Best Injectable Filler for Undereye Hollows?

What is the best injectable dermal filler (apart from fat) for under-eye hollowness? What about upper-eye hollowness? Is this safe?

Doctor Answers 11

Fat Grafting to correct hollows of Upper or Lower Eyelids

Structural fat grafting can be performed on upper eyelid hollows, to smooth hollows under the eyes, to fill sunken cheeks, for filling sunken hollows under eyes eyes and is often used for blepharoplasty correction when too much skin and or fat has been removed in an eyelid surgical procedure.
Fat Grafting requires specialized training and specialized surgical instruments, as well as patience and attention to detail on the part of the surgeon. When performed properly, permanent improvements in facial plastic surgery are possible.
The technique I use, structural fat grafting, in which small amounts (less than 0.1 cc at a time) of fat are carefully microinjected with a blunt cannula - not a needle,  in a series of discrete layers to gradually 'build' new soft tissue structure. As there is space between each microinjection, new blood vessels are able to grow into the grafted fat, allowing it to persist. If this process of blood vessel ingrowth (neovascularization) does not occur, then the injected tissue cannot truly be considered a 'graft' and is instead just another 'soft tissue filler' of limited duration.
It is important select a plastic surgeon with specialized training who performs fat grafting often.

Raleigh-Durham Plastic Surgeon
4.5 out of 5 stars 48 reviews

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Hi Hot Nani in Hotlanta,

I went to medical school in Atlanta, so I will try to answer your question with Emory pride. I have used both Restylane and Juviderm for facial filling; they are both very good hyaluronic acid filler products.

Under the eyelid in the tear trough depression area, I have again used both fillers. I have found that Restylane is most dependable in that what I put in won't go "crazy" with puffiness and swelling. I have not had any problems at all with Restylane in this area. On the other hand (or tear trough hollow) though I have treated a few patients with Juviderm in this area, after my second patient had swelling and edema (with identical technique and under correcting) I have stopped using Juviderm there. Most of the patients looked great, but I found Juviderm to be unpredictable in this sensitive area. Many other facial plastic surgeons have shared similar experiences with me. I am not a speaker or representative for either company. Make sure that you choose your experienced physician carefully for injections in this area.

Once successfully in place, Restylane in this area has impressed me with it's longevity of up to and many times longer that one year.

William Silver, MD in Atlanta is a very well respected facial plastic surgeon.

Be well.

Dr. P

Michael A. Persky, MD
Los Angeles Facial Plastic Surgeon
5.0 out of 5 stars 23 reviews

Best dermal filler for under eye hollows

This is a tough question and to some degree it is a matter of opinion and personal preference. I want to clarify that although a dermal filler is being used, the vast majority of physicians do not inject this into the dermal or subdermal layers but instead prefer to inject deep.

Probably more important than the filler is the technique of injection. Physician instructors describe a variety of approaches to this anatomy. Materials injected include: Radiesse, Perlane, Restylane, Juvederm, Hylaform, Prevelle, etc.

I personally prefer Juvederm, and I tend to inject it deep to avoid visibility or palpability. I have also used Radiesse with good results in patients requiring greater volume correction.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 54 reviews

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I use Juvederm

I never use a dermal filler in the upper eye. Under the eye, I use Juvederm in the so-called 'tear troughs.' No dermal filler is FDA-approved for the tear troughs, but this is commonly done as an off-label usage. It is generally safe as long as it is done only in the inner half of the eye (medial to the mid-pupillary line). Very small amounts are used, less than a full vial of Juvederm, so the rest can be used elsewhere. It is a subtle result that makes one look much less tired, but not fake or 'like something was done' at all.

Anne Marie McNeill, MD, PhD
Newport Beach Dermatologic Surgeon
5.0 out of 5 stars 1 review

Restylane is the best for the lower lids

For improvement of the tear troughs of the lower lids, the best injectable filler is Restylane. It works extremely well and lasts approximately one year in this area in my experience. It is best in the younger patient with early aging of the lids and thicker skin and not so good in the older patient with thin fragile skin.

Dermal fillers

There are certain fillers that are safe for hollowing under the eyes. Typically, the hyaluronic acid products such as Restylane or Juvederm can fill in the hollowing of the lower eyelids very nicely.

The eyelid skin is some of the thinnest skin in the body so you want to make sure the injector is comfortable with the eyelids so as not to cause too much lumpiness or stranding. I usually recommend to my patients that they try a non-permanent filler always before a permanent filler to make sure they are pleased with their result and have no adverse reaction.

These hyaluronic acid products are very safe products and when used judiciously can eliminate the hollowed appearance the lower lids can take on with aging as we lose fat.

Jennifer S. Landy MD
Tampa Ophthalmologist

Under-Eye Hollowness - Restylane is the Preferred Choice

Most fillers can be used effectively to improve the hollowness around the eyes. I like Restylane the most, because it is highly effective, safe and does not leave excessive swelling or cause any skin discoloration. The key is to choose an experienced and reputable physician to inject the filler. Thanks for the question.

Best Injectable for Under Eye Hollows

Tear trough injections or the area under the eyes can best be injected with Belotero or Restylane.  The injection in that area may last around 6 months or more.  This is a very delicate area and care must be used not to over inject this area.  The under eye area also tends to bruise so I always recommend that patients take Arnica before the injections.  The upper-eye hollow is an area that I do not recommend injecting.  For the best cosmetic results please consult a board certified dermatologist with experience in cosmetic injections and fillers.

Treat under-eye hollows with a hyaluronic acid filler.

Deep tear troughs under the eyes are commonly treated with a hyaluronic acid filler such as Juvederm or Restylane. To restore volume to the cheeks, Voluma works extremely well and delivers long-lasting results. To achieve the level of rejuvenation you’re looking for, you’ll need to address both areas with the appropriate filler.

Hal Michael Bass, MD
Pembroke Pines Plastic Surgeon
4.5 out of 5 stars 36 reviews

Silikon-1000 may be safely used by experienced physicians for natural-looking, permanent lower eyelid rejuvenation.

In my practice, Silikon-1000 works well for improving the appearance of lower eyelid grooves or hollowing. A very small amount of silicone is required, and your results are permanent. In my view, lower eyelid injections must be performed by a specialist familiar with non-surgical rejuvenation of this delicate area, so you should see many photos before proceeding.

Hyaluronic acid products may lead to a bluish discoloration (Tyndall Effect) that could last a year or longer, so choose your doctor with care.

I hope this is helpful for you.

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
5.0 out of 5 stars 302 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.