What is the best tear trough filler for hollowness & dark circles?

Question

I had Juvederm injected in my tear troughs six years ago and it never settled right. It bubbled and made one eye look swollen. I never wanted to dissolve it so I just kept trying different fillers (terrible idea, I know) to camouflage it. I finally decided to have it all dissolved! It looks 1000x better but it is now hollow so I would like to put some filler back. I would love some feedback on what is the best filler for this delicate area. My main concern is the hollowness and dark circles.

Erin Smith, MD · Answer

Lower eyelid filler is technique dependent, with different providers selecting filler to address certain concerns. If targeting the tear trough, I prefer to use Restylane. Discussion with your treating provider and in office examination is recommended.

Shanthala Shivananjappa, MD · Answer

Redensity RHA is a unique and innovative filler that has gained popularity for its effectiveness in treating under eye hollows. This filler is specially formulated to provide a natural and long-lasting solution for the delicate skin under the eyes, which can be difficult to treat with traditional fillers.

I use a micro-cannula technique, which minimizes discomfort and reduces the risk of bruising or swelling. I carefully place the Redensity filler into the hollows below the muscle under the eyes, where it immediately begins to fill in the depressions and create a smoother, more youthful appearance.
One of the key advantages of Redensity RHA which I like, not only fills in under-eye hollows, but it also works to improve the overall quality and texture of the skin. Another benefit of Redensity RHA is that it provides natural-looking results that are tailored to each patient's individual needs. The filler can be customized to achieve the desired level of correction and volume, allowing for a more subtle and natural-looking enhancement.
I believe Redensity RHA is an excellent choice for anyone looking to treat under eye hollows and improve the overall appearance of the delicate skin around the eyes. With its unique formulation and long-lasting results, Redensity RHA is quickly becoming the go-to filler for under eye rejuvenation in my clinic.

Nima Shemirani, MD · Answer

Hi @barbiegirl718. Restylane and Belotero are great fillers for the tear trough area. I recommend seeking treatments from expert injectors who have the skill and experience to precisely inject fillers into treatment areas and avoid risks and complications. Best of luck, Dr. Nima!

Tanya T. Khan, MD · Answer

Hello, Juvederm is probably the worst filler to inject in to the tear trough space. It will attract too much water and cause lots of swelling, which sounds like the experience you had. We use Revanesse Versa because it has a very low hydrophilic character (meaning it absorbs minimal water) and its consistency in production allow for a good tear trough fill that typically lasts about 1 year on average. Please visit an experienced oculoplastic surgeon for best results with your eyelids.

Jason Emer, MD · Answer

For unique cases where a variety of modalities could be used to treat the condition, I would suggest an in person or virtual consultation to develop a custom and effective treatment plan.  It is difficult to precisely define the best option without collecting the same information. I suggest reaching out to an expert for a consultation with surgical and non-surgical methods to get a comprehensive option. Best, Dr. Emer.

John Tang, MD · Answer

I like to use Restylane or Restylane Refyne in this area to help with the hollowness.  The most important thing to have a great result is good injection technique (injecting in the right plane/depth) and when done properly these products look smooth and in many cases the dark circles resolve.  The "injection technique" is learned and perfected by doing countless number of patients and procedures.

Nelson Lee Novick, MD · Answer

I'm sorry you have had this difficulty and suffered for so many years.  Plain Juvederm is a poor choice for the under-eye area as it has a particular tendency to draw water to itself and is thus is well-known to experienced injectors for causing swelling, the kind you describe, especially when injected into the thin, delicate under-eye tissue. So, the problem you had is hardly surprising. Sorry. In answer to which HA filler(s) are best for region, the answer depends upon the underlying cause(s) of the hollows and dark circles. Very often volume deficit in the border region of the upper cheek and the lower lid (a very significant support region for the under-eyes) is responsible for the hollowness. If this is indeed so, then the use of a robust HA volumizing filler in this region to reestablish the necessary support can go a long way to remedying the hollowing (and even to some extent the dark circles). If additional HA filler is needed directly into the infraorbital region, then the use of a low viscosity, malleable, cohesive HA filler, injected with the proper technique may be added to further improve its appearance. You would be wise to make sure that you are consulting with an experienced, board certified cosmetic dermatologist and of course, before agreeing to proceed, make sure to ask to see his/her personal before and after photos.

Richard Ort, MD · Answer

I have used Restylane for years in the tear trough with a very low incidence of problems. I have also used Belotero successfully here. I would avoid Juvederm Ultra in this area because it pulls in too much water. The key in my hands is to use a blunt cannula for tear trough filler. This makes treatment safer and minimizes bruising.
Regards,
Dr. Ort

Leonard Grossman, MD · Answer

There’s absolutely no better way to get rid of the tear trough than with the use of your own fat. If you go to a plastic surgeon like myself, who has a great deal of experience in fat grafting techniques, the results are extremely natural and permanent. I hope this helps and good luck from New York City Plastic Surgery.

What is the best tear trough filler for hollowness & dark circles?

Answers (9)

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