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

Question

I see extremely mixed reviews on under eye filler, and doctors/nurses seem to be just as divided on the procedure. It's a 'love it' or 'hate it' procedure, it seems. Who is the right type of candidate for this? Why is it so unpopular with some? How can I avoid changing the appearance of eye shape/size when filling under eyes? Can you damage or stretch the under eye skin by using filler in the troughs? ( i have sunken dark troughs, but no under eye puffiness when face is at rest).

Camille Cash, MD · Answer

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.

Jonathan Kulbersh, MD · Answer

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.

Jason Emer, MD · Answer

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​​​​

Tanya T. Khan, MD · Answer

#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.

George Yang, MD · Answer

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

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

Answers (8)

Answer: Under eye filler

Answer: Under eye filler

Answer: Hollowing limited to the tear trough area, but decent volume above and below.

Answer: Hollowing limited to the tear trough area, but decent volume above and below.

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

Answers (8)

Answer: Under eye filler

Answer: Under eye filler

Answer: Hollowing limited to the tear trough area, but decent volume above and below.

Answer: Hollowing limited to the tear trough area, but decent volume above and below.

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Recommended reading

Everything you need to know about Dermal Fillers

Our mission is to create a world where every investment in modern beauty is Worth It.