Recommend Filler for Tear Trough Without Causing Hollowness?

I have been getting Botox for brow and eye (outer & under portion) for wrinkles and have been very happy with the results.

My treatments last well into 5 months. However, now I have that "hollow" look under my eyes that are also dark looking, but mostly in the corner by the tear glands & under.

I had eyelid surgery in 1996 and it has looked wonderful until the hollow look started. Which is a better filler for me? Juvederm or Evolence?

Doctor Answers 12

Options for filling the tear troughs under eyes

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Both Juvederm and Restylane work well in this area. Evolence is a great product for nasolabial lines, but the eyelid area often requires that the filler go into a deeper layer. I do disagree with the comment that Restylane is superior because it doesn't cause as much swelling; in the immediate term, it has more uncrosslinked HA which would lead to more swelling, though this is not usually a clinically significant issue. Both products create volume by holding on to water.

Fillers for Tear Trough

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This hollowness is often the result of removing too much fat during a lower lid bleph. To correct it I use deep fillers such as Radiesse or Evolence. If it's severe a superficial filler, such as a hyaluronic acid filler, may be needed in a layered fashion.

Of course I'm the "Phat Doc" and love micro fat grafting for a more permanent solution.

Recommend filler for tear trough without causing hollowness?

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Dear Theresa,

I agree with the previous 2 postings by my colleagues.

A hyaluronic acid filler is preferable because of its ease, duration and, if needed, reversibility. At this time Restylane has shown to be superior as it does not retain as much water and cause as much swelling as Juvederm. This does NOT mean that Juvederm is inferior to Restylane EXCEPT that in this location Restylane offers a better fit.

Hope this was helpful.

Peter A Aldea, MD, FACS

Peter A. Aldea, MD
Memphis Plastic Surgeon

Treatment for hollow eyes

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The best injectable for around the eyes is an HA filler such as Juvederm. You need to be very careful with injections around the eye since the skin is so thin and unforgiving. I see several patients every month who come to me after seeing other injectors who left lumps around their eyes. For the HA fillers we do have an injection that will dissolve the lumps in most cases. For other fillers, such as collagen, there is not dissolving agent. Good luck with your injections.

Tear Trough and fillers

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All fillers are used as an off-label, non FDA approved indication in this area. There is only so much of the hollow that can be filled in without gettting to close to the eye. There are risks to this procedure and it might be safer to use the hyaluronic acids such as Juvederm or Restylane so that the product might be dissolved by the use of an injection of hyaluronidase if there is an acute problem.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 38 reviews

Botox and Restylane for tear troughs

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If you are getting Botox under the eye area it is possible that this is making the hollow look worse.  I only use Restylane for tear troughs.  Juvederm takes on too much water and is too tricky in this area.  You might try skipping the undereye area with Botox and see if this helps. 

Janet M. Neigel, MD
Florham Park Oculoplastic Surgeon
4.6 out of 5 stars 21 reviews

Tear trough filler of choice

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I have had good results with both Restylane and Filler, however, my top choice would be Restylane. Restylane tends to swell less in the tear trough area and is more predictable (tends not to migrate).

Good luck.

Bryan K. Chen, MD
San Diego Dermatologist

Neither, Use Restylane for Tear Trough Hollows

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Hi Theresa,

Stick with Restylane for filling of the tear trough hollows as Juvederm sometimes can attract a little too much fluid and result in unwanted puffiness in this delicate and unforgiving area.

Choose your injecting physician most carefully for injections in this area!

Good luck and be well.

Dr. P

Michael A. Persky, MD
Encino Facial Plastic Surgeon
4.8 out of 5 stars 36 reviews

Restylane is your best bet for hollow eyes

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Treating the hollow area under the eyes requires a great deal of skill. However, many patients get excellent results with the correct treatment.

Any filler will add volume under the eyes. The issue is which type of volume enhancement is the best option. In my opinion the best option for under the eyes is Restylane.

Juvederm is any excellent filler. However, in some patients Juvederm tends to swell. This can happen with Restylane as well, but that is much more uncommon.

The big advantage of Restylane (and Juvederm) is that it can easily be dissolved. No matter how skilled the cosmetic surgeon, some patients need a touch up and that is easy to do with Restylane and Juvederm.

Evolence is collagen based. For that reason it can not be dissolved. If there is anything that you don't like about the treatment, you would need to wait for the product to dissolve on its own.

Hope this is helpful.

Marc Cohen, MD
Philadelphia Oculoplastic Surgeon
4.8 out of 5 stars 24 reviews

Filler for the tear trough area

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Juvederm and Restylane have worked well for my patients. I do not have any experience with Evolence. I like Juvederm and Restylane because those can be removed using hyaluronidase. So, if you don't like the look there is recourse. With Evolence I don't think you can reverse it.


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.