Filling Eye Hollows with Dermal Fillers: What Are The Risks?

This has been a very popular post throughout the year.  So, I decided to post an update.

While I did not have deep hollows, fullness in the eye hollow area or tear trough gives you a  more youthful look.

I  had seen the work of a local plastic surgeon and decided to had my eye hollows filled. His choice of filler was Juverderm which surprised me because Restylane seemed be a preferred filler for this area. Since I had seen other patients who had their eye hollows filled by this PS, I trusted his judgment.  The Juevederm made my eye area very puffy and I was quite bruised.

I went back to the same doctor and he concluded that he should dissolve some of the filler with hyaluronidase and start fresh with Resytlane, which he should have used to begin with.  The hyaluronidase worked great. I went back a week later and he injected a small amount of Restylane under each eye.  I came back a week later and he decided that his nurse (RN) might have better luck, as I still needed tweaking. Indeed she did. She was quick and precise. The entire process took around 4 weeks to resolve.  I was quite bruised for several weeks. It has been over a year now and I have just started noticing that my eye hollows are in need of filler again. I would not go back to the same PS for the filler, as his RN no longer works there.

Conclusion: Is it worth it?  Yes- if you have an experienced injector, who routinely injects the eye area.

Do you dislike those hollows in your lower eyelids or the dark circles under your eye?

Many people are choosing to get treatment for this area with either Juvederm or Resytlane.

JUVÉDERM® is a smooth consistency gel made of hyaluronic acid – a naturally occurring substance in your skin that helps to add volume and hydration. Restylane® is also an hyaluraonic acid used to add volume and hydration.  Both fillers can be used to fill the eye trough area- but with caution.

I have been reading many online posts from patients who have had both fillers and have experienced puffiness, lumps, and a baggy look after the injection. Others have had good results. What is clear after reading the  many posts and talking to others is that you must be very cautious when making this decision.

Performing “tear trough” treatments to the hollow area under the eyes requires meticulous technique and can be a very satisfying treatment when done correctly.

Here are some guidelines to consider before you jump into filling those hollows under your eye:

1. Go to a board certified surgeon or  an oculoplastic surgeon.

2.Ask him/her how many treatments they have preformed. Proper injecting into the site is key for good results. If the filler is not injected deep enough it can leave lumps,  pillows or pockets of puffiness.  If too much is injected it can  also cause puffiness.  This is such a very delicate area to treat.

3. Ask to see before and after pictures.

4. Ask the doctor if you are good candidate for this procedure. As we age our skin thins. It is easier to treat  younger skin that is not so thin. Bruising is common plus one could get permanent discoloration as hemosiderin pigment is left behind.

5. Plan on being bruised for 7-10 days. I would not plan to have this done before any event or vacation.

6. Take SinNeech or Arnica before and after the treatment. There are also pre/post injection formula capsules made by GliSodin.  I would highly recommend starting them before treatments.

Taking these supplements will help  you heal faster with less bruising. Do not take ibuprofen or St John’s Wart, Fish Oil and Vit E for a least 3 weeks before your treatment.  If in doubt ask your physician what not to take prior to the treatment.

The good news is that there is a medication called Hyaluronidase injections and these can dissolve the Juvederm or Restylane. The filler will dissolve in a few days rather than months. Depending on how much filler you need to dissolve, you may need to go back for additional injections. A competent surgeon should not charge you for his or her mistake.  Ask if you will be charged should you need the treatment to be reversed. You  already probably spent between $600-800 for the treatment.  If you do need it reversed, hopefully you will not need all the filler dissolved, since it would be nice to have some benefit from the treatment and the money you just spent!

I think that if physicians are going to continue to treat the tear trough area, proper training is imperative. From my experience not all surgeons are good injectors.  With injectables- technique is key for good results.  Plastic Surgeons and physicians  preforming these treatments could benefit from more training in this area.

Fillers for eye hollows is not FDA approved, which is OK since many anti-aging treatments are being used off-label. However, if there are more negative outcomes than positive- perhaps it is time for the FDA to step in or for the dermal filler companies to be more responsible.

In the end it is your decision – base it on good information and a referral from someone you know and trust.

Perhaps soon, there will be a dermal filler more suited for this delicate area.

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  3. Hi iam 28 years old i have to much hallow and dark circle my eyes plz help me if u possible plz call me my no is 07950481706


  4. This procedure should be done by an experienced dermatologist, not a plastic surgeon. A derm will be more precise and delicate. I don’t think that’s a plastic surgeons specialty.


  5. I find it odd that after the story recounts how an RN performed this procedure with proficiency, providing better results then the initial injecting plastic surgeon, the article concludes with the advice to seek out a qualified surgeon to perform this procedure. As the author herself experienced, sometimes an RN can be just as, if not more, proficient at under-eye fillers then an MD. I myself, am an aesthetic RN, who performs this treatment on hundreds of patients a year, with a high satisfaction rate and little to no use of hyaluronidase (which can produce severe secondary problems, including dissolving healthy tissue in the area in which it is injected. It should not be used casually.) Yes, it is true, that this is a highly specialized injection technique, and unless the injector (MD or RN) can produce photos of their before/afters that you are comfortable with, do not move ahead with them. I personally do not prefer Juvederm in this area, but I know many skilled injectors who do, depending on technique. As the author suggests, just because an MD is highly acclaimed in surgical techniques, does not guarantee that they are a good injector. Do your research.


      1. Thanks for response. I’m not sure what a “Nurse MD” is, but thank your for clarification anyway. Maybe you meant “RN”?


  6. My daughter had the procedure done by what appears to be a reputable surgeon approximately 6 month ago. About 3 weeks ago swelling appeared under one of her eyes and since than both eyes have been affected with severe swelling. She is presently being seen by the same surgeon and I am just wondering if you have any knowledge of this happening so many month after the actual treatment? The surgeon as far as I am informed has no answer.

    Thank you so much,

    Marlena Otsuka

    Liked by 1 person

    1. I am not an MD, however maybe she is having an allergic reaction of some kind. Perhaps she should ask her surgeon about a short term predisone dose pack for swelling to see if that helps. She can also have the HA filler dissolved, if her MD thinks that is what is causing the problem.


  7. I am making the effort lately to get some reasonable anti aging cream but it appears presently there is actually absolutely nothing that will cure my skin. However, if someone really know some treatment method that are able to help to make miracles just inform me and therefore I most certainly will admire that.


    1. My best advice to go to a reputable dermatologist in your area to discuss your concerns. There are many excellent products and treatments to treat a wide array of skin problems.


  8. I have been a reader for a long while, but this is my first time as a commenter. I just wanted to let you know that this has been / is my favorite entry of yours! Keep up the great work and I’ll keep on coming back. If you’d be interested in swapping blogroll links with me, my website is MonaVie Scam.


    1. Safe method? Not sure what you mean? Injecting fillers into the eye hollows is safe as long as you go to a qualified physician who has done this procedure many times in the past. There is always a risk with any medical treatment or procedure.


      1. There is risk and risk… I was shocked to know that blindness is a risk in this procedure although very rare but it is still present. People would for non surgical procedures to avoid big big devastating risks that s the point of non surgical procedures… but with the eye area everything seems risky to me…


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