Why Didn't The Filler for Under Eye Hollows Do the Job?

I have dark and recessed under eye hallows and went to get restylane to correct the problem. After two weeks of major swelling, I was left with little pools of the product under each eye and still had hollowed out under eye circles! I went to see a plastic surgeon who injected said it may not have been injector error, maybe my anatomy just doesn't support a "filled in" under eye area. The rest of my face looks good for my age (42) but my eyes look old, do I just have to live with it?

Doctor Answers 15

Tear troughs with Restylane

I have found tear troughs to respond well to Restylane, but I always inject deep under the muscle and above the bone. If the product is placed to superficially, pools of product may form without correcting the hollow. If this occurs, the superficial product can be dissolved with hyaluronidase. You don't have to live with it!

While I have not had patients who can't "support" filler in the tear trough, some patients need surgical procedures to correct the problem (blepharoplasty) if their hollows are severe.

Saint Louis Dermatologic Surgeon
5.0 out of 5 stars 6 reviews

Filler can be great for dark circles under the eyes but not always

Filler under the eyes doesn't always work. It depends on your anatomy and the cause for the dark circles. The best candidates are people with small bags, then a dent called a tear trough then a cheek mound. Hll-valley-hill. The valley between the two hills is filler with filler such as Restylane. If you just have hollow eyes, filler may not always do the trick. You can't always treat certain shapes of facial anatomy by adding injection of a gel. Sometimes it may just be a matter of using less or doing it in stages.

Steven J. Pearlman, MD
New York Facial Plastic Surgeon
4.9 out of 5 stars 126 reviews

Why Didn't The Filler for Under Eye Hollows Do the Job?

           Restylane to the tear troughs is probably as good a treatment option as is available. You may need more product placed at a different depth or a different locale to balance the appearance.   You may need some of the material present dissolved prior to proceeding further.  All of this could be determined during the exam. 

Kenneth Hughes, MD Los Angeles, CA

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 496 reviews

Filler for the tear trough

Photos would really be necessary to provide you with the best advice. In general, there are numerous causes for dark circles under the eyes which may include the following:  pigmentation irregularities, sun exposure, visible blood vessels, stress, allergies, atopic dermatitis, pseudoherniation (outpouching) of fat from the eyelid, and heredity, to name a few.  Fat can cause the appearance of dark circles, which can be corrected by fat repositioning blepharoplasty.  As individuals age, skin tends to thin and the normal fat pads in the eyelids herniate from their normal positions and become more prominent.  This prominence can appear as bags under the eyes, and the shadow they cast appear as dark circles, while the thinner skin causes blood vessels to be more noticeable, contributing further to the dark hue.  Some pigment can be treated with laser and/or bleaching creams.  However, if it is too deep the treatment will not be effective.  In general, Restylane injections for the tear trough require an experienced professional. If you are not happy with the way the Restylane looks, it can be dissolved with the enzyme hyaluronidase. I would recommend communicating your concerns to your physician, as they will be able to help you determine the next step. Thank you, and I hope this helps.

Paul S. Nassif, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 47 reviews

Restyane in the hollows under the eyes

Pictures before and after would have helped but the technique for injecting these products is also key to achieving a cosmetically appealing outcome and they must be injected under the muscle to minimize lumpiness bumps or discoloration.

Hratch Karamanoukian, MD, FACS
Buffalo Phlebologist
4.8 out of 5 stars 41 reviews

Hollow eyes and Restylane

Restylane works great in mild hollowness of lower eyelids only in the 'Tear Trough' areas. If you have large fat bulges or have hollowness more on the sides away from the nose, then the result is not as great. In those cases Blepharoplasty is the only good solution.


Dr J

Disclaimer: This answer is not intended to give a medical opinion and does not substitute for medical advice. The information presented in this posting is for patients’ education only. As always, I encourage you to see your personal physician for further evaluation of your individual case.

Tanveer Janjua, MD
Bedminster Facial Plastic Surgeon
5.0 out of 5 stars 105 reviews

Dark circles under eyes

Dark circles are often related to the thin skin. Many times the dark circles are related to the underlying muscle.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Filler under the eyes

If you would post pictures, we would all be able to provide you better thoughts. However, generally speaking, facial fillers, particularly under the eyes!, is an art. If the patient doesn't have the right facial anatomy, the filler won't look good. Additionally, if the filler is placed too high or too low, it will also not look good.

F. Victor Rueckl, MD
Las Vegas Dermatologist
4.6 out of 5 stars 17 reviews

Restylane and under eye treatment

Without first viewing photo's or seeing you in person, it is very difficult to answer your question. You should consider posting photo's and providing more info for better review.

Sam Naficy, MD, FACS
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 221 reviews

Restylane for Under Eyes

Hi Toluca.  We'd be happy to give our opinion, but you would need to post photos before and after the procedure to give you a better idea.  The "pools" of product you mention does not sound right.  If your injector were to inject under the muscle, which is the most widely accepted way to inject for this procedure, you should not wind up with pools of product.  That's not to say that you wouldn't be disappointed with your results, but pools of product sounds like a superficial injection and that you should find someone that injects under the muscle.  Good luck.

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
4.4 out of 5 stars 7 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.