Under-Eye Filler Isn’t For Everyone. Top Oculoplastic Surgeons Share Their 3 Favorite Alternatives.

Under-eye filler isn’t for everyone. Experts share the best filler-free solutions for common eye-area concerns.

Despite its ubiquity across social media, hyaluronic acid (HA) filler isn’t a panacea for tired or aging eyes. “In fact, only very select patients are good candidates—those with true hollowness, nonexistent or very small under-eye bags, no issues with fluid retention, and good eyelid skin,” explains Dr. Flora Levin, a board-certified oculoplastic surgeon in Westport, Connecticut. Anyone who doesn’t meet these criteria—i.e., most adult mortals—will likely see subpar results or complications from tear-trough filler, according to Dr. Levin.

The “good eyelid skin” prerequisite—meaning taut, firm lower lids—tends to limit top contenders to those in their 20s and 30s, points out Dr. Mitesh Kapadia, a board-certified oculoplastic surgeon in Boston. “Older patients with some skin laxity can occasionally be treated with fillers,” he says, “but it takes a lot more experience to give them a nice result.” 

Even if you do qualify for tear-trough treatment—and have a genius injector—you can’t count on filler to solve your every issue. In the under-eye area especially, “fillers have real limitations,” says Dr. Christopher Zoumalan, a board-certified oculoplastic surgeon in Beverly Hills, California. “They don’t help with skin texture, crepiness, dynamic crow’s-feet, or discoloration”—be it melanin-related or vascular in nature. 

Dr. Zoumalan also warns that, in most cases, attempting to veil or blend under-eye bags—aka herniated fat pads—with filler is a setup for side effects, including persistent puffiness, a lumpy or uneven result, and a bluish tinge. Adds Dr. Kapadia, “When you try to camouflage significant bags, it may look okay immediately after treatment, but it’ll often appear odd and unnatural with time.” Only a blepharoplasty can eliminate bulging bags—but, of course, eyelid surgery alone can’t correct hyperpigmentation or wrinkling, which is why it’s so frequently paired with nonsurgical treatments like lasers, peels, and the like.

The moral of the story? Under-eye filler isn’t for everyone. If a trusted injector refuses to fill you, thank them for sparing you future headaches and move on to a more suitable treatment. Ahead, experts share the best filler-free solutions for common eye-area concerns.

For fine lines and crepey skin: CO2 laser or microneedling 

While Botox can help keep crow’s-feet and under-eye crinkles from forming or deepening, it rarely eradicates them completely. Smoothing those etched-in lines generally means jump-starting the body’s healing response, to kick up collagen production for plumper skin. While there are various ways to do this, the oculoplastic surgeons we spoke to lean toward fractionated CO2 lasers for fairer skin tones and some form of microneedling for darker complexions or anyone aiming for less downtime. 

“The CO2 is an ablative laser that creates microscopic columns in the epidermis,” explains Dr. Tanya Khan, a board-certified oculoplastic surgeon in Austin, Texas. “As this topmost layer of skin sloughs off in the post-treatment period, the body is forced to produce its own collagen and elastin, to repair the columns created by the laser. As such, the CO2 laser will simultaneously help with both erasing superficial areas of discoloration and reducing crepey skin by thickening the skin itself.”

When reaching for the CO2, Dr. Khan first preps the skin with numbing cream for about an hour and shields the eyeballs with both “bandage contact lenses”—prescription-free lenses of a standard size—as well as a special “metal plate that goes over the eyeball and under the eyelid, to help tent the skin for better exposure of [its] surface and to protect from stray laser radiation,” she says. For the first week or so after CO2 treatment, patients typically look red, swollen, and scabby—aftercare involves disinfectant vinegar soaks plus occlusive ointments—but impressive results can be seen fairly quickly, usually by 10 to 14 days out.

While CO2 lasers can truly transform the skin, they are among the spiciest of resurfacers. For those who can’t tolerate them, there’s microneedling—both the traditional, energy-free form and the newer, radiofrequency-charged modalities. (Most types of needling require a series of treatments; the CO2 laser is a one-and-done option.) Dr. Zoumalan is a fan of mechanical microneedling for tackling crepey skin and fine wrinkles on Fitzpatrick skin types IV and above. While its effects aren’t as dramatic as those achieved with a CO2 laser, he says, “it can provide great results—and it doesn’t cause post-inflammatory hyperpigmentation.” 

Dr. Levin prefers the Morpheus8, an RF needling device with adjustable needle depths, for rejuvenating the skin under the eyes. “The thermal damage [it creates] produces contraction of collagen—for short-term tightening—and stimulation of new collagen synthesis over the long term,” she tells us. (Fresh collagen typically takes six to eight weeks to deposit.) “There may also be stimulation of growth factors, dermal thickening, and other remodeling that can help with elasticity and firmness,” she notes. Several days of redness, along with bruising and swelling, may follow treatment, with signs of improvement surfacing after your second session.

For visible veins around the eyes: the Nd:YAG laser 

To knock out darkness, providers first need to pinpoint its cause. While small amounts of carefully placed filler can brighten hollows resulting from fat loss near the inner corners of the lower lids (near the nose), HA does nothing for shadows cast by veins, says Katie Werner, a registered nurse and laser specialist in Westport, Connecticut. The most surefire fix for visible veins on the upper and lower eyelids is the Nd:YAG laser, which “targets blues and reds—the oxyhemoglobin in capillaries and deoxyhemoglobin in veins,” she explains.

Dr. Kapadia also relies on this laser to safely zap eye-area veins. “Luckily, there is a redundancy of veins, so treating those that are cosmetically bothersome doesn’t cause any functional issues,” he says. However, it’s crucial that providers have “a keen knowledge of anatomy,” he stresses, to avoid hitting unintended arteries. Targeted veins usually disappear or become barely visible after two or three treatments, adds Dr. Kapadia, and discomfort and downtime are minimal. Metal eye shields may need to be worn during the procedure—the mere thought of which freaks some people out—but once the eyeballs are numbed (with painless drops), placing and removing the shields is usually a cinch, doctors say.

For lower eyelid hyperpigmentation: chemical peels 

For lower-lid darkness that’s caused by excess melanin, chemical peels are a quick and affordable remedy—and unlike certain lasers, they can be customized to suit the majority of skin types. As a nice bonus, they tend to make the under-eye skin look a little less craggy too.  

In Dr. Khan’s experience, 20% TCA peels work well for lighter skin (Fitzpatrick types I–III). “About two passes of the peel produce great results in most patients, with a small amount of peeling over the days after treatment,” she says. For those with more melanated skin, she prefers milder glycolic acid peels, which can smooth and brighten without the risk of PIH. “Most peels take about five days for the superficial skin to flake and peel away, gradually revealing tighter, glowing new skin,” she adds.

Dr. Zoumalan routinely uses TCA peels to complement surgical outcomes, ratcheting up the potency to 30% in appropriate patients (but only after having them pretreat their skin for about a month beforehand with Skinuva Brite, a pigment-inhibiting formula he developed, to control post-peel PIH). Even when performed separate from surgery, “peels are very tolerable pain-wise—just a bit of a stinging sensation for about 30 seconds—give great results, have a low risk of PIH with my pretreatment regimen, and come with minimal downtime,” Dr. Zoumalan says. 

Most patients see the tone-evening effects of acids within two to three weeks. And since “TCA peels aren’t as aggressive as a CO2 laser, they allow for a more natural transition to the non-treated areas”—which is something he finds that men, especially, seem to appreciate.