Are You a Candidate for Under Eye Filler? Here’s How to Tell

Top dermatologists and plastic surgeons break down the benefits – and limitations – of the rejuvenating injectable procedure.
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Written by Meg Storm
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Are You a Candidate for Under Eye Filler? Here’s How to TellPhoto by Sahand Hoseini on Unsplash

You’ve likely seen the before and after pictures on social media of people who seemingly had all of their under eye concerns erased thanks to a bit of strategically placed filler in the tear trough region. For the right patient, under eye filler can have a transformative contouring, smoothing, and brightening effect. But depending on the cause of your dark circles, hollowing, and skin quality concerns, under eye filler can actually make matters worse.

So, how can you tell if you are a candidate for under eye filler? We’re talking to top dermatologists and plastic surgeons about the pros and cons of the minimally invasive procedure and the factors that go into determining whether or not it’s right for you.

The Benefits of Under Eye Filler

When we talk about under eye concerns, it's often in general terms. How many times have you heard someone say their eyes look 'tired'? Or that they want them to appear more ‘awake’? The reality is that there are a number of smaller factors that contribute to the eye area looking a little sleepy.

One of the biggest culprits of 'tired' under eyes is a lack of volume in the under eye area either due to anatomy or age. “In some patients, aging leads to the loss of fat under the eyes, giving a hollow or skeletal appearance,” says Nigar N. Ahmedli, MD, a board certified otolaryngologist in New York City who specializes in facial plastic and reconstructive surgery. Those hollows can then create the illusion of darkness in the region. "They worsen the appearance of dark circles under the eyes by creating a shadow that accentuates the darkness," she notes.

Additionally, the volume loss draws attention to the tear trough. “The ‘tear trough’ area refers to the separation between the lower eyelid and the upper cheek,” says Elizabeth Callahan, MD, board certified dermatologic surgeon in Sarasota, FL. Coupled with changes in skin quality, the result is fine lines, dark circles, a general loss of contour, and, yes, an overall 'tired' appearance.

Injecting a hyaluronic acid (HA)-based filler into the under eye area can be an effective treatment for this. “Under eye filler is best for providing volume to the hollows beneath your eyes,” says Melissa Doft, MD, a double board certified plastic and reconstructive surgeon in NYC. "Adding filler to the under eye area will help with shadows and also act as a wonderful moisturizer to help with dehydrated and crepey skin."

It can also be used to improve the contour of the upper face. "Under eye fillers can address the hollows created beneath the eyelid and at the junction of the cheek and lower eyelid," says Kenrick Spence, MD, a board certified plastic and reconstructive surgeon in Orlando, FL. "Asymmetry can be corrected and dark circles can be softened with the help of under eye fillers."

The Misconceptions About Under Eye Filler

Here’s the thing, under eye filler “can address aesthetic concerns like hollowness, volume loss, and shadows,” says Kami Parsa, MD, a board certified oculoplastic surgeon in Beverly Hills. And here comes the ‘but.’ “A misconception is that filler can help everyone,” Dr. Callahan notes. This is because “under eye filler is not a blanket intervention that addresses all under eye-related concerns,” Dr. Ahmedli adds.

With that in mind, we asked our pros to break down some of the most common misconceptions about under eye filler:

1. Under Eye Filler Treats Eye Bags

For starters, under eye filler does not treat what we colloquially refer to as ‘eye bags’ and puffiness. “Puffiness is due to excess fat or lack of proper lymphatic drainage,” Dr. Doft says. “Both of which will not improve with fillers.” Regardless of the cause, the appearance of puffiness is “the opposite of having hollows,” Dr. Ahmedli notes.

In the case of puffiness caused by excess fat, “the under-eye fat protrudes forward instead of retracting into the eye socket,” Dr. Ahmedli explains. Filler will only exacerbate this. “Adding filler to an area that’s already puffy just makes it worse,” Dr. Parsa says. This can be true even if you simultaneously have both depressions and puffiness as a result of displaced fat. “In some people, there are under eye bags, which create a relative bulge followed by a hollow,” says Lesley Rabach, MD, a double board certified facial plastic and reconstructive surgeon in NYC.

2. Under Eye Filler Erases Dark Circles

You’ll be hard pressed to find someone who hasn’t dealt with dark circles under the eye. And while under eye filler can help brighten the area by lessening the shadowing caused by hollowing, it does not directly treat discoloration. “Filler will not improve dark circles or discoloration of the skin,” says Oren Tepper, MD, a board certified plastic and reconstructive surgeon in NYC.

The reason? Dark circles are not one size fits all. “Dark circles and hollows under the eyes can be caused by various factors, including lack of sleep, genetics, aging, allergies, sun exposure, dehydration, various lifestyle factors, and other medical conditions,” Dr. Callahan shares. And remember: “Everyone has some degree of darkness under the eye,” Dr. Rabach emphasizes.

3. Under Eye Filler Is Risk Free

Getting HA filler in any part of the face can seem like a ‘quick fix’ that offers immediate results with little to no downtime. But the reality is that injecting filler – especially to the complex under eye area – requires a great deal of training and understanding of facial anatomy. “There is a misconception that placing filler under the eye is completely safe,” Dr. Doft cautions.

As she explains, under eye filler can have a tyndall effect when it’s injected too superficially, leading to a blue tint under the skin. It can also cause “scarring of the lymphatics leading to malar bags and possible blindness,” she says. For these reasons, “this is a procedure I would only have a board certified plastic surgeon or dermatologist perform,” Dr. Doft shares.

Technique is also vital to ensure a safe, effective, and aesthetically pleasing result. “Many providers place tear trough or under eye filler in the wrong spot,” Dr. Rabach notes. “It is a very delicate area, but it is most of the time placed too low – almost over the orbital rim – instead of high into the tear trough.” Seeing a board certified provider who regularly performs the procedure can help mitigate this risk.

4. Under Eye Filler Is Like a Filter

Even in the best hands, it’s also important to keep your expectations in check. “The most common misconceptions about under eye filler are that it is a simple intervention that improves under eye hollows, bags, dark circles, and skin texture,” Dr. Ahmedli explains. “It is crucial to understand that dark circles are due to the deposition of pigment into the thin skin of the eyelid, and lower eyelid skin tends to become like crepe paper – crinkled with fine lines – with aging.”

And no, you are not going to look perpetually Facetuned. “People think under eye filler will completely make under eye hollows or darkness go away, and that you will look like a heavily filtered Instagram model after treatment,” Dr. Rabach says. “No one looks like this.”

Are You a Candidate for Under Eye Filler?

Now that you know the benefits and limitations of under eye filler, it’s time to determine if you are a candidate. During a consultation with a board certified dermatologist or plastic surgeon, the provider will be studying the under eye region to determine the root cause of your aesthetic concerns. "There are so many factors when we discuss the under eye hollows because they happen for so many reasons," Dr. Rabach notes.

As she explains, it is important to look at skin tone and what is behind any darkness or discoloration. “The skin is so thin, so we can see tiny blood vessels under the skin,” she shares. “The skin is also more prone to pigmentation due to the hollow and being so delicate.” Additionally, darkening under the eyes can be caused by “light reflecting off the concavity making a shadow,” she notes. Only the latter can be improved with filler.

And then there is the contour of the under eye region. “In some people, there are under eye ‘bags’ that create a relative bulge followed by a hollow,” she says. “We also need to consider the relationship and general anatomy of where the orbital rim is related to the eyelashes and the direction of the hollow.” These factors and more, she notes, “need to be weighed for candidacy for under eye filler.”

Here are some general guidelines for what makes someone an ideal candidate for under eye filler:

Ideal Candidates for Under Eye Filler

The ideal candidate for under eye filler “is a patient who has hollows under the eyes without puffiness and without heavy dark circles,” Dr. Ahmedli says. “This allows for filler to be placed in the hollow to correct the depression and to restore the natural slope of the under eye-to-cheek transition found in a youthful face.”

When it comes to volume loss and puffiness, there is a fine line between how much is too much. “An ideal candidate for under eye fillers is someone that has a modest loss of volume, mild bulging of fat pads, and modest skin laxity under the eye region,” Dr. Spence says. This means age will be a factor. Dr. Rabach says ideal candidates for under eye filler are generally “younger” – meaning twenties, thirties, and forties.

Skin quality matters as well, Dr. Tepper notes. “Thicker skin,” Dr. Rabach says, is better suited for filler because it usually blocks any visible under eye vessels that can cause discoloration. Additionally, she said the region should have little to no pigmentation (another common cause of dark circles).

Last but not least, under eye filler can be an option for “people who are not ready for surgery,” Dr. Parsa says. In such cases, however, it’s important to know what you are signing up for. “There is definitely a limitation on how much they work,” he notes. “And the key here is to understand that fillers are not a permanent solution.” Though they may hang around longer than expected. “Fillers last many years, even though we are told they last only six months,” he cautions.

Non-Candidates for Under Eye Filler

Generally speaking, “someone who is older with larger bags, lots of excess skin, pigmentation, and/or very thin skin” would not be a good candidate for under eye filler, Dr. Rabach says.

As it relates to most dark circles, filler is not a fix. “Filler cannot correct issues such as genetic hyperpigmentation or blood vessels shown under the eyes,” Dr. Callahan shares. Similarly, it can’t necessarily contour away puffiness. “Some patients lack under eye hollows and instead have more fullness or ‘bags,’” Dr. Ahmedli says. “This creates a bubbling look in which the under-eye bulges forward and accentuates the tear trough groove underneath leading to a harsher separation between the under eye and cheek.” Filling the area can exacerbate this.

It’s also important to consider the anatomy of your entire face – not just the under eye. “If the patient lacks cheek fat, then filling the tear trough groove becomes tricky,” Dr. Ahmedli cautions. “A provider cannot fill the groove to maximal correction because the lower lid will appear even puffier, creating the dreaded ‘chipmunk’ look.” Dr. Spence agrees that those with “severe volume loss from the cheek are not going to be the ideal candidates for under eye filler.” Ultimately, Dr. Callahan says you need to identify the actual culprit of your aesthetic concerns. “Filler will not help if the real problem is lack of volume in the cheeks just below the dark circles,” she notes.

Another thing to keep in mind? Your health. “A bad filler candidate is someone who suffers from chronic/seasonal allergies (itchy swollen eyes), puffy lower eye bags, fluid retention syndrome (eye bags that swell in the morning or based on what you eat), and those who have a significant amount of loose skin under the eyes,” Dr. Parsa shares. “Adding volume with HA filler to the undereyes will make things look worse in these situations.”

Do You Actually Need a Blepharoplasty?

We’ve talked a lot about why you might not be a good candidate for under eye filler if you have under eye bags, puffiness, and skin laxity. What may be a solution, however, is a surgical blepharoplasty. “Blepharoplasty is a surgical procedure aimed at rejuvenating the eyelids,” Dr. Callahan explains. “It involves the removal of excess skin, fat, and sometimes muscle from the upper and/or lower eyelids.”

When it comes to the lower lid, the eyelid surgery can address eye bags and skin laxity concerns. “Lower eyelid blepharoplasty, or lower eyelid lift, allows for excess skin to be removed and for the fat pockets to be contoured and repositioned to improve the appearance of the puffiness and the tear trough groove,” Dr. Ahmedli shares. As Dr. Tepper explains, a blepharoplasty is the preferred treatment if “tear trough deformity is moderate to severe” and “there is excess fat protruding in the lower eyelids.” While “filler will not correct or address this,” he says, “the fat can be removed or transposed” surgically.

For some patients, under eye filler is a gateway to blepharoplasty. “It is more common for younger patients to begin with under eye filler given the lack of excess skin,” Dr. Ahmedli notes. But that is not always the case. “A lot of our patients think the best way to treat their under eye concerns is by adding volume with filler,” Dr. Parsa says. “We have had countless patients come to us to remove their under eye filler and proceed with a blepharoplasty for long-term results.” In such cases, the under eye filler must be completely dissolved before proceeding with surgery, he adds.

For others, surgery is the best and only option. “If the real problem is fat pad herniation (a.k.a. eye bags) then surgery is the best choice,” Dr. Callahan says. Additionally, “if a patient has excess lower eyelid skin that is bunching, then blepharoplasty is a better option than filler,” Dr. Ahmedli shares. Ultimately, “a patient with significant skin laxity and bulging fat pads with volume loss to the cheeks is better served with a surgical approach,” Dr. Spence says. “The procedure actually removes excess skin and fat rather than filling in any hollowness.”

The Takeaway

Under eye filler can be a rejuvenating treatment that instantly revitalizes the eye area, but it is important to understand that it has its limitations. Fillers will add volume to an area and are great for problems due to a loss of volume such as dark circles. For under eye issues due to abnormally enhanced volume, such as eye bags or festoons, under eye fillers are not appropriate and can exacerbate your problem. Says fellowship trained Facial Plastic Surgeon, Dr. William A. Kennedy, MD. If you are interested in under eye filler and think you may be a candidate, The AEDITOR — the patented 3D Aesthetic Simulator available exclusively in the AEDIT iOS app — allows you to ‘try on’ the procedure and instantly visualize medically accurate results. Download the app here, and, once you give it a try, consult with a board certified dermatologist or plastic surgeon to determine if under eye filler is the right treatment option for you.

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MEG STORMis the editorial & content director at AEDIT.

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