How does restylane/ dermal filler work for treating under eye bags or puffiness in tear trough area?

When there is already a bag/ puffiness under the eyelid in the tear trough area, how does volumizing dermal fillers such as restylane works to reduce the eye bags? By injecting something (ie, fillers) into the bag (or near the baggy area) wouldn't making it even more baggy or puffier?? Any graphical or video explaination?

Doctor Answers 5

Under Eye Bags and Fillers

Thank you for asking one of the most important questions on Real Self to date.  Many of the problems that I see is that patients are injected with fillers when they have "bags" under their eyes and it makes their eyes worse.  Fillers for the under eye area only work well when there is a depression there that needs to be filled for subtle contouring. Please consult a board certified dermatologist who is an expert in this delicate type of facial injection.  Best, Dr. Green

Tear troughs and mid cheek filling...

You are indeed correct- injecting into the fat pad itself would make things worse. The idea of Restylane or fillers such as Juvederm is to soften the tear trough area- this can lighten the line that starts at the inside angle of your eye and goes across. 

Now my favoured technique is two fold, firstly to soften the trough, and secondly to add a tiny bit of volume to the mid cheek, this gives diminishes the transition between the bags and volume loss of the cheeks. 

If fat bags are very obvious, then a surgical method is needed to remove some fat. It really depends on the cause and severity. 


All the best

Dr Davin Lim
Laser and surgical dermatologist
BRISBANE, Australia

Davin Lim, MBBS, FACD
Brisbane Dermatologist
4.7 out of 5 stars 60 reviews

Eye bags....do you always have to go under the knife?

In general, when treating structures around the eyes, it is important to go to an experienced physician/surgeon. Oculofacial plastic surgeons, like myself, specialize in the eyelid and structures around the eyes specifically. Under eye bags are caused by herniation or forward displacement of fat pads that are normally found in the lower eyelid. Three fat pads exist in the lower eyelids and two exits in the upper eyelids.

Dermal fillers can be used to minimize the appearance of eye bags as well as treat hollowness and dark circles. Fillers must be placed in the appropriate location as filler placed superficially or in the wrong location, can cause lumps/bumps, Tyndall effect (bluish hue to skin), or make the eye bags appear worse. Appropriate placement of a dermal filler with an experienced physician can truly change the appearance of the under eye region and give patients a more refreshed and younger look. 

Surgery is also an option to remove the herniated fat pads. This tends to be a more permanent solution, however for patients who are not yet ready for surgery or want a more subtle change, dermal fillers are an excellent option. 

Maryam Nazemzadeh, MD
McLean Oculoplastic Surgeon
5.0 out of 5 stars 2 reviews

Tear trough filler treats the hollows to camouflage the bags

Very good question! Filler is used to treat the hollows around the eyes. When there are subtle bags, it serves to smooth the transition from the lid to the cheek. Patients who have very large lower lid bags (from fat herniation around the eyes) will not benefit from filler and will, indeed, look like they have even larger bags. You need a trained physician to determine if you are a filler or surgical candidate.

Theda C. Kontis, MD
Baltimore Facial Plastic Surgeon
5.0 out of 5 stars 27 reviews

Fillers and lower eyelid bags

Fillers can not treat eyelid bags. Fillers can be used along the lower eyelid tear trough region to camouflage the depression but it will not get rid of the bags. That requires surgery. 

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 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.