Restylane for Hollows in Lateral Part of Eye Orbit?

In my personal opinion, Restylane (or other form of hyaluronic acid injectable) in the infra orbital hollows is a procedure searching for an indication. I have literally never seen any results I have been pleased with in my own hands, or in the hands of other surgeons. The best result yields a quasi-allergic infra orbital puffy look, the worst result leads to a bluish discoloration known as the Tyndall effect. The reason for this is that the preorbital and preseptal skin are very thin, and closely associated with muscle, which in turn overlies orbital septum and fat. The margin for elevation is rather small in these areas.
My advice is use caution in considering use of any form of injectable in the periorbital area (including fat). You may want to start with some form of topical agent containing Retin A for skin cell turnover and/or hydroquinone (minimizes pigmentation on a temporary basis)

I do use Restylane under the eyes and I do inject laterally with some success.  If the patient is coming because of dark shadows under the eyes, then I try to help them understand that fillers may soften the shadows somewhat by filling in depressions.  I also explain that skin laxity under the eyes may cause what appears as a concentration of pigmented skin and hence appear darker and hence surgery may be an option.  If there are no hollows to correct and skin is not lax, then I would be recommending a lightening agent such as hydroquinone or Lytera to lighten the region under the eyes.

The photograph reveals dark circles of skin above the muscle in the orbit. This is not a very safe area to inject Restylane or any filler. It is used more safely under muscle when this is above the bony area of the high cheek bone. Dark circles may benefit by laser resurfacing, although there is a risk of darkening (post inflammatory hyperpigmentation), vitamin K creams and in some people, who truly have darker pigment – lightening creams.