Patients seeking correction of dark circles under eyes are typically in their 20’s and 30’s. have noticed the dark circles all of their lives, and typically do not have facial sagging and herniation of the cheek fat pad. They complain of a dark circle and depression which creates a shadow which is beneath the lower eyelid starting at the nose and running out toward the side of the face. However, this depression curves upward to follow the lower eyelid but does not turn downward and extend into the cheek as does the tear trough deformity. As pointed out in several previous articles the dark circle under the eye is caused by the attachment of the arcus marginalis a condensation of tissue beneath the eyelid, attached to the bone of the eye socket, which tethers the lower eyelid skin to the bone creating a depression which creates a shadow beneath the lower eyelid. With aging of the eyes and skin, laxity of the lower eyelid skin and fat creates a slight bulge of the lower eyelid above the dark circle under the eye, which I now call the arcus deformity, and causes the dark circle to be more noticeable usually starting in the 30’s and early 40’s

The arcus marginalis, the tissue beneath the lower eyelid, attached to the bone of the eye socket and holding the lower eyelid skin to the bone, plays a causal role in both dark circles under the eyes and the tear trough deformity. However it is very important to make the distinction, and understand the difference between the arcus deformity or dark circle under the eye and the tear trough deformity because successful treatment requires very different approaches.