Under-Eye Hyperpigmentation and Dark Circles Before & After | Pico Laser in a Male Patient

Details of the Treatment

The under-eye dark circles weren't from hollowing — they were pigment with a subtle vascular component. Filler had been suggested elsewhere, but the issue was color, not shape.

Periorbital assessment showed bilateral infraorbital hyperpigmentation with the pigment concentrated medially in the tear trough region. There was no visible volume hollowing. The skin was Fitzpatrick type IV. Wood's lamp examination suggested combined dermal melanin and surface vascular component contributing to the darkness. The pattern reflected constitutional pigmentation in a darker skin type rather than acquired pigmentary change. The plan was Pico laser at conservative fluence, with the periorbital region requiring more conservative settings than the rest of the face.

Pico laser was performed at conservative fluence over the infraorbital region. Pigmentary dark circles in Fitzpatrick IV through VI patients require lower fluence than the same condition in lighter skin to avoid post-inflammatory rebound. Filler addresses volume; Pico addresses pigment. The two are different interventions for different presentations of dark circles. In the after image, improvements of this kind are typically observed gradually over several months as pigment clears, the under-eye pigmentation has lightened. The medial tear trough region reads as more uniform with the surrounding skin. The dark circle appearance has substantially reduced. Treating the patient's actual complaint rather than the standard treatment menu is the correct match for case-specific concerns.