Dark under eye circles and hollows are a very common area of requested cosmetic treatment for both men and women. They often result in a “tired, worn out” appearance that does not reflect how someone actually feels.
When researching treatment options, it is important to identify WHY these hollows and circles form. Treatment providers must consider several factors that may be concomitant issues, including: allergies (“allergic shiners”), skin pigment changes, skin vascularity, changes in skin thickness (fat and subcutaneous collagen content), periorbital fat herniation, periorbital ligament position, unfavorable orbital anatomy, malar fat pad repositioning, bone resorption, and other midface soft tissue changes with age.
In review, the “BEST” treatment is most likely a multifaceted approach combining medical management of allergies, application of cosmetics, non-surgical interventions, and surgical procedures to address each individual patients need.
I advocate avoidance of a one-size-fits-all approach to this issue. Start low and slow with conservative non-surgical measures first, especially in young patients (< 40 years). Older patients (>55 years) are less likely to obtain the results they would like without surgery, but non-surgical options should be discussed first. Turning up the aggressiveness of treatment and pursuit of surgical intervention can always be pursued later, but difficult or impossible to reverse.
Here is a link to a recent paper that highlights the etiologies and various treatment modalities to consider when treating dark under eye circles: