Analyzing Current Procedures for Periorbital Hyperpigmentation

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A novel systemic review and meta-analysis has analyzed procedural treatments for periorbital hyperpigmentation, or dark eye circles.¹ Through this analysis, it was found that lasers and combination therapies are the most effective and satisfactory treatments for dark eye circles. Intense periorbital hyperpigmentation can be emphasized based on skin laxity, vascular congestion, and the anatomical structure of the face.²

All literature published up to February 2023 in major databases like PubMed, Scopus, and Web of Science was searched. Investigators used key words like “infraorbital dark circles,” “infraorbital hyperpigmentation,” “periorbital dark circles,” “periorbital hyperpigmentation,” “dark eye circles,” and “under-eye dark circles.”

After an initial search of 278 records, 33 studies featuring 1320 patients were included in the final count. Twelve were one-arm studies, 17 were two-arm studies, and 4 were three-arm studies. Most of the trials were conducted in Iran, Egypt, India, the United States, and China.

Clinicians recorded procedure parameters, scoring methodology, clinical improvement, pre-and post-treatment pigment scores, patient satisfaction levels, and adverse events. The therapies were divided into the following categories;

• Lasers and light therapies like fractional CO₂ and Q-switched or long-pulsed Nd: YAG
• Chemical peels
• Platelet-rich plasma (PFP)
• Carboxytherapy
• Fillers and injections
• Microneedling
• Combination therapies (microneedling + chemical peels or fillers + lasers)

The most effective methods were lasers and combination treatments, with 82% and 75% of patients experiencing excellent or good improvement, respectively. This is defined as improvement of > 50%. The CO₂ laser was the most commonly used laser.

Chemical peels (63%), carboxytherapy (54%), and PRP (44%) were less effective. Additionally, only 25% of chemical peel users had “excellent” results but there was a higher rate of 37% for “good” improvement. There was only one study each that focused on fillers and autologous fat injections, so the analysis is limited. However, in those trials, 94% and 74% of participants saw a marked improvement, respectively.

In terms of patient satisfaction, combination therapies had the highest rates, with 49% of participants reporting an excellent rate of > 75%. Laser treatments were predominant in the good satisfaction rate category, with more than half of patients being satisfied with their therapies. Chemical peels (24%) and PRP treatments (17%) had limited patient satisfaction.

All therapies had some mild and transient adverse effects. The lasers were associated with short durations of burning, erythema, discomfort, swelling, pain, and edema. However, these were reduced when CO₂ laser was combined with PRP. Additionally, Q-switched and picosecond Nd:YAG lasers had higher rates of post-inflammatory hyperpigmentation compared to carboxytherapy and the picosecond 755-nm laser. But combined laser treatments also had reduced healing times.

This review does have some limitations including the lack of uniform measurements and high heterogeneity across all the studies.

“Efforts to reduce this variability through subgroup analysis and stratification by specific treatment settings and geographic location were unsuccessful, indicating the presence of complex, possibly unmeasured variables affecting treatment outcomes,” the authors wrote. “This suggests that caution is needed when interpreting these results due to the potential masking of true treatment effects.”

Future research with more objective assessment methods can help validate these existing results. Furthermore, larger sample sizes, longer follow-ups, and split-face designs can better represent the populations impacted by periorbital hyperpigmentation. 

This literature is the first of its kind to comprehensively review procedural treatments.³ With these findings, the researchers emphasize the significance of personalized treatment approaches that will fulfill patient and clinician needs and expectations.

References

1. Pour Mohammad A, Zeinali R, Jafary P, Mortaja M, Jafarzadeh A, Goodarzi A. The first systematic review and meta‐analysis of pharmacological and nonpharmacological procedural treatments of Dark Eye Circles (periorbital hyperpigmentations): One of the most common cosmetic concerns. Dermatologic Therapy. 2025;2025(1). doi:10.1155/dth/9155535

2.Maghfour J, Olayinka J, Hamzavi IH, Mohammad TF. A Focused review on the pathophysiology of post-inflammatory hyperpigmentation. Pigment Cell Melanoma Res. 2022;35(3):320-327. doi:10.1111/pcmr.13038

2. Sawant O, Khan T. Management of periorbital hyperpigmentation: An overview of nature-based agents and alternative approaches. Dermatol Ther. 2020;33(4):e13717. doi:10.1111/dth.13717