Fillers under the eye – what happens in the treatment room ?

Article: Fillers under the eye

Many people are troubled by shadows and dark circles under the eyes that make them look tired. The dark shadows and circles are often caused by a hollowness, or groove, that starts at the inner corner of the eye and forms a half-circle under the eye. This area is called the tear trough. If you have a marked tear trough, it will deflect light and cast shadows on the skin, leading to a tired look. Luckily, it can be treated with fillers under the eye that add volume to reduce the hollowness. But what does a tear trough treatment entail and what happens in the treatment room? Continue reading to find out.


Are fillers under the eye a new and experimental treatment?

Tear trough treatments have been performed for many years so it’s nothing new.* Treating people with fillers under the eye is however a bit trickier than for example lip treatments.

There are several tissues in the tear trough area that can contribute to the lack, or loss, of volume. A tear trough treatment should always be performed by a qualified and experienced healthcare practitioner who can assess the eye area correctly and determine whether fillers under the eye are an effective treatment for you or whether other treatments are more suitable.


What do fillers under the eye contain?

If you are considering a treatment with fillers under the eye you probably want to know what’s actually injected.

Almost all fillers today are based on hyaluronic acid, a natural substance that we have in many tissues, for example in our muscles, skin, eyes and joints. Hyaluronic acid binds large amounts of water and keeps our tissues lubricated. Natural hyaluronic acid in our bodies forms and degrades in just a day or two. The hyaluronic acid in fillers has been stabilized to make it last longer, for several months, by cross-linking the long hyaluronic acid chains.


Can hyaluronic acid-based fillers be trusted for tear trough treatments?

Hyaluronic acid-based fillers have been used for 25 years in aesthetics, basically since the filler RESTYLANE®, one of the biggest filler brands on the market, was launched in Europe in September 1996.1 More than 50 million treatments1 with RESTYLANE® fillers have since been performed over the world. Many healthcare practitioners have a lot of experience of treating people with fillers, including tear trough treatments.

However, as already mentioned, tear trough treatments are a bit trickier to perform than other filler treatments, such as filling lips. Make sure to always consult an experienced healthcare practitioner if you are considering a treatment with fillers under the eye, to get a correctly performed treatment with a natural-looking result that you likely will be satisfied with.


The consultation before your tear trough treatment

Before you have any treatment, you will always have a consultation with your healthcare practitioner. He or she will make a careful assessment to determine whether fillers under the eye is the right treatment for you or if other treatments are a better choice.

Tear trough treatments are effective to fill hollows or grooves under the eyes that lead to dark shadows and a tired look. However, for some, the dark shadows and circles under the eyes are caused by hyperpigmentation or superficial veins, and that cannot be treated with fillers under the eye.

As mentioned above, tear trough treatments are generally not recommended for people with puffy eyes or eyebags.


Safety concerns and medical history

Your healthcare practitioner will always ask you about your medical history during your consultation. You may also be asked to fill in a form about your medical history. Some people shouldn’t have treatment with fillers, for example people with blood disorders, or people with an inflammation or infection near the treatment area. Filler treatments are not recommended for pregnant or breastfeeding women either.

Your healthcare practitioner will also inform you about potential side effects. The most common side effects from filler treatments include tenderness and temporary swelling at the treatment site, and there can be a little bit of bruising. These side effects usually disappear within one to two weeks and are often so mild that you can go back to work after the treatment. However, make sure that you discuss all potential side effects with your healthcare practitioner before your tear trough treatment.


During the treatment

If your healthcare practitioner thinks that a tear trough treatment is effective in your case, you can decide to go on and have the treatment.

A lot of people are afraid of needles and don’t like the idea of having needles close to the eyes. The injection point at a tear trough treatment is however not very close to the eye. The filler usually contains a local anesthetic, lidocaine, to make the treatment more comfortable.

Generally, the “needle to skin time” is very quick and can take less than or close to a minute. In other words, a treatment with fillers under the eye doesn’t take long once the actual treatment starts.


Many healthcare practitioners “underfill” when performing tear trough treatments

Even if you want to get rid of hollows and grooves under your eyes, you probably don’t want to look swollen after your tear trough treatment.

Many healthcare practitioners actually “undertreat” patients at their first visit, meaning that they inject a little bit less filler than they believe is the optimal amount. They then ask the patient to come back after a couple of weeks for a retouch. This way they can make sure that the patient won’t end up with a swollen look. So, don’t be surprised if your healthcare practitioner uses this procedure.


How often do I have to come back for retreatments?

Fillers normally last for several months before they are degraded by the body. Usually, fillers are broken down a little bit quicker in areas that move a lot, such as the lips. In areas that are less dynamic, for example around the eyes, fillers can last longer.

Exactly how long fillers under the eye last is also individual. Furthermore, it’s a matter of subjective taste. The filler won’t disappear from one day to the next. It recedes gradually. In other words, it’s up to you when you think it’s time to have your next tear trough treatment.


Targeted, trusted, recommended: Long-lasting results with Restylane® EYELIGHT™

A filler targeted for tear trough treatments is Restylane® EYELIGHT™.2 It’s based on the trusted NASHA™ gel technology that has been used for 25 years to create RESTYLANE® fillers.1

During a tear trough treatment with Restylane® EYELIGHT™, a small volume is injected to fill the groove under the eye that causes the shadows and dark circles. With the groove filled, you will have a refreshed and less tired appearance.2

Restylane® EYELIGHT™ provides results. A recent study showed that after 6.5 months, as many as 88.6% of patients still reported they looked less tired.2 Also, 94.3% said they would do the treatment again.2

Read more about treatments with Restylane® EYELIGHT™ here.



* See for example Lambros VS.; Plast Rec Surg. 2007 Nov;120(Supplement):74S-80S.

  1. Data on file (MA-39680).
  2. A.Nikolis et al. A Randomized, Crossover-Controlled Evaluator-Blinded Trial Evaluating Cannula- Vs Needle-Assisted Hyaluronic Acid Injections for Infraorbital Deformities. ASJ 7-2021.