause, whether it is getting adequate sleep, reducing exposure to an allergen, or treating a sinus infection. 

Occasionally, there is another type of fluid swelling that appears in the upper cheek area that fluctuates but never goes completely away. These are called festoons. They are best treated with a steroid injection. 

With all of the above, there appears to be a dark circle under the eyes. This darkness is caused by shadowing and can be more noticeable with direct overhead lighting (common in bathrooms). Sometimes dark circles under the eyes are not from too much volume but actually too little volume. This can create deep “tear troughs”. In some patients these types of dark undereye circles do not change day to day. They are best treated with adding volume to the area. This can be from fat grafting for a long-term result (many years) or filler injections which are more short term (9 months to a year).

Screen time does not directly cause dark undereye circles but can contribute to less sleep. In this way, excess screen time at night may contribute to dark undereye circles. If sleep deprivation is the cause for dark undereyes, that will be remedied within a week of getting more restorative sleep.

Less commonly, dark undereyes are not from an issue with volume, but are from pigmentation changes in the area. For these, a course of hydroquinone cream can be helpful in decreasing the dark pigmentation in this area. It is not always known what causes the dark pigmentation in this area. 

Dark circles under the eyes may occasionally be a sign of illness like allergies, a sinus infection, or insomnia. It is also possible that sudden excessive weight loss can cause undereye hollowing and this gaunt appearance with dark undereyes can be seen if someone has a medical condition causing them to lose too much weight. If you or a loved one has a concern about your undereye area, it is worthwhile for you to be seen by a reputable facial plastic surgeon to help direct the best course of treatment.