What type of patient is a good candidate for under eye filler?

#1, this procedure should ONLY be performed by oculoplastic surgeons. It is our specific surgical anatomy that we are most familiar with, compared to any other provider. This is a difficult question to answer without seeing photos and would require an in person consultation for a reliable recommendation, however, the ideal candidate is someone who does not have a lot of fat prolapse (the fat that protrudes and causes puffiness within the lower eyelids). Additionally, someone who does not have a lot of loose lower eyelid skin. When performed by the appropriately experienced provider for the right patient, it is a wonderful treatment.

Hello and thank you for your question. Good candidates for under-eye fillers are those with hollowing or volume loss under the eyes, have mild to moderate sagging under the eyes, and have good skin thickness and elasticity. But the best way to find out your eligibility for the procedure is by scheduling an in-person consultation with a reputable board-certified facial plastic surgeon, particularly one with extensive experience with injectables and a skilled aesthetic eye for producing natural-looking results. Your surgeon can assess your skin, recommend the best treatment plan, and ensure you achieve the best possible results.

You need medical clearance from your physician prior to undergoing any cosmetic procedure. Fillers like Belotero, Volbella, and Restylane Silk are good for improving under the eyes, but keep in mind that a combination approach will give the most improvement. My patients try to get non-surgical treatments to avoid surgery, so we use fillers, lasers, microneedling/PRP and stem cells. I suggest consulting with an expert to develop a treatment plan best suited for you. Best, Dr. Emer​​​​

Good Question. In general, under eye filler is good for patients who have indented rim around their lower eyelid area. The lower eyelid skin directly under the eyes also looks like it has decent volume, but lacks transitional volume from the lower eyelid to the upper cheek, then I think these patients are good candidates for lower eyelid filler.
If the area between the lower eyelashes and tear trough is also hollow, meaning the whole eyeball, appears to be sinking into the eye socket, then I think these patients are not ideal candidates for any filler or even fat grafting. Any additional volume around the eyes will make the eyes appear even more sunken, because the eyeballs are "actually" sinking in. Filling the transitional area (under eye filler area) may make the cheek appear slightly higher and reduce the dark circle somewhat, but the fact is that the eyeball is actually sinking into the socket. The additional filler may cause the eyeball to be buried and look smaller. If the patient smiles, it may look like the lower eyelid is swallowing the eyeball.
If the injector tries to directly inject the filler in the gap between the eyeball and the eye socket, it may be prone to form eyebags, in addition to the above listed problems.
In summary for the right patient, which is 60-80% of patients, but for the minority it can backfire, and the injector needs to be aware of which patients will have problems and not inject them, as well as explain to them why. Otherwise, they will simply go to another injector who is unaware and end up getting the injections anyway.
Hope the response was helpful. Happy New Year! Best, Dr. Yang

Under eye filler can be very effective to improve contours in this area adding correctly placed volume. There is an art to fillers and you want to be sure to select an injector who is experienced. Look at before/after photos and discuss your goals for treatment. Those with severe under eye bags or pronounced loose skin are better candidates for lower blepharoplasty than for fillers. Your injector will be able to let you know if you are a good candidate after an evaluation.

That's a great question - you're right, some doctors and nurses are adamant about avoiding under eye filler, while others perform under eye filler on a regular basis. It's important to consider the pros and cons of under eyelid filler, but above all, only trust an expert - who is usually an oculoplastic surgeon who has had special training in orbital and eyelid anatomy, filler, and surgery around the eyes.
Filler placed too superficially in the skin can appear lumpy and bumpy as well as take on a blue hue known as the Tyndall effect. The eyelid skin is the thinnest skin on the body, and so placing filler too superficially comes with these types of problems. The type of filler used is also important. A filler that pulls in a lot of water like, for example, Juvederm Voluma, is not meant for under the eyes because it can lead to puffiness. I like Restylane products such as Restylane-L or Restylane silk for under the eyes.
If your injector considers all these factors and has lots of experience, they should not have a problem filling in dark circles under your eyes. Another option is fat transfer plus or minus a lower eyelid blepharoplasty - again, important to visit someone who is aware of filler techniques and all your options.

Hi there,

You should suffer no negative side effects if you see a board certified injector.
Volume loss under the eye brings on hollowness and therefor you are a good candidate.
If done properly it will not change the appearance of your eye shape.
Again, see an expert!
Best of luck!

These are excellent questions. They do, however, require an extended answer, for which I apologize. The simple part is who is a candidate. The answer is anyone with under eye volume deficit, either from a congenital variation in the area or from volume loss from natural aging or weight loss without significant excess skin. The confusion as how to improve the area and why there are so many problems goes back to when we first started using fillers. At first we had collagen fillers followed in 2002 by Restylane and in 2003 Juvederm Ultra. These were mainly used in the nasolabial lines and similar areas. As we got bolder, we started treating the under eye similar to what we had done elsewhere. This worked some of the time and gave us hope, but frequently produced more swelling than it corrected. Since Restylane tended to cause less swelling, we at first assumed it was the filler. However, we eventually learned that it was where we were injecting the filler, superficially above the orbital ligament. This placement obstructs the lymphatics, the fine vessels that drain fluid from the tissues, thus causing abnormal swelling. In 2005, when Radiesse, a heavy filler, became available, I and a number of other injectors began using it deep on the bone or muscle below the ligament, elevating the ligament and the surface tissues erasing the depression. I was told I was "crazy." However, when I switched back to what everyone else was doing, I again got problems, so I resumed using Radiesse. In 2015, Allergen introduced Juvederm Voluma another heavy filler. They had done research on the proper placement and suggested that it be placed deep and below the ligament. This is how those of us using Radiesse were injecting. It corrects the problem and does not obstruct the lymphatics. It is also safer in other ways. In spite of this, since most injectors were injecting a light filler above the ligament superficially because of habit or because that is what they were initially taught, they continued to use that antiquated method. You may ask "why?" It is because even physicians are slow to change. Even today, almost 7 years after Allergen began teaching the proper technique, probably 90% of injectors still use the wrong method. In fact, studies have shown that it usually takes up to 13 years after a discovery for it to be widely adopted. This means you need to educate yourself about the qualifications and methods used of whoever you see for treatment as you sound like an excellent candidate in the right hands.