Would You Recommend Dermal Fillers for Under Eye Hollows? (photo)

It's possible your provider may or may not have much experience treating the tear trough area - I would suggest meeting with a well-trained and reputable provider for assessment and your best options - based on what you've posted, you likely would benefit from treatment.

Hollows, dark circles and tear troughs are common problems of the lower lids. It has become standard practice to treat this region with lighter weight fillers, like Juvederm or Restylane, to lift, straighten, and contour this region. Although they have become routine treatments, they are considered off-label uses for approved products.

Occasionally, if fillers are inadvertently placed too superficially, a bluish discoloration related to light scattering (a phenomenon known as the Tyndall effect) can occur, which can actually make the dark circles more prominent. Belotero, a new hyaluronic acid product, has been manufactured to avoid this. However, I have found that the addition of a tiny amount of Radiesse, a whitish-colored filler to the Belotero Balance to be an excellent way of treating tear troughs and hollows and lightening existing dark circles. However, only an experienced, board certified aesthetic dermatology or plastic surgeon injector should attempt to treat this area in this fashion.

     Restylane is a good choice to fill the tear troughs.  Bruising and swelling can be problematic due to the vascularity of the tissue.  Kenneth Hughes, MD Los Angeles, CA

Using fillers to add volume to depressed areas under the eyes is an off-label use for fillers, however, it is a very commonly performed procedure.  The results can be very dramatic.  Care must be taken to use the correct filler.  Thicker filler materials such as Radiesse should be avoided in this area as they may create palpable or even visible lumps or lines.  Hyaluronic fillers such as Restylane are ideal for this area.  The use of blunt-tipped needles may decrease the risk of nicking a blood vessel and creating bruising under the eye.

I have had great success injecting the lower lid hollows with Restylane or Belotero. It is a difficult procedure to master, so I would suggest seeing someone with a great deal of experience with this procedure. There is often bruising from the injections, so don't have it done right before a big event. Because there is very little facial movement in that region, the cosmetic results may last a year or more.

Fillers are an ideal treatment for treating under eye hollows. Not every filler should be injected. I recommend temporary reversible fillers such Belotero and Restylane. If the correct filler is injected in the correct location, it is a very safe and effective treatment. See an oculoplastic specialist or someone else with experience injecting in the eyelids.

My father used to say: "If the butcher tells you the meat is bad, you should listen."  I suspect your dermatologist is telling your that they have had no success in treating the under eye area.  The truth is that the undereye area is a very tricky area to treat.  One really has to know what they are doing to fill this area.  Looking at your under eye hollows, a well done Restylane service will make a huge difference for you.

Use of Restylane in the tear troughs can be beneficial in the right circumstance, but is limited in the amount of volume that can be used and carries a moderate risk of Tyndall effect (bluish appearance under the eyes). At age 20, severe under eye hollows are most likely related to mid-facial hypoplasia and other options exist to correct this problem.  Although you may not be willing to pursue other options (Sculptra, fat grafting, cheek implants, etc.), a consultation would be helpful in giving more information and alternatives.  Restylane, although generally considered the best filler for the tear trough, is not FDA approved for this indication.

Undereye hollows result from loss of volume (fat) and can cause a tired appearance.  Hyaluronic acid fillers are an excellent choice to replace volume under the eyes.  Restylane, Juvederm, and Belotero can all be used (off-label).  Belotero is a newer hyaluronic acid filler that has less of a risk of causing the Tyndall effect, or a bluish discoloration.  Injecting under the eyes is considered an advanced technique.  If too much filler is used, or is placed superficially, it can appear lumpy.  Of note, Radiesse and Sculptra should not be used in this area. 

HA is the best choice for filling the tear troughs.  Usually one syringe or a partial syringe placed properly does a beautiful job lifting the shadow.  Careful attention in this area due to the superficial blood vessels - bruising and swelling are common side effects.