![]() ![]() The American Academy of Plastic Surgeons recently revealed data indicating that a total of $12.6 billion (USD) was spent on cosmetic procedures in the United States an increase of 15% from the previous year. This data do not include the resources that will be spent on surgical and other more invasive treatments to the periorbital region. This expenditure phenomenon is worldwide, as the global beauty industry has been projected to be valued at $390.07 billion (USD) by 2020, and the skin care segment is anticipated to be the fastest growing subcategory. ![]() On an average, a woman in the United States spends $15,000 (USD) in her lifetime on cosmeceuticals and makeup, a large percentage of which is spent on under-eye concealers. Throughout cultures, societal perceptions are similar, in that periorbital dark circles contribute to a tired, aged and even sad appearance. Perceptions regarding the degree of a person's fatigue and age are preferentially based on periorbital aesthetics. The armamentarium for treatment includes minimally invasive interventions such as makeup and cosmeceuticals, a variety of laser and chemical treatments, fillers and fat transfer, as well as more invasive surgical manoeuvres. An understanding of the deep and superficial anatomy is crucial to the management of this complex entity. This review provides a detailed discussion of the aetiology, pathogenesis, evaluation and management of infraorbital dark circles. A comprehensive review of the literature was performed and the data were assimilated with evidence from our practice. A literature search using MEDLINE and non-MEDLINE sources was performed utilising keywords including: ‘Dark circles’ ‘infraorbital dark circles’, ‘infraorbital pigment’, ‘under-eye circles’ and ‘lower eyelid bags’. A variety of treatment options exist, and a customised management strategy can be developed for the particular anatomic changes present. Infraorbital dark circles represent a common and multifactorial challenge in the world of aesthetic medicine and are the result of a variety of factors including deep facial anatomy, soft tissue changes, as well as contributions from the skin. ![]()
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