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The Ultimate Guide to Dark Eye Circles: Causes, Treatment and Prevention


First and foremost, we need to understand the root causes of dark eye circles. It is not something that just happens on your skin surface, and this is why even the best eye creams will not be sufficient. It is the ageing and loss of collagen that’s happening deep inside.

And we know how irritating it gets. Our faces looked tired and sick all the time, and we literally live and breath with concealers every day.

Dr. Terence Tan, from Halley Medical Aesthetics, is an aesthetic doctor who has helped many patients to get rid of their dark eye circles with medical-grade treatments such as Ultherapy, lasers, threadlifts and fillers. Therefore, he understands the struggles and pain, and today, he will be sharing his personal insights on getting rid of dark eye circles with non-surgical, non-invasive, medical-grade treatments (and not eye creams).

What are dark eye circles?

A dark eye circle is the ‘darkening’ of the skin just below your eyes. We often hear that not getting enough sleep leads to dark eye circles. However, there’s more than one reason why people suffer from dark eye circles. Dark eye circles are different from eyebags. Eyebag refers to the swelling or puffiness under our eyes. It can be caused by the sagging of the fat below our eyes or fluid retention.

What causes dark eye circles?

There are six main causes of dark eye circles:

1. Ageing

To begin, the skin around our eye area is very thin. They are on average about 0.5 mm thick while the skin on the rest of your body is about 2mm thick. As we age, you lose the elastin and collagen needed to maintain your skin elasticity. This causes the skin to be thinner, thus the dark blood vessels under your skin become more visible. Furthermore, the loss of collagen combined with bone resorption (loss of bone mass) also creates a hollow under our eyes. The area that used to be plump and full of volume is now skeletal-looking, dark, and shadowy as a result. The sagging of the fat of the cheeks just under our eye creates undesirable shadows under our eyes. That results in a tired, fatigued look.

2. Sun exposure

Our body produces more melanin (a pigment that gives our skin its colour) when we are in the sun. The skin around our eyes tends to produce more melanin than other parts of our body.

3. Fatigue 

A lack of sleep or excessive tiredness can cause the blood vessels under the eye to dilate. That creates a shadow effect that exposes the underlying veins.

4. Allergies

Allergies cause our body to release histamines. These are chemicals that can cause fluid build-up in the area. The histamines may also cause swelling of tissues and circulation changes, making the dark vessels under our eye to be more obvious.

5. Genetics

If your parents have dark eye circles, you are likely to have them too. Darker or more olive-toned complexions often have higher concentrations of pigment (melanin) under the eyes. This results in discolouration and shadows. If you inherit fair or thin skin under the eyes, it is more obvious when the blood pools in that area.

5. Smoking

Smoking accelerates ageing because it breaks down the collagen and elastin in our body. These are the things that help you look youthful and fresh. If you’re a smoker, the delicate tissue around your eyes breaks down faster. This makes the blood vessels under your eyes more prominent.

Now, you will understand why even the best eye creams don’t work. It is simply because it is not treating the root causes of the problem.

What are the options for dark eye circle treatments in Singapore?

Let us focus on medical-grade treatments that are effective enough to correct dark eye circles with no surgery and minimal or no downtime.

Ultherapy (non-invasive with no downtime)

The dark circles under your eyes are made worse due to loosening of the skin in the undereye area. The is due to the loss of collagen. Ultherapy uses focused ultrasound energy to stimulate your body into producing collagen. It’s capable of penetrating deep into the skin. It passes the epidermis, dermis, and fat/connective tissue to stimulate the SMAS layer. The SMAS layer is responsible for producing collagen.

Also read: Understanding Ultherapy in Singapore

In the past, the SMAS (subcutaneous musculo-aponeurotic system) is only accessible by plastic surgeons with an incision. With Ultherapy, doctors are now able to use focused ultrasound energy to stimulate collagen production and lift sagging skin without any incisions. With Ultherapy, it addresses two root causes of dark eye circles and reduce the appearance of the dark shadows:

  • Tighten the skin under their eyes to reduce loose skin
  • Tighten up the cheeks to lift up cheek fat to reduce the hollows below our eyes

Dermal fillers (minimally invasive with no downtime)

Dermal fillers are often associated with facial sculpting, e.g. a higher nosebridge or a sharper chin. However, it is also commonly used to restore facial contours. They are designed to reduce the appearance of wrinkles by adding volume to areas on the face that are sunken in because of ageing. Unlike Ultherapy, an undereye dermal filler fills up the hollow space and the irregular undulations of the skin between our eyes and cheeks. When that area is volumised, it reduces the appearance of the dark eye circle.

When I combine Ultherapy and dermal fillers, I am able to tighten the skin above and lift the skin below. This is what I call the “Sandwich Effect” that helps my patients achieve a youthful looking undereye skin. However, it’s important to note that not every brand of dermal filler is suitable for the undereye area. The filler should be soft (and not firm) so as to give a natural result. To help you with your research, here’s some suitable brands.


Laser (non-invasive with no or very minimal downtime)

Laser treatments are used to treat varied skin conditions such as acne, acne scar removal, removal of tattoos, skin toning, and skin lumps. Lasers are very powerful beams of light that can be tuned to different wavelengths. These different wavelengths address different types of skin problems.

What happens under your skin after a PicoSure laser treatment

Similar to dermal fillers, not all lasers can be used for treating dark eye circles. For under-eye treatment, pigment lasers like PicoSure can be used to target the source of dark circles by fragmenting the pigmentation that darkens the skin. After which, the body’s immune system will rapidly absorb it and eliminate them naturally. It also tightens the loose, saggy skin and generates new collagen to volumise the undereye area.

Fraxel Dual (a type of resurfacing laser) is also suitable but it works in a different way. It replaces skin damaged by photo-ageing with new skin which has less pigmentation and more collagen.

Threadlift (minimally invasive with no downtime)

Threadlift of the undereye is actually a misnomer. Unlike conventional threadlift procedures, threads for undereye rejuvenation do not ‘lift’ like threads used for other area and so it is technically not really a “threadlift”. In this instance, threads are inserted under the eye for support and stimulate the production of collagen. This will help reduce the wrinkles, loose skin, and the bulginess of the eye bags. Most undereye threads are made from Polydixanone (PDO). They are inserted under sterile conditions with a blunt cannula for safety.

Dr. Terence, how many sessions are required to see results?

This varies from patient to patient. Your doctor will be able to suggest the number of sessions you require depending on your problem areas. Generally, one session of Ultherapy, dermal filler, and threadlift is enough to see results. But a yearly refresh for Ultherapy and threadlift is recommended. Most dermal fillers last one to two years, however, semi-permanent fillers can last longer. As for the lasers, it can take anywhere between one to six sessions to see good results depending on the condition and expectations of the patient. As you can see, the sessions required varies with each type of treatment. It’s best for you to find a trusted doctor and discuss how you would like to go about with your dark eye circles treatment.

What is the best non-surgical method for dark eye circle treatment in Singapore?

Of course, this will depend largely on what the patient wants and the condition of their dark eye circles.

For example, if the patient has an important event coming up and requires quick results, then dermal filler or a threadlift is recommended. For patients who want to erase their fine lines, wrinkles for an overall improvement of their skin texture, then Ultherapy and laser treatments are ideal.

Combination treatments can also be done for some patients because their condition is very severe and they desire a more dramatic result. This is because different treatments are able to penetrate different depths of the skin. For example, Ultherapy is able to go down 4.5mm below the skin, whereas lasers target mostly your skin surface at 1.0mm. Dermal filler and threadlifts work deeper underneath of the skin.

“My friend told me that combining treatments can cause more harm than good!”

I understand combining treatments might seem like a scary thing to do. Many times, patients come up to me asking me if it would be an overkill to do multiple treatments. However, from my experience, combining treatments can actually help to produce more natural results as each method is used to address different underlying causes of dark eye circles. Combining treatments also reduce the reliance on a single treatment method.

What happens during a dark eye circle treatment session in Singapore?

Application of numbing cream

Firstly, a numbing cream is applied to the treatment area and left on for about 20 minutes regardless of the treatment. After the numbing cream is washed off, here are the different processes for each type of procedure. Each treatment duration is around 30 minutes.

  • Ultherapy: Your doctor will apply gel to the face to ensure good contact between the skin and the Ultherapy transducer. He will be able to see a live ultrasound scan of the specific treatment area to ensure that the ultrasound energy will be deposited to where it is most beneficial. The ultrasound energy is delivered with pinpoint accuracy at 4.5mm, 3.0mm, and 1.5mm beneath the skin.


  • Dermal filler: Your doctor will inject the filler using a “Magic Needle” or micro-cannula (it’s a flexible thin tube) rather than a typical needle to ensure a more even distribution of the filler. The blunt tip of the micro-cannula helps to minimise discomfort to the lowest because it slides under the skin easily. This method also minimises bruising.


The “magic needle”

  • Laser: Your doctor will place the probe which discharges the laser energy over the areas that require treatment. The wavelength and lenses are customised to the patient’s skin type and desired result.


  • Threadlift: In addition to the numbing cream, the doctor will inject a local anaesthesia, Lidocaine, before inserting the threads under your skin with a thin yet flexible thin tube (cannula). The doctor will then insert the threads with the cannula, that will gently push your skin aside to minimise discomfort and bruising. No incision of the skin is made. Once the threads are inserted, they can be tightened as desired. Then, the ends of the threads are cut off. No stitches are necessary.

Doctor, how safe is a dark eye circle treatment in Singapore?

The treatments mentioned in this article do not involve any surgical incisions, which means that there is no or very little recovery time needed. This greatly minimises any potential risks and complications.

Treatments like Ultherapy, PicoSure, and Fraxel Dual are all approved by the US Food and Drug Administration (US FDA). However, it’s always good to do your research and find a doctor who has sufficient experience in these treatments.

What are the potential complications/side effects of a dark eye circle treatment?

Your skin might be flushed and there might be some swelling right after the treatment but these will disappear within a few hours. The treated area will also feel tender to touch, almost like the skin is “aching” for a few weeks after Ultherapy but that is normal. It is an indication that the skin is responding to the treatment. Optimal results are expected in about three months’ time.

You might experience some bruising, swelling, redness, tenderness, or slight bleeding at the injection sites. However, these reactions are very rare. They are usually temporary and would most likely resolve within a week.

Your skin might be flushed and there might be some swelling right after the treatment. These will disappear within a few hours. The treated area will also feel tender to touch but that is normal. It is an indication that the skin is responding to the treatment.

Now, let us know! Who is the best doctor for dark eye circle treatments in Singapore?

Different doctors have different treatment philosophy but there are always important key factors for you to consider when you are seeking a doctor. First and foremost, you need to be comfortable with the doctor who is treating you, and not forgetting the factors below:

  • The ability of the doctor to listen and provide an unbiased consultation
  • Transparency in pricing with no hard-sell or upselling
  • Credentials of the doctor and the practice
  • His/her previous works to see if their aesthetic sense appeals to you.

I hope this helps you in your quest to eliminate these dreaded dark eye circles. Good luck!


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