Restylane Vs. Livefill for Severe Under Eye Hollows

I have had bad eye hollows since I was a kid. I am now older and I am tired of looking half-dead. I believe most of my dark circles come from the shadowing caused by these hollows. I've look at several options, & am contemplating Livefill (I'd love a more permanent solution than regular fillers) or Restylane. However, I've heard horror stories about Restylane - permanent bags or discolorations or even more extreme indentations. I am not sure what to do. Also, if anyone knows any good plastic surgeons knowledgeable with this kind of treatment, let me know. Thank you.

Doctor Answers 11

Restylane works great for under eyes, but is off-label

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Restylane works nicely off-label for under eye hollows. You should stay away from any long term fillers or implants in this area because of the delicacy of the eye structures. I would look for an oculofacial plastic surgeon to inject these areas as we are specialists that have the most training and experience with this part of the anatomy.

New York Oculoplastic Surgeon
4.7 out of 5 stars 68 reviews

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LiveFill can only be used in subtle fashion or it will appear lumpy. Usually this is best with a short incision cheeklift.

For patients with minor changes of aging, hyaluronic acid fillers with gradually increasing amounts and filler thickness is a better strategy.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 194 reviews

Fillers under the eyes

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Placing fillers such as restylane or juvaderm under the eyes is a very delicate procedure. It can be frought with lumps and bumps. I would not recommend fat grafting in this area, because lumps from this material are extremely difficult to remove.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Restylane Versus Livefil for Lower Eyelid Hollows

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Hi Sots,

Restylane is a great product to use in the lower lid eye hollow area. The lower eyelid area is very delicate and unforgiving, so it is essential that you choose an experienced and skilled physician for these injections.

The main adverse side effect that occurs in my hands is occaisional bruising. You should be off all medications that thin your blood for at least 10 days prior to your treatment, and leave yourself at least one week before any major event just in case there is a bruise. About 90% of my patients do not bruise. I do not use Livefil as we have found Restylane to be best in this area. Restylane can last 1 to 2 years in this area, and sometime longer.

I agree that there are "horror" stories out there, but they are not due to "Restylane", but due to the injector who is putting it in. This area should only be injected by very experienced and well trained cosmetic physicians.

Good luck and be well.

Dr. P


Michael A. Persky, MD
Encino Facial Plastic Surgeon
4.8 out of 5 stars 39 reviews

Fillers for under eyes

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it's always safer to try a temporary filler first to see the result and find out if you like it before you have a permanent filler. There can be risks of lumpiness. I have not seen permanent color changes from temporary fillers.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 39 reviews

Livefill is a proprietary tissue grafting method

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LivefillTM is a fat grating method so it requires surgery. Like other fat grafting methods, approximately 70% of the material ultimately survives. This means that after many months, you will feel like you lost some of the effect of surgery and may feel motivated to have additional treatment to address this loss.

Regrading complications of this method, I will speak generally about fat grafting to the lower eyelid area rather than specifically about LivefillTM. The under eye area is a very unforgiving area for fat grafting. The reason for this is the fat that the eyelid skin is very thin and there is essentially no fat under this skin. As a result, it is challenging to obtain a perfectly smooth result. This may be subtle and very acceptable or not so subtle prompting revisional surgery or the potential need for additional procedures.

In terms of fillers, the hyaluronic acid fillers are preferred. My personal bias is that I believe that Restylane works better in this area than other hyaluronic acid fillers. Restylane treatment lasts well over a year and in some patients it appears to last up to two years. No surgery is needed. The material is placed with a comfortable office service. The material can easily be adjusted in the office with an enzyme if necessary and or augmented with additional filler as needed.

One concern I have with surgical fillers including fat grafting is the creation of scars in tissue planes that should normally glide. Scar tissue does not seem to be stimulated by the hyaluronic acid fillers.

Hope this information helps.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Permanent Fillers Could Mean Permanent Problems

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I like Restylane for the periorbital area because it dissolves with hyaluronidase if needed.  Anything permanent that is injected could cause problems down the road and there is no easy antidote.  Surgery may be required to fix a permanent filler problem.

Debra M. Kroll, MD
New York Oculoplastic Surgeon
5.0 out of 5 stars 9 reviews

Hollow eyes

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Your pictures show hollowness in the lower lid area.

MICRO FAT GRAFTING. Small amounts and small fat cells, injected through a blunt very fine needle is superior.

Resylane also has to be done expertly. Start with restylane if you do not like it, then it can be disolved. If you like it and have confidence in the expertise of the doctor then proceed with fat injection

Samir Shureih, MD
Baltimore Plastic Surgeon

Treatment of under eye hollows

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Your photographs clearly demonstrate an area of soft tissue deficiency in the infra orbital region. I have used filler injections into this area with excellent results. I believe the down side is lack of permanency from this procedure. The other option would be fat injections or dermal-fat grafts (Livefill). Both of these treatments are likely to give you good results. One option would be to get a filler injection to be sure you like the results before having something more permanent such as fat or dermal-fat grafts.

Maurice M. Khosh, MD
New York Facial Plastic Surgeon

Fillers for under eye hollows

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I have used restylane under the eyes for over four years now and have yet to have a problem or complication with it. It has proven itself as the safest filler under the eyes. I have, however, seen patients who have had too much injected. I have also are patients with long term swelling from Juvederm or Radiesse in this area.

In general, I recommend restylane if you need volumes in the range of 1 to 2 cc. In those who need more volume, or when a more permanent result is desired, fat graft is my treatment of choice. You can see results of both on the "spotlight" section on my home page, along with A link to a TV appearance focusing on Restylane under the eyes. I hope this helps.

Behrooz Torkian, MD
Beverly Hills Facial Plastic Surgeon
4.3 out of 5 stars 17 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.