Dermal fillers are gel-like products injected beneath the skin to restore lost volume, fill hollows and give the eye area a more rested appearance. Around the eyes, hyaluronic acid based fillers are the ones I use. Hyaluronic acid occurs naturally in the skin; because it binds water, it adds both volume and hydration to the tissue.
The periocular region is the most demanding area for filler treatment. The skin is the thinnest on the face, there is little space between muscle and bone, and the vascular network is dense. A product and technique that work comfortably elsewhere on the face may be entirely unsuitable here.
Tear trough filler is the placement of hyaluronic acid into the groove that runs beneath the lower eyelid. It is often described as brightening the under-eye, but nothing in the product itself brightens anything: the area looks lighter because the shadow cast by the hollow is gone.
The tear trough is the transition line between the under-eye fat and the upper cheek. With age, reduced cheek fat support, changes in bone structure and forward displacement of orbital fat make this line more defined, leaving a tired shadow beneath the eye.
Contrary to a widespread belief, not every patient with dark circles is suitable. In the following situations filler either fails to help or makes the appearance worse:
Filler is a safe method in the right patient with the right technique, but it is not risk-free. I discuss these openly before treatment.
A major advantage of hyaluronic acid fillers is that they are reversible. In the event of an unwanted result or prolonged oedema, the filler can be dissolved with hyaluronidase. This is the main reason I do not use permanent products around the eyes.
In the short video below I explain when under-eye filler is better avoided.
There is no single correct method for the under-eye. The right one depends on the source of the problem.
In most patients these are complementary rather than competing methods. I set out the combined approach on the periocular rejuvenation page.
I am an ophthalmologist working in oculoplastic surgery in Kadıköy, Istanbul. I hold the FEBO diploma of the European Board of Ophthalmology and am an active member of ESOPRS and of the Oculoplastic Surgery Unit of the Turkish Ophthalmological Association.
For patients travelling from abroad, one practical point matters more than any other with under-eye filler: swelling can take weeks to settle, and the result should be reviewed before any further volume is added. I would rather a patient leave with slightly less than the target and return, than fly home over-filled. Where a review visit is not possible, I say so before treatment and adjust the plan accordingly.
The first three of these require urgent assessment. Every patient who has had filler should know how to reach the physician who performed it.
As an Ophthalmologist, Dr. Ayşe Dolar Bilge, I provide diagnosis and treatment services with my experienced team.
It is the method applied for the under-eye hollowing we call tear trough deformity and the shadow it casts. Hyaluronic acid filler is placed deep, supporting the groove. Although it is often described as brightening, nothing in the product brightens anything: the area looks lighter because the shadow is gone.
The most common are swelling, bruising and prolonged oedema lasting weeks, because hyaluronic acid binds water. Filler sitting too superficially can produce a bluish tint (the Tyndall effect), and excess volume can cause irregularity and lumps. Vascular occlusion is very rare but the most serious risk, which is why the procedure should be performed by a physician familiar with the vascular anatomy of the region.
Contrary to a widespread belief, not every patient with dark circles is suitable. Where there is significant fat herniation, pigmentary darkening, persistent oedema, very thin skin or lower lid laxity, filler either fails to help or makes the appearance worse. In a suitable patient, however, it makes a clear difference.
In the under-eye area hyaluronic acid fillers usually last 9-18 months, varying between individuals. The duration depends on the product, the amount used and the patient's metabolism. Treatment can be repeated as the effect diminishes.
Yes. The most important advantage of hyaluronic acid fillers is that they are reversible; in the event of an unwanted result or prolonged oedema they can be dissolved with hyaluronidase. This is the main reason I do not use permanent products around the eyes.
The expected swelling and bruising usually settle within days. Because hyaluronic acid binds water, however, under-eye oedema can persist for weeks, and this is the most common cause of dissatisfaction. Limiting salt intake for a few days and using cold compresses on the first day ease this period.
In patients with mild to moderate hollowing and relatively thick skin, hyaluronic acid filler is usually enough, and being reversible is an advantage. In patients with thin skin and impaired texture, NanoFat injections prepared from the patient's own fat may suit better. The decision is made at examination.
If there was unexpectedly severe pain during or immediately after the injection, if the skin has blanched or become mottled, or if there is blurred vision, a dark patch or any sense of visual loss, you should seek help without delay. These findings can indicate vascular occlusion.
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