All About Eye Fillers

If your eyes appear fatigued or hollow even after a full night’s rest, under-eye fillers might be a viable option.

Deciding whether to undergo an eye filler treatment is a significant choice. You’ll want to weigh factors such as:

• expense
• kind of filler
• who will perform the procedure
• downtime
• possible adverse effects

While eye fillers can produce impressive improvements, they aren’t a cure-all. For instance, results are temporary and they won’t correct every concern, such as crow’s feet.

Consulting with a physician about the outcomes you hope to achieve is a crucial first move.

Everyone deserves to feel good about their appearance. If you’re contemplating under-eye fillers, this article explains the procedure and what to expect from the results.

What are under-eye fillers?

Under-eye fillers are injected into the tear trough—the area beneath the eye—to create a fuller, brighter appearance. Diminishing shadows in this zone can make you look more rested.

There are several categories of fillers that practitioners use for this area.

It’s worth noting that no filler currently has FDA approval specifically for use under the eyes.

Nonetheless, several products are frequently used off-label, including:

Hyaluronic acid

Hyaluronic acid occurs naturally in the body. HA fillers consist of a synthetic gel formulated to imitate that natural substance. Common brand names include:

• Restylane
• Belotero
• Juvederm

Hyaluronic acid fillers have been found to encourage collagen production. Some HA products also contain lidocaine, a local anesthetic to lessen discomfort.

Because they’re clear, blend smoothly, and are less prone to clumping, HA fillers are the most frequently chosen option for the under-eye region.

Hyaluronic acid tends to offer the shortest duration of effect among fillers but is often considered to yield the most natural appearance.

Poly-L-lactic acid

Poly-L-lactic acid is a biocompatible synthetic substance that can be injected using a technique called linear threading.

This material powerfully stimulates the skin’s collagen production and is sold under the name Sculptra Aesthetic.

Calcium hydroxylapatite

This biocompatible dermal filler is composed of calcium and phosphate. It encourages collagen synthesis and supports connective tissue, adding volume to the treated area.

Calcium hydroxylapatite is denser than hyaluronic acid and is often mixed with an anesthetic before injection.

Some clinicians avoid this filler because of concerns that the under-eye area might appear excessively pale or that nodules could form beneath the skin.

Calcium hydroxylapatite is marketed under the name Radiesse.

Fat transfer (fat grafting, microlipoinjection, or autologous fat transfer)

For pronounced tear troughs where the lower eyelid meets the cheek, your provider might suggest grafting your own fat to restore volume.

Fat grafts are commonly harvested from areas such as the:

• abdomen
• hip
• buttocks
• thigh

Pros and cons of each filler type

The table below outlines advantages and drawbacks of each filler option. Discuss these choices with your physician to determine which approach fits you best.

Filler typeProsConsHyaluronic acidtransparent and straightforward for an injector to smooth during treatment

natural appearance

can be repositioned or dissolved if complications arise during the sessionprovides the shortest-lived outcome of the filler optionsPoly-L-lactic acidstrongly stimulates collagen production

disperses within a few days of placement, yet effects persist longer than hyaluronic acidthicker than hyaluronic acid

may lead to small lumps beneath the skin in some casesCalcium hydroxylapatitedenser than other fillers

may be more difficult to smooth for less-seasoned injectors

longer-lasting than other fillersin rare cases, can form nodules beneath the eye

some clinicians think it can produce an overly pale lookFat transferthe longest-lasting approachrequires liposuction and surgical recovery

involves increased downtime and greater risk due to anesthesia

not suitable for people who tend to resorb fat quickly, such as high-level athletes or smokers

What does the procedure involve?

Procedures differ slightly depending on the filler selected.

Your initial step will be a pre-procedure consultation where you’ll review your concerns and choose the best option. During this visit, your doctor will also explain the treatment and recovery expectations.

Procedure

Here’s a typical sequence for the treatment:

1. Your physician will mark injection sites and cleanse the area.
2. A topical numbing cream will be applied and given a few minutes to take effect.
3. A small needle will pierce the skin. In some approaches, the filler is injected directly through that needle; in others, a blunt cannula carrying the filler is fed through the puncture.
4. One or more injections will be placed under each eye. With linear threading, the injector deposits a tunnel of filler while withdrawing the needle slowly.
5. The physician will then massage and smooth the filler into the desired position.

If you’re undergoing fat transfer, liposuction under general anesthesia is performed first.

Most people experience little to no pain during under-eye filler injections. Some describe a mild pinch. You’ll sense some pressure or fullness as the product is introduced.

Even though the needle isn’t inserted immediately adjacent to the eyeball, the idea of a needle approaching the eye can be unsettling for some.

The whole session typically takes between 5 and 20 minutes.

Recovery

Generally, recovery looks like this:

• After the treatment, your clinician will provide an ice pack to apply.
• You may notice redness, bruising, or swelling, but these effects are usually temporary.
• Your doctor will schedule a follow-up a few days later to evaluate the area and determine whether additional filler is necessary.
• Multiple injections over several weeks or months may be advised.
• Unlike synthetic fillers, fat grafting usually requires about two weeks of downtime.

Results

Fillers gradually break down and are absorbed by the body. They do not produce permanent outcomes. Typical durations are:

• Hyaluronic acid fillers generally last about 9 months to 1 year.
• Calcium hydroxylapatite usually endures for 12 to 18 months.
• Poly-L-lactic acid can persist up to around 2 years.
• Fat transfer may offer results lasting up to 3 years.

Who is a suitable candidate?

Darkness in the tear trough often runs in families, but other causes include:

• aging
• insufficient sleep
• dehydration
• excess pigmentation
• visible blood vessels

Under-eye fillers are most successful for people whose hollow, dark under-eye appearance stems from genetics or age-related volume loss rather than lifestyle factors.

Some individuals naturally have deeper sunken areas beneath the eyes, casting shadows that fillers can sometimes correct; in other cases, surgery may be a more suitable remedy.

Aging frequently contributes to a hollow, shadowed look as orbital fat diminishes or descends, creating a pronounced separation between the under-eye area and the cheek.

Not everyone is an ideal candidate. If you smoke or vape, your physician might advise against fillers because smoking can impair healing and potentially shorten the duration of results.

Eye fillers have not been evaluated for safety during pregnancy or breastfeeding and are typically not recommended at those times.

What are potential side effects?

Tell your doctor about any allergies to reduce the risk of an allergic reaction to a filler product.

Most side effects from under-eye fillers are mild and short-lived. They can include:

• redness
• swelling
• tiny red pinpoint at injection sites
• bruising

If the filler is placed too superficially, the area may develop a bluish or puffy tint, a phenomenon called the Tyndall effect.

In such instances, the filler may need to be dissolved. For hyaluronic acid products, an injection of hyaluronidase can rapidly break down the filler.

Reducing risk of complications

The best way to minimize serious complications is to select an experienced, board-certified dermatologist or plastic surgeon to perform the injections.

Less-qualified providers increase the chance of problems from uneven filler placement or accidental puncture of a blood vessel.

Serious complications may include:

• asymmetry between the eyes
• small lumps beneath the skin
• nerve damage
• scarring
• loss of vision

Note that the FDA has issued warnings regarding certain dermal fillers. Discuss these advisories with your practitioner prior to treatment.

How much will it cost?

Because under-eye fillers are elective cosmetic treatments, they are not covered by insurance.

Prices vary but commonly fall in the range of $600 to $1,600 per syringe, with total expenses of up to $3,000 for both eyes per session.

How to locate a board-certified surgeon

The American Society of Plastic Surgeons provides a ZIP code lookup to help you find qualified, board-certified surgeons in your region.

Prepare a list of questions for your initial consultation, such as:

• How many years have you been practicing?
• How often do you perform this particular procedure annually?
• How frequently do you treat patients my age or with my condition?
• Which type of filler do you commonly use and why?
• Which filler would you recommend for me and what is your rationale?

Key takeaways

Under-eye fillers are a popular option for diminishing dark hollows in the tear trough area.

Most filler products are used off-label for this purpose since none are FDA-approved specifically for the under-eye region. Hyaluronic acid is the most common choice among available options.

Whichever filler you select, choosing a highly skilled, board-certified dermatologist or plastic surgeon is the most critical decision you will make.