Dark circles

For under-eye hollows (tear troughs) that cast shadows and read as dark circles, a 2024 meta-analysis of 31 reports covering 2,556 participants found a pooled patient satisfaction rate of 91 percent with HA filler. The catch: most included studies were uncontrolled case series rather than randomized trials, and filler helps shadowing from hollowness, not true pigment. The under-eye is also the least forgiving injection site, with swelling, lumpiness, and a bluish Tyndall effect as known problems. Most tear trough treatment is off-label.

A 2025 systematic review of 14 studies comparing PRP and PRF for the under-eye area found PRF associated with improvements in texture, crepiness, and fine wrinkles, but objective improvements were mixed, benefit for true pigmentation was only moderate at best, and gains often diminished by 6 months. Most studies were small, unblinded, and used different preparation protocols, so no reliable effect size exists. PRF cannot fill a deep tear trough the way HA filler can.

Under-eye PRP is heavily promoted, but supporting data amounts to small split-face and comparative trials, such as a 2021 randomized split-face study of injection techniques for periorbital hyperpigmentation, and in one comparative RCT more than half of PRP-treated patients were nonresponders for infraorbital dark circles. There is no meta-analytic support; treat marketing claims here with skepticism.