Dark circles under the eyes are a common but challenging problem in aesthetic practice. The causes of dark circles are multifactorial and can be grouped into three categories. Aetiological factors described in the literature include a ‘shadow in the valley’, due to the obicularis retaining ligaments and tear trough ligaments, superficial venous congestion and skin discolouration. Several validated treatment modalities have been described, including cosmetic surgery, dermal fillers, energy-based devices, needle-based therapy, chemical peels and topical agents. A review of the available management options, their therapeutic targets and the author's evaluation of their efficacy and cost in practice is presented in this paper.

Marshall Murdoch - Plastic and Reconstructive Surgeon, Wits Donald Gordon Medical Centre and Honorary Lecturer, Division of Plastic and Reconstructive Surgery, University of the Witwatersrand, Johannesburg, South Africa