What is the best injectable filler for undereye hollows?

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

Hi @Nani! The upper cheek is a major support for the under eyes. I would first begin with addressing the volume loss in the cheeks followed by addressing the tear trough area. I commonly use Juvederm and Restylane. Best of luck to you!

I almost always use Belotero in that area. The reason is that other hyaluronic acid filers (Juvéderm, Restylane, Voluma etc) can leave a blue discoloration when placed close to the skin or underneath thin skin (ex: under eyes). This is called the Tyndall effect and is not desirable. In my experience, Belotero does not cause this blue discoloration. Additionally being a lighter molecular weight filler, Belotero is less likely to leave lumps or bumps under the thin under eye skin.

Hello and thank you for your question. I often treat this area with Restylane, although Juvederm and a few other select fillers also work well in the tear troughs. More important than the specific filler used is the method in which it is delivered. In my practice we use a blunt-tipped cannula, rather than a needle, to treat this area. The cannula tends to minimize bruising after treatment and create the smoothest possible result. Make sure you choose a very experienced, board-certified injector to ensure the best possible outcome.

My preferred filler for the area around the eye is restylane L. This can be used to treat the under and sometimes the upper eye hollow. In expert hands, it is safe and effective. I almost always use blunt cannulas to minimize the chance of intravascular injection. This should only be done by a board certified, experienced injector. 

For my practice I prefer the Restylane products: however most hyaluronic
acid fillers should provide a nice result depending on the injector. Since some fillers may appear through the
skin causing a bluish or bruised look, I would not
recommend Voluma, Restylane Lyft or Radiesse.  Best

It is extremely important to have a proper assessment to determine if in fact the issue is with the hollows, as sometimes the issue is actually the fat that creates the illusion of hollows underneath. However, if the hollows are indeed the issue, they can be filled on certain patients with hyaluronic-acid based injectable fillers. Keep in mind that this is a very delicate and sensitive area that requires great care and a sophisticated injection technique. For this reason, it is a very good idea to ensure that your injector has a wealth of experience.   

Fillers like Belotero, Volbella, and Restylane Silk are good for improving undereye hollows, but keep in mind that a combination approach will give the most improvement. For my patients who prefer to avoid surgery, we can a combination of fillers, lasers, microneedling/PRP and stem cells. I suggest consulting with an expert to develop a treatment plan best suited for you. Best, Dr. Emer

I'm a big fan of Restylane Refyne for the lower eyelids. I find it attracts less water than other fillers so it avoids the dreaded "puffy" lower eyelid you often see with fillers in this area.The foregoing information provided is not intended nor implied to be a substitute for professional medical advice, it is provided for educational purposes only. You assume full responsibility for how you choose to use this information. Always seek the advice of your physician or other qualified healthcare provider before starting any new treatment or discontinuing an existing treatment. Talk with your healthcare provider about any questions you may have regarding a medical condition.

Hello Nani,
Good question! I have been injecting Restylane in the tear trough (under-eye area) for years with great results. Restylane provides a natural result and is often injected using a cannula technique which can decrease the risk of swelling/bruising. It is important you’re treatment is performed by someone with experience in injecting the tear trough, as this is a delicate area of the face. 

Best of Luck!

Dr. Thomas E. Kaniff 

Hi- thanks for your question! Fillers can be an excellent way to manage under-eye and select cases of upper-eye hollowness. I am especially fond of Restylane for this purpose. Make sure you chose an injector that is an expert in the anatomy of this area to ensure a safe and effective treatment.