The shadow under the eyes that makes a face look tired is, for a lot of people, not a pigment problem and not something a cream will reach. It is a hollow, a loss of volume in the tear trough, the groove that runs from the inner corner of the eye, and the skin above it simply falls into shadow.
Where that is the cause, the correction is a hyaluronic acid filler placed into the trough to restore the volume that was lost. Done well it is subtle: the hollow lifts, the shadow softens, and the face reads as rested rather than as done.
It is also an area where care matters more than almost anywhere on the face, because of what runs beneath it. Before I begin I mark the face against the anatomical landmarks, so that every placement is precise and away from the structures that must be avoided. A few drops of local anaesthetic go in first, so the treatment is comfortable rather than something to endure.
The reason it is worth naming the cause correctly, volume loss, not ageing in the abstract, is that it changes the answer. If the darkness is pigment, filler does nothing for it. If it is a hollow, no amount of brightening cream will fill it. The assessment is what tells the two apart, and it is the part that comes before any needle.
Associate Professor Dr. Lubna Rani Faysal
MBBS (Gold Medalist), FCPS (Dermatology), MHPE · 13 years in dermatology
