tired-looking eyes
Under-eye hollows
Tired-looking eyes usually have one of three causes: a hollow between the lower eyelid and the cheek, a fat pad that has moved forward, or pigment and thin skin. Each has a different treatment, and some of the most effective options are not injections at all.
Clinically reviewed by Dr Munroe, September 2026
what it is.
The tear trough is the groove that runs from the inner corner of the eye, down and out along the bony rim of the eye socket. When it deepens, it catches shadow and the eyes can look tired regardless of how much you have slept.
It is often confused with two other concerns. An under-eye bag is a fullness above the groove, usually caused by fat moving forward, while a dark circle is a change in colour, from pigment or from blood vessels showing through thin skin. Overhead light can help tell them apart: a hollow casts a shadow beneath it, a bag casts a shadow below the fullness, and pigment looks the same whatever the light.
what causes it.
With age, the mid-face gradually loses support. The fat pads of the cheek become thinner and descend, and the bone around the lower eye socket changes shape, so the skin over the groove has less beneath it. Some people inherit a deeper tear trough and notice it from their twenties, and weight loss can make it more visible.
Under-eye bags have a different cause: the membrane that holds fat within the eye socket weakens with time, allowing the fat to move forward. Dark circles are often genetic, more common in some skin types, and made worse by sun exposure, rubbing and allergies. Puffiness that varies with sleep, salt and alcohol is fluid rather than a change in structure.
who gets it.
Most people notice the tear trough from their thirties onwards. It often appears earlier in those with a naturally deep groove or a slim face, after weight loss, and after pregnancy. Pigmented dark circles are more common in darker skin types and in people with eczema or hay fever.
the options.
Including the ones not offered here at Dr Munroe Clinic.
Tear trough filler
May suit a true hollow where the skin over it is in reasonable condition. Small amounts are placed deep, often after the cheek has been supported first. Offered at Dr Munroe Clinic.
Cheek support first
Where the hollow reflects lost support in the cheek, restoring the mid-face can soften the tear trough without treating it directly. Offered at Dr Munroe Clinic.
Polynucleotides
May suit thin, crepey under-eye skin where the aim is to improve skin quality, hydration and texture. Offered at Dr Munroe Clinic.
Skincare and pigment treatment
Daily sunscreen and skincare that targets pigment can help dark circles caused by colour rather than shadow.
Lower eyelid surgery
Suited to under-eye bags caused by fat moving forward, and to loose skin on the lower eyelid. This is not offered at Dr Munroe Clinic, and where it is the most appropriate option, we can refer you onwards for surgical consultation with one of Dr Munroe's excellent colleagues.
No treatment
Puffiness that changes from day to day is usually fluid, and often improves with sleep, less salt and time rather than treatment.
what Dr Munroe recommends.
An assessment comes first, because the three causes can look similar but need different approaches. A common plan uses polynucleotides in the tear troughs whilst considering the surrounding volume replacement needs. Where the concern is fat moving forward, filler can make the area look heavier, and this will be explained at consultation.
common questions.
Why do my eyes look tired even when I have slept?
This is usually because of the shape of the area rather than sleep. A hollow under the eye casts a shadow in overhead light, whereas puffiness from sleep and salt changes from day to day.
Can filler treat under-eye bags?
Filler is not usually suitable for under-eye bags. A bag is most often caused by fat moving forward over the bony rim, and filler placed beneath it can make the area look heavier. Under-eye bags are generally a surgical question.
Are dark circles treated with filler?
Only when the darkness is a shadow caused by a hollow. Pigment, and blood vessels showing through thin skin, are better addressed with skincare, skin treatments or a dermatologist.
How long does under-eye treatment last?
Tear trough filler usually lasts around nine to twelve months. Polynucleotides are given as a course of three treatments, with maintenance every six to twelve months.
the next step.
Every plan starts with a consultation: a review of your skin and what you'd like to change, and an honest account of which of these options applies to you.
Clinically reviewed by Dr Tiffany Munroe, MBBS MRCS, GMC 7293952.
Last reviewed . Next review .
About Dr Munroe