Under-eye filler is touted as an effective treatment for diminishing dark circles. But is it for everyone? The answer, according to expert injectors, is no.
Whether the result of stress, screen time, lack of sleep or genetics, dark circles under the eyes are not uncommon. And in most cases, they tend to become more pronounced with age. “This is because the area underneath the eyes, known as the tear trough, loses volume as we age – becoming more sunken,” explains Daniel Ezra, specialist ophthalmic and oculoplastic consultant at Moorfields Eye Hospital.
It is a natural part of the ageing process (albeit one we may not like) that doesn’t need cosmetic intervention. The best concealers and eye creams can truly work wonders here. But if you are contemplating a cosmetic procedure to remove dark circles caused by volume loss – specifically under eye filler (also known as tear trough filler) – swot up on the facts first.
Increasingly in demand, Google searches for ‘tear trough fillers before and after’ have shot up 110% in the past year. On TikTok, ‘tear trough filler results’ has amassed 18 million views and counting.
But before you get pulled in by the before and afters, be sure to do your research. As with all cosmetic treatments, it is not without risk and finding a highly qualified, reputable expert is key. Ahead, expert injectors break down everything you need to know about under-eye filler – including downtime, side effects and results.
What is under-eye filler?
“Under-eye filler is a popular cosmetic solution for tackling tired-looking eyes,” explains Ezra. “It is a non-surgical procedure that involves carefully injecting a gel-like substance into specific areas around the eyes, which works to replace the lost volume brought about through the ageing process.”
Not that dissimilar to any other hyaluronic acid fillers, under-eye filler is like a watered-down version. “Regular fillers will be noticeable under the very thin skin under the eye and are likely to attract water, resulting in puffiness or swelling,” says Dr Joney De Souza, an award-winning cosmetic doctor based in Marylebone. This is why under-eye fillers are much softer and more liquid in consistency.
Erase them or embrace them.
What can under-eye filler help (and not help) with?
“Hyaluronic acid dermal fillers injected into the tear trough can help add volume to areas where volume has been lost,” says Dr Maryam Zamani, oculoplastic surgeon, facial aesthetics doctor and founder of MZ Skin. And as we already mentioned, we lose volume as we age which can lead to hollowing under the eyes that, in turn, creates shadows. “Without the hollowing, the eyes look immediately brighter and less tired,” continues Zamani, who adds that this treatment can also address signs of ageing, “by filling out fine lines and wrinkles.”
So, under-eye fillers are an effective option for patients with tear through hollows and under-eye wrinkles. “They are not, however, helpful with swelling or for patients with larger bags under the eyes,” notes De Souza, “and in fact, are more likely to worsen this issue.” It’s also worth noting that while under-eye fillers can improve darkness under the eyes – “this isn’t always the case,” says De Souza, “when the darkness is a result of excessive pigmentation, it will have no impact.” But if the darkness is caused by skin laxity due to ageing or genetics, under-eye filler will add volume, brightening the area without causing puffiness.
Who is an ideal candidate for this treatment?
“Tear trough filler works best in individuals who have dark circles caused by volume loss or mid-face descent,” says Zamani. Dr Brendan Khong, aesthetic doctor a Dr David Jack clinic, agrees and add that the ideal candidate will meet the below requirements:
- Those with a genuine hollowing under the eyes known as the tear trough.
- Have good skin elasticity and quality, especially under the eyes
- Are not prone to puffiness and swelling under the eyes.
- Those without excess skin sagging or puffy eye bags
- Those without a large loss of volume in the mid-face area.
What’s the difference between under-eye filler and Botox?
“Botox is a neurotoxin which helps to paralyse muscle in the eye area, particularly the crow’s feet, frown lines and horizontal forehead lines,” says Khong. “This helps to soften the appearance of fine lines that occur naturally over time and with repeated movement.” Khong would recommend Botox to patients who specifically want to target fine lines. “Careful placement can also help to subtly lift the eyebrow, if so desired.”
Under eye filler, on the other hand, addresses the tear trough area, replacing lost volume to make the area appear brighter and less tired. “This is a good treatment for patients who have concerns about a genuine volume loss in the area and want to tackle shadows caused by hollowing,” says Khong. Dr Rita Bonanno, medical specialist at HAIR&SKIN, adds that “both are temporary treatments and can be done together as they act in different ways and complement each other.”
Are under-eye fillers safe?
It may be a simple procedure, but it still has potential risks. “Beyond the risk of bruising, swelling and occasional infection, the main risks include excessive placement of fillers, that cause an unnatural appearance; superficial injection of the filler, making it visible and unsightly; placement of a filler that attracts water, giving the appearance of swelling,” lists De Souza.
De Souza assures us that bruising and swelling should resolve within a week. If, however, too much filler has been injected, or the filler has been injected too close to the skin's surface (which can cause the area to have a blueish tint due to how the light scatters) - it's advisable to have the filler dissolved using hyaluronidase, an enzyme that breaks down the hyaluronic acid.
In the extremely rare episodes in which the product is injected inside a vein, particularly when using a needle instead of a cannula, it may lead to vision loss. “This is why it is so important to seek a qualified and highly experienced injector who not only knows the anatomy but also knows the signs and symptoms of potential issues and how to treat them effectively,” adds Zamani.
How long does under-eye filler last?
According to Zamani, hyaluronic acid fillers can last anywhere between six to 18 months. “Although in my experience, I have seen that it can be even longer.” De Souza seconds this and adds that results tend to last for at least two years. This is because under-eye fillers are typically injected deeper under the skin compared to fillers in other parts of the face, say, for example, cheek filler or lip filler. Also, we tend to move the area under the eyes less, which may contribute to longer-lasting results.
Is under-eye filler treatment painful?
As with any other injectable treatment like Botox or Profhilo, there is some level of discomfort. But, as Zamani assures, under-eye filler is a quick procedure. “Before the treatment, numbing cream is applied onto the area, followed by the insertion of the cannula that will place the filler at a deeper level, which can cause some discomfort,” explains De Souza.
When using a cannula, one to three insertion points are created, and the cannula is inserted. With a needle, injection points vary. “I air on the side of caution and inject less rather than more,” says Zamani. “If patients feel they need more, they can return after two weeks for re-evaluation.”
How to prepare for an under-eye filler procedure
The preparation begins about a week before the procedure. Khong recommends avoiding aspirin and ibuprofen at least seven days prior to treatment, as this can increase your risk of bruising. “It's also important to refrain from alcohol and fish oils 24 hours before your treatment, as these too can increase your risk of bruising.” And if you’re pregnant, you should refrain from getting both Botox or under-eye filler.
Will you see a difference immediately?
The experts confirm that results are noticeable immediately. “But it is only after 10 days that the final result can be seen,” says De Souza. In most cases, there is no downtime and there is very little swelling or bruising. If, however, you have bruising and notice that it's spreading, or you're experiencing severe pain under the eyes, consult the doctor who did the procedure immediately.
How much does under-eye filler cost?
Prices vary depending on who you see and where you go to have the procedure. Generally speaking, under-eye filler usually costs upwards of £650. At Zamani’s clinic in London, treatment starts from £875. At Dr David Jack's clinic, dermal fillers start from £490 per syringe (depending on the practitioner).
If you are seriously considering this treatment, don’t shop around for a good deal. It’s always best to go to a reputable doctor with lots of experience in this area.
And what about aftercare?
“Don’t exercise on the day of treatment,” says Zamani. “After treatment, I recommend no steam, sauna, facial or massage for one week.” If you do experience swelling, Zamani recommends taking an antihistamine to help. “Also, avoid touching the area where your doctor has carefully injected the filler and go makeup-free after the treatment to minimise the risk of infection,” adds Khong.
“Your doctor may also suggest, for the first two nights following the procedure, not sleeping on the side, so as not to compress the face on the pillow,” says Bonanno.
