Pathophysiology of Periorbital Dark Circles

Periorbital hyperpigmentation (POH) — commonly called dark circles — is a multifactorial condition affecting up to 47% of the general population. Sarkar et al. (2016) classified POH into four etiological categories: vascular (dilated or increased periorbital vasculature visible through thin skin), pigmentary (increased melanin deposition in the epidermis and/or dermis), structural (tear trough deformity, infraorbital fat pad atrophy, or malar festoon creating shadows), and skin-texture (dermal thinning, loss of collagen, and fine rhytides). The periorbital skin is uniquely vulnerable because it is the thinnest skin on the body (0.3-0.5mm compared to 2mm on the cheeks), lacks subcutaneous fat in many individuals, and overlies the orbicularis oculi muscle whose reddish-purple color can show through translucent skin. Genetic factors, UV exposure, allergies, sleep deprivation, and aging all contribute to dark circle severity. This multifactorial etiology explains why single-modality treatments (eye cream alone, filler alone) produce suboptimal results compared to the multi-layer approach used at RE:BERRY Myeongdong.

Hyaluronic Acid Filler for Tear Trough Volume Restoration

Tear trough deformity — the concavity that runs from the medial canthus along the inferior orbital rim — is a primary structural cause of dark circles in patients over 30. As the malar fat pad descends with age and periorbital fat atrophy occurs, this groove deepens, creating a shadow that appears as a dark half-moon under each eye. Hyaluronic acid filler injection into the tear trough has become the gold standard non-surgical correction. Belotero Balance (Merz Aesthetics) is specifically favored for the periorbital area due to its cohesive polydensified matrix (CPM) technology, which distributes evenly in tissue without creating the Tyndall effect — a bluish discoloration caused by light scattering through HA particles in thin skin. Berros et al. (2015) demonstrated that HA filler injection using micro-cannula technique in the tear trough produced significant improvement in 93% of patients at 6-month follow-up, with a high safety profile when performed by experienced injectors who understand the complex periorbital vascular anatomy.

PDRN (Rejuran) for Periorbital Skin Regeneration

Polydeoxyribonucleotide (PDRN) derived from salmon DNA activates adenosine A2A receptors in fibroblasts, stimulating proliferation, migration, and extracellular matrix synthesis — making it particularly effective for repairing the thin, damaged periorbital skin that contributes to dark circle visibility. Kim et al. (2019) showed that intradermal PDRN injection increased dermal thickness by 22% and collagen density by 31% at the 12-week follow-up in periorbital skin. This thickening effect is crucial for dark circle treatment because it reduces the translucency that allows underlying vasculature and muscle to show through. Eye Rejuran at RE:BERRY Myeongdong uses a specialized formulation with lower molecular weight PDRN optimized for the delicate periorbital area, allowing painless injection at very shallow depths (0.5-1mm) across the entire lower eyelid and lateral canthus region.

Sarkar R et al. J Cutan Aesthet Surg. 2016;9(2):65-72. doi:10.4103/0974-2077.184046

Berros P et al. J Cosmet Dermatol. 2015;14(4):391-395. doi:10.1111/jocd.12181

Kim JK et al. J Cosmet Dermatol. 2019;18(4):1127-1133. doi:10.1111/jocd.12821