The Complete Guide to Under-Eye Treatments

The under-eye area is one of the first regions to show signs of ageing, fatigue, and stress. With skin that is just 0.5mm thick — the thinnest anywhere on the body — and minimal subcutaneous fat, the periorbital region is uniquely vulnerable to dark circles, hollowing, fine lines, puffiness, and crepey texture. Fortunately, modern aesthetic medicine offers a range of effective treatments to rejuvenate this delicate area.

At Axiom Aesthetics, under-eye rejuvenation is one of our most requested treatment areas. This guide covers the causes of under-eye concerns, the full range of treatment options, and how to choose the right approach for your specific needs.

Understanding Under-Eye Concerns

Anatomy of the Periorbital Region

The under-eye area has a unique anatomy that makes it particularly prone to visible changes:

• Extremely thin skin: 0.5mm compared to 2mm on the rest of the face, making underlying structures more visible
• Minimal subcutaneous fat: Limited padding between the skin and underlying muscle and bone
• Dense vascular network: Blood vessels are closer to the surface, contributing to dark circles
• Orbicularis oculi muscle: Constant movement from blinking (15,000–20,000 times per day) accelerates fine line formation
• Orbital fat pads: Deep fat pads that can herniate forward as supporting ligaments weaken, creating bags
• Tear trough: The groove between the lower eyelid and cheek, which deepens with volume loss

Types of Under-Eye Concerns

Concern	Cause	Appearance	Best Treatments
Dark circles (vascular)	Visible blood vessels through thin skin	Blue-purple discolouration	Skincare, filler, PRP, carboxytherapy
Dark circles (pigmented)	Melanin overproduction, genetics	Brown discolouration	Chemical peels, skin lightening, laser
Tear trough hollowing	Volume loss, bone resorption	Deep groove under the eye	Dermal filler, fat transfer, Profhilo
Under-eye bags	Fat pad herniation, fluid retention	Puffy bulges below the eye	Surgery (blepharoplasty), RF, lifestyle
Fine lines (crepey skin)	Collagen loss, dehydration, sun damage	Crinkly, paper-thin texture	Skin boosters, microneedling, peels, retinoids
Malar festoons	Chronic fluid accumulation in cheek tissue	Swollen, hammock-like folds on the cheek	Specialist assessment, surgery, RF

Non-Surgical Under-Eye Treatments

1. Tear Trough Filler

Hyaluronic acid filler injected along the tear trough can dramatically reduce the hollow, shadowed appearance under the eyes. This is one of the most transformative single treatments in aesthetic medicine — but also one of the most technically demanding.

Products used: Soft, low-viscosity HA fillers designed for delicate areas (e.g., Teosyal Redensity II, Restylane Eyelight, Belotero Revive)

Technique: The filler is placed deep on the bone (supraperiosteal plane) using a cannula for maximum safety and minimal bruising. Typically 0.3–0.5ml per side is sufficient.

Results: Immediate improvement in hollowing and shadow. Results last 9–18 months depending on the product and individual metabolism.

Cost: £350–£600 per treatment

Risks: The under-eye area has complex vascular anatomy. Bruising, swelling, and the Tyndall effect (a bluish discolouration from filler placed too superficially) are the most common concerns. Vascular occlusion is a rare but serious risk. This treatment should only be performed by experienced practitioners with excellent anatomical knowledge.

2. Polynucleotide Eye Treatments

Polynucleotide (PN) injections specifically formulated for the periorbital area (e.g., Nucleofill Medium, Ameela Soft) stimulate fibroblast activity, improve skin thickness and elasticity, and reduce dark circles through anti-inflammatory and tissue-regenerating effects.

Evidence: Clinical studies show improvements in skin elasticity, hydration, and dark circle appearance after 2–3 sessions. PNs are particularly useful for patients with thin, crepey under-eye skin who are not suitable candidates for filler.

Treatment course: 3 sessions, 2–4 weeks apart. Cost: £200–£350 per session.

3. Profhilo Eyes

A specific Profhilo technique using small amounts (0.1–0.15ml per side) of the standard Profhilo product placed in the periorbital region. This bio-remodels the delicate under-eye skin, improving hydration, elasticity, and fine lines.

Treatment course: 2 sessions, 4 weeks apart. Cost: £250–£400 (often combined with full-face Profhilo).

4. PRP (Platelet-Rich Plasma)

PRP uses the patient’s own blood, processed to concentrate growth factors, which is then injected or microneedled into the under-eye area. Growth factors stimulate collagen production, improve circulation, and enhance skin quality.

Evidence: A 2019 study in the Journal of Cosmetic Dermatology found PRP treatment reduced dark circle severity scores by 65% and improved skin thickness measurements on ultrasound after 3 sessions.

Treatment course: 3 sessions, 4–6 weeks apart. Cost: £250–£400 per session.

5. Microneedling

Gentle microneedling (0.25–0.5mm depth only) around the periorbital area stimulates collagen in the superficial dermis, improving fine lines and skin texture. Often combined with growth factor serums or PRP for enhanced results.

Treatment course: 3–6 sessions, 4 weeks apart. Cost: £150–£300 per session.

6. Chemical Peels for Dark Circles

Very gentle chemical peels can address pigmentation-related dark circles:

• Mandelic acid (10–20%): Gentle enough for the periorbital area, reduces pigmentation
• Lactic acid (10–20%): Hydrating peel that brightens without irritation
• Retinol peels: Stimulate cell turnover and reduce melanin deposition

Surgical Options

Lower Blepharoplasty

For patients with significant fat pad herniation (bags) or excess skin, lower blepharoplasty remains the definitive treatment. This surgical procedure can:

• Remove or redistribute herniated orbital fat
• Tighten the lower eyelid skin
• Combine with fat transfer for volume restoration
• Provide long-lasting results (10+ years)

Cost: £3,000–£6,000 in the UK. Recovery time: 1–2 weeks.

Combination Treatment Plans

At Axiom Aesthetics, we often recommend combination approaches for comprehensive under-eye rejuvenation:

• Hollowing + crepey skin: Tear trough filler + polynucleotide treatment (staggered by 2–4 weeks)
• Dark circles + fine lines: PRP + gentle microneedling + targeted skincare (vitamin C, retinol, peptides)
• Mild hollowing + skin quality: Profhilo periorbital treatment + LED therapy
• Comprehensive: Tear trough filler for volume, followed by a course of microneedling with PRP for skin quality and dark circles

Home Care for Under-Eye Health

Professional treatments are most effective when supported by appropriate daily skincare:

• Retinol eye cream (0.025–0.05%): Stimulates collagen production; start with low concentrations and use every other night
• Vitamin C eye serum (5–10%): Brightens dark circles and provides antioxidant protection; lower concentration than facial serums to avoid irritation
• Peptide eye cream: Caffeine peptides reduce puffiness; copper peptides stimulate collagen; Haloxyl and Eyeliss target dark circles specifically
• SPF protection: Mineral sunscreen or large sunglasses to protect the delicate periorbital skin from UV-induced collagen breakdown and pigmentation
• Adequate sleep: 7–9 hours per night on a slightly elevated pillow to reduce morning puffiness
• Hydration: Both topical (hyaluronic acid serums) and internal (adequate water intake)

Frequently Asked Questions