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

I've asked my dermatologist at my last visit if she would recommend it and she felt strongly that I should avoid getting it done. Unfortunately she didn't elaborate. I'd love to hear from both sides of why this may or may not be a smart decision. Is filling hollows an approved use for any of these fillers? I know that its a temporary fix and won't completely solve my under eye issue, but are there any more serious cons? Would keeping up with it for a long period of time have any side effects?

Doctor Answers 14

Under eye hollows and filler

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Hyaluronic acid fillers are a great way to soften the transition between the lower eyelid and the upper cheek. If done properly, this can help patients look more rested. Some consider filler injection in the tear trough an advanced technique, and not every injector is comfortable with this procedure. If too much filler is placed, swelling can occur that takes months to resolve. Thyroid patients are much more at risk for this to occur. If the wrong filler is used, or if it is injected too superficially, nodules or a bluish tint may occur. For these reasons, I would seek an injector that has experience with injecting in this area. If a hyaluronic acid filler (i.e. restylane, belotero) is used, there is an eraser called hyaluronidase. If you are displeased with the results, the filler can always be dissolved.  Anything outside the nasolabial folds or lips is considered off label, but almost all injector place product outside of those areas everyday without issue.

Saint Louis Dermatologic Surgeon

Fillers for undereye hollows

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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. 

Donna Bilu Martin, MD
Aventura Dermatologist

Banishing under eye hollows with Restylane

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Using Restylane to fill and lift the under eye area is one of the more appreciated procedures these days. 

The use of any filler under the eye is not "approved" but then, most all of the common uses for fillers are off-label. (Off label simply means that particular area / use was not included in the FDA study for safety and effectiveness.)

A key consideration is your doctor. Not all physicians are comfortable with injecting under the eye and many choose not to.

You should be certain your doctor does have expertise in this injection technique. As with any filler injection, there is always some level of risk and the eye area does require that the doctor know EXACTLY where and how to inject. The use of micro-cannulas instead of needles makes the placement of the product virtually painless and reduces risks and bruising potential.

On the flip side of the coin, if someone has bags under the eyes, filling beneath them is not a solution. If the filler is accidentally injected into the ruptured fat compartment (which is what causes the bag in the first place), then the entire eye anatomy is "off".


Nissan Pilest, MD
Irvine Dermatologic Surgeon
4.6 out of 5 stars 23 reviews

Restylane and under eye treatment

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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.

Sam Naficy, MD, FACS
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 231 reviews

Hollows ( & Dark Circles & Tear Troughs) Respond Well To A Combination of Belotero Balance & Radiesse

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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.

Nelson Lee Novick, MD
New York Dermatologic Surgeon
4.9 out of 5 stars 33 reviews

Would You Recommend Dermal Fillers for Under Eye Hollows?

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     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

Under eye hollow fillers

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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. 

Cheryl Lee Eberting, MD
Salt Lake City Dermatologist

Fillers for Tear Trough or Under Eye Hollows

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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.

Edwin C. Pound, III, MD
Atlanta Plastic Surgeon
4.6 out of 5 stars 26 reviews

Lower lid fillers

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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.

Theda C. Kontis, MD
Baltimore Facial Plastic Surgeon
5.0 out of 5 stars 42 reviews

Fillers for under eye hollows can be ideal

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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.

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 91 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.