Which Filler is Best for Under Eyes (Tear Trough)?

i had restylane under my eyes and mid section of face to give volume i love it but after reading all the posts i am afraid its not going to last as long. can anyone make a suggestion on other fillers for those areas.


Doctor Answers 28

Least problematic under eye filler thus far overall is Restylane

There are no FDA approved fillers for under the eye. Most fillers only have FDA approval for Naso Labial Folds. At this date there is only one FDA approved filler for lips (Restylane).

Risking long term or permanent fillers under the eye is not worth the potential negative results. Restylane injected properly under the eye typically lasts longer than it does in other areas, so you'll likely see the volume you are enjoying longer than you might think.

Fillers have been used for many years in "off label" application.The "off label" use of fillers is chosen independently by each physician. Off label is not illegal and in most cases not dangerous. It simply means the filler is being used in a way or in an area of the face that was not included in the FDA clinical studies.

Most U.S. physicians who treat under eye hollows with fillers will generally choose Restylane or Juvederm. Both fillers consist of hyaluronic acid gel which is a degradable product most closely resembling natural skin tissue. 

Careful injection of these hyaluronic gels at the proper depths and within the anatomical safety boundaries generally gets good results.The nice "fail safe" of HA gels is that they can be dissolved quite easily if the patient is not happy with the results.

There are fillers which are "contraindicated" in certain areas - meaning they are known to create a problem or are suspected to be capable of creating a problem.

Because the tear trough is such a sensitive area, and the skin is thinnest there, any "lumping" will show. It is also a highly reactionary area and more easily bruises or swells.

Injector techiqiue and precise knowldege of eye area anatomy is extremely important. Pick experience over price promotions - particularly for eye area injections.

It sounds that you are happy with your Restylane. If you were my patient I would encourage you to accept the temporary nature and appreciate the safeguards that come with it.

Los Angeles Dermatologic Surgeon
4.0 out of 5 stars 21 reviews

Fillers around the eyes can cause visible lumps

You are very fortunate that you have had good results with Restylane around the eyes into the tear trough. Since you have had good luck with Restylane, stick with it and the doctor who gave you a good result.

Longer lasting fillers are more likely to result in lumps and of course take longer to go away.

I have seen many, many patients who complain of visible lumps especially when fillers are injected into the dark cirlce under the lower eyelid, which is above the tear trough. actaul tear trough injections are less likely to cause this problem

Only consider two fillers: HA and Fat. All Others Will Age your Face!

The only two fillers you should ever consider at this point are crosslinked HA like Juvederm Ultra Plus or Perlane and autologous fat.  Restylane silk is a newer filler that is less prone to lumps and bumps that is also a good choice.  ALL OTHER LASTING FILLERS HAVE HORRIBLE EFFECTS ON YOUR FACE.  The other long lasting fillers become too firm causing fat atrophy, skin stretch strange textures and FACIAL AGING!!!  Fat is the ideal filler but requires a longer recovery than HA fillers but it lasts if placed appropriately.  I tell my patients with confidence that one year after injection of HA they will still look better than the day of injection.  In rality the results of my "aesthetic Facial Balancing" procedures with HA fillers last several years.
All the best,
Rian A. Maercks M.D.

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Which filler is best for under eye trough?

In 2014 we have different fillers which are used in this area. The skill of the injector is the most important thing for you to choose. Restylane works well and is probably the most popular filler used in the tear troughs followed by Juvederm and Belotero. All work well in the right hands.

Michael Gold, MD
Nashville Dermatologic Surgeon
4.0 out of 5 stars 16 reviews

Best cosmetic dermal filler for tear troughs

As most of the panel members agreed, Restylane is the product of choice in our practice for the tear trough area. We like the fact that it does not migrate as easily as Juvederm, that it may be resolved with hyaluronidase if needed, comes in 1/2 syringe for those that require less product in this area (which is not uncommon), and is much, much safer than a semi-permanenent or permanent filler.

We recommend that you don't trade safety for longevity as the tear trough area is very unforgiving and requires meticulous technique and the correct dermal filler.

Please refer to the below link for photos and further details for this procedure.

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
5.0 out of 5 stars 6 reviews

I would recommend only non permanent fillers. i only use...

i would recommend only non permanent fillers. i only use juvederm in this area.
the skin is paper thin and you will likely bruise.

try icing 5 minutes before injection to shrink the blood vessels. some physicians will inject an anesthetic with epinephrine before injecting this area.

these injections are the trickiest injections on the face. make sure you feel confident with your injector for this area in particular. it is a very unforgiving area

Pramit Malhotra, MD
Ann Arbor Plastic Surgeon
4.5 out of 5 stars 48 reviews

Restylane for Tear Troughs

In our practice, Restylane is the only injectable filler that we use in the tear trough area.  It has the most natural and consistant result of all the fillers - it is also has a very good safety profile.  You want to be sure to go to someone very experieced before getting injections in this region.  Restylane can often last 6-12 months in the tear trough region. 

Dr. Grant Stevens


Grant Stevens, MD
Los Angeles Plastic Surgeon
4.5 out of 5 stars 95 reviews

Filler for under eyes ONLY Fat Grafting- View MANY Photos for Evidence

Structural fat grafting is the only material to be placed under the eyes. Look at my gallery of fat grafting to see result weeks, months and years after surgery (link below)  Some doctors recommend other fillers for the under eye area. Look for photos weeks and months after surgery. The results often look unnatural, distorted, puffy and lumpy. When expertly administered, the results of fat grafting are smooth, natural looking and permanent.   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 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.

Michael Law, MD
Raleigh-Durham Plastic Surgeon
5.0 out of 5 stars 70 reviews

Best under eye filler is Restylane using blunt cannulas..see video

I am now convinced that Restylane is the best dermal filler for treating tear troughs and periocular depressions. It has a long track record of safety around the eye and does not spread around like juvederm does (which is good). It needs to be injected deep (onto the bone). Bruising is now a lot less with a newer technique (blunt microcannulas). There is less swelling, less discomfort, less recovery, and greater satisfaction using blunt cannulas. These have changed the game for treating this area. On top of this, the procedure is much safer with very little to no risk of vascular or visual changes because the cannulas can't enter into the vessels. Steve Weiner, MD, Facial Plastic Surgeon, Destin, Florida.

Steven F. Weiner, MD
Panama City Facial Plastic Surgeon
4.5 out of 5 stars 9 reviews

Fat injections are an option, but restylane lasts longer in the eye area

Fat injections are an option, but restylane lasts longer in the eye area. More recently practitioners are finding that restylane in the eye area can last more than one year. We have patients that have results for over 2-3 years. For longer results you can think of fat injections. Restylane is the best in the eye area from a filler standpoint. Restylane usually lasts around 6 months to a year. But in the eye region again the results can be longer.

Philip Young, MD
Bellevue Facial Plastic Surgeon
3.5 out of 5 stars 43 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.