Under-Eye Fillers: Benefits, Risks, Procedure, and What to Expect

Tear trough fillers (under-eye fillers) use injectable hyaluronic acid (HA) to correct volume loss, hollowing, and shadowing in the infraorbital region — one of the earliest and most impactful signs of facial aging.

Anatomy and Indications

• Tear trough: Groove from medial canthus diagonally downward.
• Palpebromalar groove: Extends laterally along orbital rim.
• Indications: True hollowing (volume loss), shadowing, dark circles from structural deficit — NOT for pigmentary dark circles, festoons, or significant skin laxity.

Filler Selection (HA Only for This Area)

Product	Characteristics	Best For
Restylane-L / Refyne	Low G', cohesive; minimal hydrophilicity	Standard tear trough; natural integration
Belotero Balance	Lowest G'; monophasic; superb integration	Thin skin; superficial placement
Restylane Eyelight	Designed for tear trough; low swell	Specialized; minimal edema
Juvéderm Volbella	Vycross; low HA conc; smooth	Fine lines + subtle volume

Never use: High G' fillers (Voluma, Restylane Lyft), CaHA, PLLA, PMMA — high complication risk in this vascular, mobile zone.

Procedure Details

• Technique: Cannula (preferred) or needle; supraperiosteal or suborbicularis (SOOF) plane.
• Anesthesia: Topical + lidocaine in filler; nerve block optional.
• Volume: Typically 0.3–0.7 mL per side.
• Duration: 15–30 minutes.

Risks — Specific to Tear Trough

• Tyndall effect: Bluish discoloration from superficial placement — prevented by deep placement.
• Vascular occlusion: Retinal artery embolism → blindness (rare, catastrophic); angular/ophthalmic artery anastomoses.
• Edema: Prolonged (weeks–months) due to poor lymphatic drainage; HA hydrophilicity.
• Overfilling: "Pillow face," malar mounds, worsened bags.
• Granulomas, migration.

Risk Mitigation

• Cannula technique (blunt tip; fewer vessel punctures).
• Deep (periosteal/SOOF) placement.
• Low G', low hydrophilicity HA.
• Conservative volumes; serial building.
• Aspiration before injection.
• Hyaluronidase immediately available.

Cost and Longevity

• Cost: $600–$1,500/syringe (often 1 syringe treats both sides).
• Duration: 9–18 months (metabolism faster in mobile area).

Contraindications

• Significant lower lid laxity (snap test positive) — needs surgery.
• Festoons/malar bags — filler worsens.
• Active infection, autoimmune flare, pregnancy.
• Prior permanent fillers in area.

This is the highest-risk filler zone. Choose an expert injector with specific tear trough mastery.