Deep hollows under your eyes can make you look tired and dull.
HA fillers can fill your hollows for a refreshed and more youthful look.
Filling eye hollows is a delicate business and there are risks. The biggest risk is bruising, lumps, overfilling and swelling. In some cases if not done properly it can actually make your lower eye area look worse. Today there are more hyaluronic acid (HA) fillers in the aesthetic tool box and techniques for treating this delicate area have improved.
I’ve read many posts online about patients who have had fillers and are experiencing puffiness, lumps, bruising, swelling and a baggy look after the injections. Others have good results. I’ve also experienced good and bad results. Please choose your injector wisely. This is a very difficult area to treat.
Performing “tear trough” treatments to the hollow area under the eyes requires meticulous technique. When done correctly the results are very satisfying. The most important factor is to go to an injector who is has a lot of experience in this area.
Below are some guidelines to consider before you jump into filling your eye hollows (tear trough).
Parts of this post was originally written in 20o9 when I had my tear troughs treated for the first time.
A business colleague had her tear trough area filled by a local plastic surgeon in San Francisco, CA . I was very impressed with her results and decided to fill my eye hollows, for a more youthful look. At the time there were only two HA fillers on the market Juvederm and Restylane. Although both fillers were very similar Juvederm tends to create more puffiness in the eye area than Restylane, as it absorbs more water. My surgeon choose Juvederm which surprised me because Restylane was the preferred filler for this area. However, I trusted his judgement.
Afterwards I very bruised, swollen and lumpy. I waited patiently a couple of weeks hoping it would resolve. The bruising diminished but the puffiness persisted. I looked like I had been punched in the face and knew that OI needed a correction. Fortunately HA fillers can easily be dissolved with hyaluronidase.My surgeon concluded that he should dissolve the filler with hyaluronidase and start fresh with Restylane. The hyaluronidase worked almost immediately and I could see a difference. I went back a week later for a small amount of Restylane under each eye. My eye looked much better. The following week his aesthetic nurse tweaked the area with a little more filler. She did a great job. I was very pleased with my results. The entire process took around 4 weeks to resolve. The Restylane in my tear trough area lasted for over a year, as filler tends to last longer in that area than in other facial areas. However, due to my experience I was hesitant to have my eye hollows filled again.
Recently I decided to try under eye fillers again, my eye hollows looked more sunken and there are more HA fillers to choose from. New HA fillers have entered the market which are better for the delicate eye area and injection techniques have evolved.
I went to see Dr. Dave Sieber, a plastic surgeon in Mill Valley, CA. We decided to use Restylane rather than Restylane Silk a newer HA filler. This time a cannula was used instead of a needle. A cannula is not a sharp as a needle and there may be less chance of bruising or trauma to the area. I bruise easily, despite the use of a cannula. To speed up my healing time, Dr. Sieber treated me with a laser. Being in the aesthetics industry, I’m used to bruising even after taking precautions icing and using Arnica before and after the injection.
The results after the bruising and swelling looked great. I did, however, go back for a little tweak a few weeks later as its best to do less and go gradually especially in this delicate area. After the tweak, though the fill was a little too much and I ended up having a little dissolved. As I said, this area is tricky to treat even for the most experienced injector.
Resytlane Silk, Belotero and the newest filler Vobella can all be used to treat the eye area. However all of these fillers have not been FDA approved for tear troughs and are used “off-label”.
HA’s such as Belotero and Restylane Silk have the shortest durations (3-6 months) BUT the greatest hydration, therefore they are very effective to treat the tear troughs and delicate areas. Some cosemtic injectors will mix HA fillers, such as Juvederm Voluma with saline to thin the consistency to use in the tear trough area. As Voluma is thicker, lasts longer and is voluminzing, it is not usually the first choice when filling the tear trough. However, I have seen excellent results when it is diluted and injected by a highly skilled injector.
Safe HA fillers for the eye area:
JUVÉDERM® VOLBELLA® is the newest HA filler with lidocaine is formulated with an innovative combination of low and high molecular weight technology, which improves the cross-linking efficiency of HA chains. This more effective cross-linking allows for a lower concentration of HA to be used, which results in less swelling because it absorbs less water. The Vycross technology delivers an ultra-smooth gel, which results in a natural look and feel, as well as improved duration up to 12 months.
JUVÉDERM® is a smooth consistency gel made of hyaluronic acid – a naturally occurring substance in your skin that helps to add volume and hydration. Juvederm attracts water so it is not as effective in treating tear troughs producing more puffiness.
Restylane® is also an hyaluraonic acid used to add volume and hydration. It does not attract as much water and will not swell as much as Juvederm when injected into the tear troughs. Many practitioners and injectors prefer Restylane for the tear trough area.
Restylane Silk is newer HA filler FDA approved for fine line and lip volume. It does have a tendency to initially swell more, but can also be used in the eye area. In my experience Silk does not last long and I prefer Restylane.
All these fillers can safely be used to fill the tear trough area, but require an experienced skilled injector, as this is a very delicate area.
Conclusion: Is it worth it? Yes. But proceed with caution. Remember less is more and all HA fillers are not permanent.
1. Do not take ibuprofen or St John’s Wart, Fish Oil and Vitamin E for a least 3 weeks before your treatment. Some people will bruise regardless. If in doubt ask your physician what not to take prior to your treatment
2. Purchase SinNeech or Arnica start taking it a couple days before your treatment. You can also buy pre/post injection formula capsules made by GliSodin, which will help you heal quicker. www.glisodinskin.com Taking these supplements may help you heal faster and lessen the amount of bruising.
3. Go to a board certified surgeon, oculoplastic surgeon, board certified dermatologist or an experienced aesthetic RN injector.
4. Ask how often they treat tear troughs. 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. It can also leave you with a slight blue tint called the Tindle Effect. This is such a very delicate area to treat.
5. Ask to see before and after pictures.
5. 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.
6. Plan on being bruised and you may swell. Bruising can last for 7-10 days. However, a zap with a laser treatment will shorten your bruising time. I would not plan to have this done before any event or vacation.
7. Ask if you will be charged should you need the treatment to be reversed.
The good news is that there is a medicine called Hyaluronidase injections which can dissolve the HA fillers. 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. 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!
From my experience not all physicians are good injectors. Physicians treating the tear trough area must have proper training. Injection techniques are always evolving and technique is everything for good results. Plastic Surgeon, physicians and aesthetic providers could benefit from on-going injectable training symposiums.
Today’s fillers for treating the eye hollows are not FDA approved. Many anti-aging treatments are used “off-label”.
Perhaps soon, the FDA will approve a filler for the delicate eye area.
In the end it is your decision – base it on good information and a referral from someone you know and trust.
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Thanks for sharing! The best Restylane Beverly Hills has to offer is with Dr. Steinsapir. It is a popular non-surgical treatment for dark under eye bags & circles. Thanks again for sharing this insightful post!
Had undereye filler with Chris Thiagarajah in Denver. He really knows what he is doing. He used volbella.
That was not my experience. He overfilled my lower eyelids with filler, despite the fact that I told him that in the past it did not work. After the injections I was so horribly puffy under my eyes for over a year and then he said I had festoons. I had to pressure him to remove them and Voila!, the so-called festoons disappeared. I have wasted a lot of money on fillers, that had to be dissolved. Not a pleasant experience!
I had face fillers two months ago. Yes, there is a puffiness but it is temporary. I was little swelled for several days only. All these concerns are really not necessary. The procedure is painless and easy.
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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.
Hi Kay, Many Board Certified Plastic Surgeons are highly skilled and trained in injectables. It’s important to due your homework first as not all plastic surgeons are equally skilled or trained. There is no guarantee that a Derm is more precise and delicate. As with all specialist there, some are better skilled in this area than others. Not all Derms are good injectors. I attend Aesthetic Medicine Conferences Nationwide and have the opportunity to watch live the skills of both plastic surgeons and dermatologist at these meetings. I have been injected by both. Some plastic surgeons do more fillers than others. While some plastic surgeon’s offices hire Nurse Injectors and do not do any of the injections themselves. I have had good and bad filler experiences with both. Best advice is to ask the plastic surgeon how often he injects fillers and see patient before and after pictures.
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.
Thank you for your comment. My advice is to seek a qualified injector, whether it is a PS, Dermatologist or Nurse MD.
Thanks for response. I’m not sure what a “Nurse MD” is, but thank your for clarification anyway. Maybe you meant “RN”?
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,
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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.
That takes us up to the next level. Great posting.
I’ve had the same thing happen both times after I’ve had filler placed. I would get swelling a few months later. I can’t find out what it is. Did your daughter find out?
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.
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.
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Is this safe method??
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.
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…