Under Eye Filler - Procedure, Pros, Cons & Costs

11 sources cited
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What is Under-Eye Filler?

Under-eye fillers are a standard procedure used in dermatology and cosmetic surgery to prevent signs of aging, add volume, and improve skin texture. 

Since the tear trough (under the eye area) is sensitive and delicate, the U.S. Food and Drug Administration (FDA) has only approved JUVÉDERM® VOLBELLA® XC for under-the-eye filler treatment.1

However, many licensed healthcare professionals use under-eye filler treatments as an off-label cosmetic procedure to reduce wrinkles, fine lines, and dark circles. It is estimated that 2.6 million people get dermal fillers each year.2

please female patient during the mesotherapy procedure

How Does Under-Eye Filler Work?

As we age, our skin loses elasticity, volume, and moisture. Dermal fillers help to restore volume loss and youthful appearance.

Under-eye dermal fillers are gel-like substances injected directly into the skin. The fillers contain natural substances already found in soft skin tissue. They work by attracting water and locking in moisture to create volume and provide structural support.

Dermal fillers are temporary because they are reabsorbed by the body, losing their initial effect after a couple of months. The procedure can be repeated when the desired result subsides.

The most common and effective substances found in under-the-eye fillers include:

  • Hyaluronic acid is a sugar naturally found in human and animal tissue
  • Calcium hydroxylapatite is a mineral essential for bone function 
  • Poly-L-lactic acid (PLLA) is a biodegradable, synthetic material that stimulates collagen production 
  • Autologous fat transfer uses fat grafting to restore volume
  • Polymethylmethacrylate (PMMA) contains cow collagen and is not reabsorbed by the body

The FDA has approved hyaluronic acid fillers (JUVÉDERM® VOLBELLA® XC) to be used in the tear trough to improve infraorbital hollows (eye hollows) in adults over the age of 21.1 

Under-eye hollows are caused by a loss of volume resulting in dark circles, puffy eyes, and dark shadows. According to studies, tear trough treatments using hyaluronic acid are safe, painless, and have a high patient satisfaction rating.5

In addition to improving eye hollows, dermal fillers are approved to:

  • Correct moderate to severe facial wrinkles and skin folds
  • Increase fullness of lips, chin, the cheek area, and the backs of hands
  • Restore fat loss for people with HIV
  • Correct cheek acne scars

Is Under-Eye Filler Safe?

Overall, hyaluronic acid fillers are safe to use under the eye. However, like all medical procedures, dermal fillers come with risks and possible complications, including:

  • Lack of symmetry between the eyes
  • Overcorrection
  • Undercorrection 
  • Blue or puffy appearance (Tyndall effect)
  • Persistent inflammation
  • Allergic reaction 
  • Damage to blood vessels causing blood flow blockage
  • Central retinal artery occlusion (CRAO), which leads to permanent blindness
  • Skin infection

Pros and Cons of Under-Eye Filler

The decision to get under-eye fillers is personal and should be discussed with a licensed healthcare professional to review the risks and benefits.

Pros

The pros of hyaluronic acid under-eye filler include:

  • Natural-looking results
  • Absorbed by the body
  • Can be reversed using hyaluronidase
  • Easy to smooth out during treatment
  • Immediate results
  • Corrects under-eye circles and hollow appearance
  • Locks in moisture 
  • Improved skin elasticity
  • Helps prevent signs of aging (wrinkles, fine lines, and sagging skin)

Cons

  • Only lasts 4 to 12 months
  • Possible swelling or bruising
  • Slows down natural hyaluronic acid production
  • Expensive and usually not covered by insurance
  • Risk of infection and deformity if proper technique is not used

Under-Eye Filler vs. Botox

Many people might think of Botox when they hear under eye filler, but they are not the same thing. While dermal fillers increase volume and plumpness, Botox improves the appearance of fine lines and wrinkles. 

Botox is not a dermal filler and is only used on areas of the face that have muscle movement (which aids in facial expressions). The FDA refers to Botox as an injectable drug that keeps muscles from tightening, resulting in less visible facial wrinkles.6 

Other uses for Botox include improving:

  • Crow’s feet 
  • Frown lines 
  • Forehead lines 
  • Chronic migraine
  • Overactive bladder
  • Spasticity 
  • Excessive underarm sweating

The FDA has not approved using dermal fillers in combination with Botox.6 

However, studies have shown that using both onabotulinumtoxin A (Botox) and dermal fillers containing hyaluronic acid and calcium hydroxylapatite had the best facial enhancement results.9 

Under-Eye Filler Procedure

Under-eye filler treatment is a non-surgical procedure typically done in a doctor’s office in about 15 to 30 minutes. 

How to Prepare

Your first visit will include a consultation with a healthcare professional to discuss expectations, goals, and concerns. 

Other topics addressed by the medical professional include:

  • Family and medical history, including allergies, skin, and neurological conditions
  • What medication you take (NSAIDs and blood thinners can increase bruising)
  • Discussing the treatment area and what type of dermal filler will be used
  • Confirming side effects and possible complications 

What to Expect

Right before the procedure, the licensed professional will mark the location of the treatment area and clean it. A topical anesthetic numbing cream will be applied to the treatment area before the injection to minimize pain and discomfort. 

The steps of under-eye filler treatment include:

  1. The provider will strategically inject gel filler into the deep tear troughs under the eyes with either a needle or a blunt-edged cannula
  2. You may feel a burning or stinging sensation during the procedure
  3. The provider will smooth the filler into place
  4. You should see immediate results with a hyaluronic acid filler

One or more injections may be needed depending on treatment goals.

Aftercare 

After the eye filler procedure, you can typically return to normal activities immediately. They may have you ice the treatment area for 15 to 20 minutes before leaving to reduce redness and swelling.

Your provider may recommend the following aftercare instructions:

  • Refrain from strenuous activity for 1 to 2 days
  • Avoid sleeping face down
  • Periodically apply ice for the first 24 to 48 hours after treatment
  • You can smooth out any lumpiness with your finger
  • Stay out of the sun and avoid using tanning beds

Side Effects

The most common side-effects of eye fillers typically go away after 7 to 14 days and may include:

  • Redness
  • Swelling
  • Risk of bruising
  • Tenderness
  • Itching
  • Rash

To minimize side effects and complications, it is essential to only receive dermal fillers from licensed healthcare professionals trained in proper injection techniques. 

These professionals might include:

  • Board-certified dermatologist
  • Board-certified plastic surgeon
  • Ophthalmologist
  • Dentist

Results & Maintenance 

Results of improved facial rejuvenation are typically noticed immediately after hyaluronic acid eye fillers. 

While it depends on the type of eye filler used, results typically last 4 to 12 months. People can come in for repeat injections when volume loss and wrinkles reappear. 

Cost

Eye fillers are considered a cosmetic procedure and are typically not covered by medical or vision insurance.

While costs can vary depending on the professional and geographical location, injections can range from $684 to $2,508 per syringe. Usually, multiple syringes are needed to achieve desired results.11

Always use a board-certified healthcare professional for dermal fillers to minimize risk and complications.  

Summary

Dermatologists and cosmetic surgeons commonly use under-eye fillers to add volume, prevent signs of aging, and decrease dark circles. The FDA has approved the hyaluronic acid filler, JUVÉDERM® VOLBELLA® XC, for use in tear troughs (the under-eye area). 

The procedure is usually done in a doctor’s office and takes about 15 to 30 minutes. It is considered safe as long as a licensed professional trained in injection technique is doing the procedure. 

Mild side effects include swelling, bruising, redness, and tenderness, which typically go away after 7 to 14 days.

11 Cited Research Articles
  1. Abbvie. “FDA approves JUVÉDERM® VOLBELLA® XC for undereye hollows.” www.news.abbvie.com, 2022. 
  2. American Society of Plastic Surgeons. “Taking the mystery out of Botox and dermal fillers.” www.plasticsurgery.org, 2019.
  3. Walker, Kendra, et al. “Hyaluronic acid.” STATPearls, 2021.
  4. American Board of Cosmetic Surgery. “Injectable dermal fillers guide.” www.americanboardcosmeticsurgery.org, n.d.
  5. Diwan, Zoya, et al. “A prospective study on safety, complications and satisfaction analysis for tear trough rejuvenation using hyaluronic acid dermal fillers.” Plastic and Reconstructive Surgery-Global Open, 2020.
  6. U.S. Food and Drug Administration. “Dermal filler do’s and don’ts for wrinkles, lips, and more.” www.fda.gov, 2022.
  7. American Academy of Ophthalmology EyeWiki. “Eyelid filler injection.” www.eyewiki.org, 2022.
  8. American Academy of Dermatology Association. “Fillers. FAQs.” www.aad.org, n.d.
  9. Fink, Bernhard, et al. “The effect of incobotulinumtoxin A and dermal filler treatment on perception of age, health, and attractiveness of female faces.” The Journal of Clinical and Aesthetic Dermatology, 2014. 
  10. American Academy of Ophthalmology. “Treating tear trough deformities with dermal fillers.” www.aao.org, 2014.
  11. American Society of Plastic Surgeons. “How much do dermal fillers cost?” www.plasticsurgery.org, n.d.
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