While we can all appreciate the eye-opening effects of double-shot lattes and brightening highlighters, they can only go so far. If you’ve got deep under-eye hollows (aka tear troughs) that make you look perpetually exhausted, you may be a candidate for treatment with injectable filler. “Under-eye filler has become our top in-office procedure over the past several years, with an increasingly eager patient population looking to correct tired eyes and dark circles,” says Dr. Tanya Khan, a board-certified oculoplastic surgeon in Plano, Texas.
If you’ve started to do your research into under-eye filler, you might have noticed that there are multiple filler brands used for this treatment, which may lead you to believe that they’re all basically the same. Not so—they all feature significantly different benefits and drawbacks. “Patients should care about the products used for their under-eye filler treatment,” says Dr. Robert Schwarcz, a board-certified oculoplastic surgeon in New York City. “The different properties of various fillers can have different effects.” (For example, if you’re treated with a filler that’s too thick, it may be very noticeable.)
While you can absolutely leave the choice of product up to your injector, you should also feel confident in asking questions and giving your opinion. A good provider will want you to be informed about the filler they’re using for your under-eye treatment. “My role is to support a patient’s decision-making with product data, experience, and anatomical knowledge,” explains Dr. Darren Smith, a board-certified plastic surgeon in New York City. “The patient is empowered to use this information to make decisions most aligned with their desired results.”
When it comes to feeling empowered at the doctor’s office, a little pre-reading never hurts. To help guide you ahead of your under-eye filler consultation, we’re breaking down each of the commonly used fillers, potential risks, and other things you should know before pulling the trigger on this treatment—or rather, before your provider pushes the plunger on the syringe.
Restylane-L and Restylane Eyelight
Like the majority of the products on this list, Restylane fillers are made out of hyaluronic acid (HA), which is naturally present in the human body; HA molecules can be stabilized into a gel to be used as filler by “crosslinking” them, which gives them a 3D structure. That doesn’t mean all HA fillers are identical: Some are denser than others—very thick fillers, such as those used to augment cheekbones or the jawline, will not be well suited to the under-eye because of how thin the skin is there and how shallowly the filler must be placed. Further, while all HA attracts water, some fillers are especially hydrophilic, meaning they can more powerfully draw in water.
While Restylane-L and Restylane Eyelight are marketed differently (the former features FDA approval for facial folds; the latter, for under-eye treatment), they’re actually the same product. “Eyelight is simply repackaged Restylane-L in 0.5cc syringes instead of the full 1cc syringe,” says Dr. Khan. Adds Dr. Schwarcz, who served as an investigator in the clinical trials for Restylane Eyelight, “the smaller volume syringes remind the injector that less is more.” This product does not attract too much water, and it’s reasonably thin but dense enough to provide good lift and structure to deeper hollows without being noticeable.
This is Dr. Smith’s and Dr. Schwarcz’s favorite product to use for under-eye filler; the former refers to it as his first choice and the latter has been using it in his patients for 20 years. However, not all patients are the same, and you may do better with one of the other fillers on this list, depending on your goals and your provider’s recommendations.
Belotero Balance
Though it’s actually FDA approved for nasolabial folds, Belotero is a thinner, flexible filler with low hydrophilic properties—which makes it a suitable choice for fine lines in the under-eye area, says Dr. Smith. “I like this product because it can be given a little more superficially and is easier to use for the less experienced injector,” says Dr. Schwarcz. Dr. Khan notes that while it behaves well under the eyes, she tends to favor other products. “In our experience, it can cause more bruising—presumably because it was formulated without lidocaine until recently—and it seems to dissolve more quickly, within six months or so,” she says.
Juvéderm Volbella
Volbella was the first filler to be FDA approved for the treatment of tear troughs; its first indication was for plumping lips and smoothing lipstick lines. It features a thin texture, which makes it suitable for placement under thin skin, like that of the lips and orbital area. It features Juvéderm’s signature Vycross technology, which, simply put, makes the gel smoother and makes it last longer.
RHA 2
The RHA Collection of fillers, which debuted in the United States in 2020, features RHA 2, which is FDA approved for moderate facial wrinkles but can be used under the eyes too. Dr Schwarcz likes it, due to its lightweight formula, which he notes has “a lot of stretch.” “There’s less chance of it forming bumps, and it’s a nice option for layering with another product or to place on the outer corner of the eye or areas where skin is a little thinner,” he says. Because of its thinner nature, it may not be as effective in treating very deep tear troughs. “I use RHA 2 if I am looking for more superficial smoothing rather than volume building,” says Dr. Smith.
Revanesse Versa
This Canadian-born filler may not be as well known as some of the other products and brands on this list, but it’s Dr. Khan’s top pick, due to its low-hydrophilic character. It has a very smooth structure and is easy to build up while maintaining a natural look. Versa also offers fewer side effects: “In head-to-head studies with Restylane-L, it was shown to produce 50% less edema [swelling] than Restylane,” says Dr. Khan. [Note: These studies were not comparing the treatments on the eye area.] She finds it lasts an average of a year in her patients.
Radiesse
Radiesse differs from the aforementioned fillers in that it doesn’t use HA as its primary ingredient, instead featuring calcium hydroxyapatite microspheres. “When injected, Radiesse is absorbed and fibroblasts appear, stimulating the production of collagen in the body, which addresses common patient concerns like wrinkling and fine lines,” explains Dr. Schwarcz. However, none of the experts featured in this story recommend this product for under-eye treatment. In addition to being far stiffer than any of the other fillers here, which results in an unnatural look, Radiesse cannot be dissolved, warns Dr. Smith, which is especially worrying in the event of a life-threatening vascular occlusion.
Transferred fat
Though this is not a filler product, it can serve the same function; Dr. Schwarcz often uses the patient’s own fat to treat eye concerns, on its own or in conjunction with a lower eyelid blepharoplasty. Because fat does not dissolve, it can provide very long-lasting results and is also usually well tolerated. “Moreover, fat grafts have stem cells, and this cell population can improve overlying skin quality, potentially treating pigmentation issues and smoothing fine lines,” adds Dr. Smith. Keep in mind that fat also can’t be dissolved, so fat grafts should be administered only by a skilled practitioner.
What are the risks of under-eye filler?
There are many critical blood vessels around the eye, which is why treating the under-eye is considered one of the most, if not the most, difficult and dangerous filler procedures. The most perilous risk here is the aforementioned vascular occlusion. “This occurs when the filler is injected into an artery and then blocks blood and oxygen delivery to the target tissue, which can lead to skin loss,” says Dr. Smith. “In the under-eye area, this can potentially even cause blindness if the artery involved supplies blood to the retina.” For this reason, it’s critical to use an HA filler in this area—it can be dissolved, in case of an emergency, with hyaluronidase.
Other risks include contour irregularities, which are heightened by using a filler that’s too hydrophilic. “We don’t want ‘plump’ undereyes—we just want to replace the lost volume as seamlessly as possible,” says Dr. Khan. (This is why not all lip fillers are a good choice for under-eye filler.) There’s also the Tyndall effect, a telltale giveaway you’ve gotten filler injected under your eyes. “This is when the clear filler magnifies dark muscle or blood product under a thin or lighter skin and displays a bluish hue,” explains Dr. Schwarcz.
And, while this is not so much a risk, you may just be unsatisfied by your results if you’re not a true candidate. The best candidates for under-eye filler will have dark circles that are caused by deep tear troughs rather than hyperpigmentation and won’t be looking to correct bags, the appearance of which may be exacerbated by filler. If you get filler when you actually need surgery, like a blepharoplasty, your injectable treatment may make it harder for your surgeon to operate later on. It’s for all these reasons that it’s essential to see a highly skilled provider to determine if under-eye filler is right for you.
