What's New With Under Eye Treatment: A Multispecialty Systematic Review of Recent Under Eye Treatments

BACKGROUND Infraorbital hollowing and hyperpigmentation are common cosmetic concerns resulting from structural volume loss, pigmentary changes, vascular prominence, and skin laxity. OBJECTIVE To systematically review current and emerging treatments for infraorbital concerns with an emphasis on patient selection and anatomy-driven approaches. MATERIALS AND METHODS A systematic PubMed search was conducted in March 2025 per Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines for English-language studies published after 2010. Fifty studies were selected and categorized by treatment type. Each modality was evaluated for efficacy, safety, and patient suitability. RESULTS Treatments were organized into injectables, energy-based devices, microneedling, peels, topicals, polynucleotides, platelet-rich plasma/platelet-rich fibrin, neuromodulators, and surgery. Fillers remain foundational for volume loss; lasers address melanin, vascularity, and skin laxity. Microneedling and polynucleotides target texture and fine rhytides. Chemical peels and topicals are effective for superficial dyschromia. Botulinum toxin benefits orbicularis oculi hypertrophy and sequelae. Surgery is preferred for herniated fat and poor lower eyelid support. Patient-specific factors, including fat pad integrity, skin quality, and eyelid support, are critical for optimal results. CONCLUSION Infraorbital concerns are multifactorial and require individualized treatment strategies. This review integrates evidence and clinical expertise to guide personalized, anatomy-driven interventions that optimize outcomes in periorbital rejuvenation.