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Dark circles and bags under the eye occur for several reasons: the skin there is much thinner than it is elsewhere on the body and becomes looser as we age. This very thin skin also sits on top of underlying purple muscle and blood vessels and therefore appears darker. In addition, some people have hereditary pigmentation in this area. As we age, fat comes out of the space enclosed by the eye socket, called the orbit, and forms a puffy area under the eye. This fatty tissue can fill with water, making the hollow appear even deeper. The condition becomes even more noticeable when water is retained in the fat pad, which can occur for a variety of reasons, including eating too much salt, lying flat in bed, not getting enough sleep, allergies and monthly hormonal changes.

Treating the hollow space under the eye is straightforward and can be done by injecting a filler such as Restylane. Immediately after this procedure, the so-called tear trough is softened, and any visible pigmentation becomes noticeably lightened. A carbon dioxide (CO₂) laser also can be used to resurface the skin, which tightens and thickens it as well as lightening the coloring. For hereditary pigmentation, CO₂ laser resurfacing and bleaching creams are sometimes helpful. As an option, a surgeon can perform blepharoplasty to fix the fat pad under the eye.