Which Filler is Best for Under Eyes (Tear Trough)?

i had restylane under my eyes and mid section of face to give volume i love it but after reading all the posts i am afraid its not going to last as long. can anyone make a suggestion on other fillers for those areas.


Doctor Answers 53

Least problematic under eye filler thus far overall is Restylane

There are no FDA approved fillers for under the eye. Most fillers only have FDA approval for Naso Labial Folds. At this date there is only one FDA approved filler for lips (Restylane).

Risking long term or permanent fillers under the eye is not worth the potential negative results. Restylane injected properly under the eye typically lasts longer than it does in other areas, so you'll likely see the volume you are enjoying longer than you might think.

Fillers have been used for many years in "off label" application.The "off label" use of fillers is chosen independently by each physician. Off label is not illegal and in most cases not dangerous. It simply means the filler is being used in a way or in an area of the face that was not included in the FDA clinical studies.

Most U.S. physicians who treat under eye hollows with fillers will generally choose Restylane or Juvederm. Both fillers consist of hyaluronic acid gel which is a degradable product most closely resembling natural skin tissue. 

Careful injection of these hyaluronic gels at the proper depths and within the anatomical safety boundaries generally gets good results.The nice "fail safe" of HA gels is that they can be dissolved quite easily if the patient is not happy with the results.

There are fillers which are "contraindicated" in certain areas - meaning they are known to create a problem or are suspected to be capable of creating a problem.

Because the tear trough is such a sensitive area, and the skin is thinnest there, any "lumping" will show. It is also a highly reactionary area and more easily bruises or swells.

Injector techiqiue and precise knowldege of eye area anatomy is extremely important. Pick experience over price promotions - particularly for eye area injections.

It sounds that you are happy with your Restylane. If you were my patient I would encourage you to accept the temporary nature and appreciate the safeguards that come with it.

Los Angeles Dermatologic Surgeon
4.1 out of 5 stars 22 reviews

Only consider two fillers: HA and Fat. All Others Will Age your Face!

The only two fillers you should ever consider at this point are crosslinked HA like Juvederm Ultra Plus or Perlane and autologous fat.  Restylane silk is a newer filler that is less prone to lumps and bumps that is also a good choice.  ALL OTHER LASTING FILLERS HAVE HORRIBLE EFFECTS ON YOUR FACE.  The other long lasting fillers become too firm causing fat atrophy, skin stretch strange textures and FACIAL AGING!!!  Fat is the ideal filler but requires a longer recovery than HA fillers but it lasts if placed appropriately.  I tell my patients with confidence that one year after injection of HA they will still look better than the day of injection.  In rality the results of my "aesthetic Facial Balancing" procedures with HA fillers last several years.
All the best,
Rian A. Maercks M.D.

Rian A. Maercks, MD
Miami Physician
4.9 out of 5 stars 75 reviews

Fillers around the eyes can cause visible lumps

You are very fortunate that you have had good results with Restylane around the eyes into the tear trough. Since you have had good luck with Restylane, stick with it and the doctor who gave you a good result.

Longer lasting fillers are more likely to result in lumps and of course take longer to go away.

I have seen many, many patients who complain of visible lumps especially when fillers are injected into the dark cirlce under the lower eyelid, which is above the tear trough. actaul tear trough injections are less likely to cause this problem

Best under eye filler is Restylane using blunt cannulas..see video

I am now convinced that Restylane is the best dermal filler for treating tear troughs and periocular depressions. It has a long track record of safety around the eye and does not spread around like juvederm does (which is good). It needs to be injected deep (onto the bone). Bruising is now a lot less with a newer technique (blunt microcannulas). There is less swelling, less discomfort, less recovery, and greater satisfaction using blunt cannulas. These have changed the game for treating this area. On top of this, the procedure is much safer with very little to no risk of vascular or visual changes because the cannulas can't enter into the vessels. Steve Weiner, MD, Facial Plastic Surgeon, Destin, Florida.

Steven F. Weiner, MD
Panama City Facial Plastic Surgeon
4.7 out of 5 stars 41 reviews

I would recommend only non permanent fillers. i only use...

i would recommend only non permanent fillers. i only use juvederm in this area.
the skin is paper thin and you will likely bruise.try icing 5 minutes before injection to shrink the blood vessels. some physicians will inject an anesthetic with epinephrine before injecting this area.

these injections are the trickiest injections on the face. make sure you feel confident with your injector for this area in particular. it is a very unforgiving area

Pramit Malhotra, MD
Ann Arbor Plastic Surgeon
4.6 out of 5 stars 87 reviews

Improving the tear trough area

There are several good fillers on the market for improving the tear trough area. Restylane seems to be the easiest to use with the lowest risk of dissatisfied patients. There is usually no bruising or excessive swelling with Restylane use and it typically lasts up to 9 months. On some occasions, other products can leave the skin with a blue hue or excessive swelling.  An Oculoplastic Surgeon will be able to judge the right amount of filler to use without over-filling or causing the skin to be bumpy. I hope you find this helpful.

James R. Gordon, MD, FACS, FAAO
New York Oculoplastic Surgeon
5.0 out of 5 stars 144 reviews

Which filler is best for under eye trough?

In 2014 we have different fillers which are used in this area. The skill of the injector is the most important thing for you to choose. Restylane works well and is probably the most popular filler used in the tear troughs followed by Juvederm and Belotero. All work well in the right hands.

Michael Gold, MD
Nashville Dermatologic Surgeon
4.0 out of 5 stars 18 reviews

Best cosmetic dermal filler for tear troughs

As most of the panel members agreed, Restylane is the product of choice in our practice for the tear trough area. We like the fact that it does not migrate as easily as Juvederm, that it may be resolved with hyaluronidase if needed, comes in 1/2 syringe for those that require less product in this area (which is not uncommon), and is much, much safer than a semi-permanenent or permanent filler.

We recommend that you don't trade safety for longevity as the tear trough area is very unforgiving and requires meticulous technique and the correct dermal filler.

Please refer to the below link for photos and further details for this procedure.

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
4.4 out of 5 stars 7 reviews

Best tear trough filler

Much time has passed since this question was first asked, but I feel obligated to update it for those who are reading many answers as they are researching a particular product or problem.

I think most dermatologists or plastic surgeons with experience with hundreds of patients would agree that Restylane is a very good filler for this area, if placed at the appropriate depth and amount.

Beletero is the new kid on the block, and is wonderful for certain types of dark or depressed circles. It is unique in that it has many different particle sizes, so as you inject each particle advances until it cannot go further easily, and then smaller and the smaller particles continue to fill into the gaps.  This means it spreads out more like spackle than a ball, and gives a very smooth result. For that reason, it is also excellent above the lateral brows to lift and fill in the depressed and furrowed skin, or under the brows to lift the upper eyelid. It seems to swell very little after injection, and never seems lumpy.

I agree that cannulas are great for minimising discomfort and bruising. The blunt tip pushes tissue, vessels and small nerve branches aside rather than nicking them. The technique requires more skill, however!

Sheryl D. Clark, MD
New York Dermatologist
5.0 out of 5 stars 8 reviews

Restylane for tear troughs

Restylane fine line is my preferred product for tear troughs.  In cases where someone has deep set eyes resylane product  is a good choice.   The fine line product which has been available in Canada for a number of years is very smooth forgiving and does not leave lumps.  I inject the majority of the product just superficial to bone. .  

Philip Solomon, MD, FRCS
Toronto Facial Plastic Surgeon
4.3 out of 5 stars 96 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.