![]() On an average, a woman in the United States spends $15,000 (USD) in her lifetime on cosmeceuticals and makeup, a large percentage of which is spent on under-eye concealers. Throughout cultures, societal perceptions are similar, in that periorbital dark circles contribute to a tired, aged and even sad appearance. Perceptions regarding the degree of a person's fatigue and age are preferentially based on periorbital aesthetics. The armamentarium for treatment includes minimally invasive interventions such as makeup and cosmeceuticals, a variety of laser and chemical treatments, fillers and fat transfer, as well as more invasive surgical manoeuvres. ![]() ![]() An understanding of the deep and superficial anatomy is crucial to the management of this complex entity. This review provides a detailed discussion of the aetiology, pathogenesis, evaluation and management of infraorbital dark circles. A comprehensive review of the literature was performed and the data were assimilated with evidence from our practice. A literature search using MEDLINE and non-MEDLINE sources was performed utilising keywords including: ‘Dark circles’ ‘infraorbital dark circles’, ‘infraorbital pigment’, ‘under-eye circles’ and ‘lower eyelid bags’. A variety of treatment options exist, and a customised management strategy can be developed for the particular anatomic changes present. Infraorbital dark circles represent a common and multifactorial challenge in the world of aesthetic medicine and are the result of a variety of factors including deep facial anatomy, soft tissue changes, as well as contributions from the skin.
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