After years of asking dermatologists how to treat my my tired-looking eyes, I realized the most effective option would be undereye filler. That’s because undereye filler, also known as tear-trough filler, would actually level things out and diffuse the dark shadows, something that eye creams, specifically those promising to fix dark circles and puffy undereye bags (which are often hereditary) could not.
Still, I was nervous. Even though I’ve gone under the knife and have no issue getting Botox, the mere thought of a needle that close to my eyeball freaked me out. Would I be able to feel something under my skin each time I touched the area? Could I survive without fainting?
Finding a reputable doctor (and getting tired of smoothing the area in Facetune every time I uploaded a photo) eventually won me over. Although the final results were subtle, they made a noticeable difference that’s already convinced me to go back again when the effects wear off. That said, it’s not an ideal treatment for just anyone, nor is it a job for just any injector. If you’re considering booking your own appointment, here’s what you need to know before you get undereye filler, according to expert injectors.
Understand when undereye filler works—and when it doesn’t.
According to Dara Liotta, MD, a New York double-board-certified plastic surgeon, most people who come to her office for tear-trough filler have the same complaint I did: I always look tired because of the indented shadows under my eyes, no matter how much sleep I get or how much concealer I tap on. Volume loss under your eyes is what filler works best for, says Dr. Liotta, but it can also be used in some cases to treat puffy bags (known as pseudoherniation of orbital fat).
What filler won’t help with is pigmentation. If your dark circles are actually caused by darker pigment in your skin, filler will only accentuate them. Not sure how to tell? Hold a mirror and look up so that bright overhead lighting hits you directly. If the shadow disappears, your dark circle is caused by a hollow. If the color is still there, it’s pigment.
Do your research and see a reputable injector for the job.
As with most cosmetic procedures, it’s important to become informed about the treatment and consult medical professionals. “I cannot emphasize enough the importance of seeing a well-qualified, board-certified physician, or physician’s office, who does this procedure frequently,” Tracy Evans, MD, board-certified dermatologist, Mohs surgeon, and medical director of Pacific Skin and Cosmetic Dermatology in California, tells Glamour, noting that injecting the undereye area has more risks compared with other areas of the face.
“When it comes to your face, don’t price-shop. Do your due diligence in researching your injector,” Renée Moran, DO, double-board-certified anesthesiologist, injector, and owner of Dr. Renée Moran Medical Aesthetics and The Men’s Den, says. “Make sure the injector has a specific background, has done specific trainings, and practices safe injection habits. Some things to look out for are how long they have been injecting, are they keeping up with industry standards and regulations, and whether they are completing continuing education in their field.”
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There are potential risks and side effects.
On that note, all injections come with a risk, and it’s important to know what they are before going in. “Be super certain that you fully understand the risks associated with filler injections around the eyes,” Jaimie DeRosa, MD, double-board-certified facial plastic surgeon at DeRosa Center for Facial Plastic Surgery and Facial Aesthetics in Boston, advises. Common side effects include bruising and swelling, and nodules and bumps under the eye can occur. “Blindness is a rare side effect if the filler enters a blood vessel of the eye and occludes it,” she says, hence the importance of seeing a well-trained injector to decide if you are a good candidate.
What is malar edema?
One of the potential complications from undereye filler is malar edema. According to Dr. Kami Parsa, MD, an oculoplastic surgeon, malar edema can result from hyaluronic acid filler injections blocking lymphatic flow. This can lead to the appearance of swelling or raised mounds around the undereye area. "The ‘job’ of the lymphatic system around the eyes is to remove fluid from the soft tissues—but if the system is blocked, there's poor lymphatic draining, which can cause fluid to collect in the ‘malar’ area of the cheek, located just below the eye socket bone," Dr. Parsa says.
Swelling at the injection site is normal in the weeks after your procedure. If there's still swelling after several weeks, notify your doctor immediately. If you experience malar edema, it's important to work with your doctor for the best treatment option. “Treatment is individualized based on the patient’s lifestyle and history, and geared towards reducing the worsening or recurrence of fluid retention,” says Dr. Parsa. “We may remove old hyaluronic acid fillers with dissolving agents, or utilize radiofrequency technology to promote lymphatic drainage, de-puffing and tightening of the skin.”
Make sure you’re getting hyaluronic acid fillers.
Most doctors use FDA-approved hyaluronic acid dermal filler for the tear trough, especially if it’s a patient’s first time. You should ask during your consultation what they will use. “The only type of filler that should be injected under the eyes is a hyaluronic-acid-based filler. Other types of fillers like poly-l-lactic acid (Sculptra) and calcium hydroxyl-apatite, or Radiesse, should never be injected in the undereye area,” registered cosmetic nurse Kristina Kitsos explains. “Hyaluronic acid is an ideal filler material because it is safe and effective and can be dissolved easily with an enzyme called hyaluronidase.”
Hyaluronic acid is popular for its ability to replicate soft-tissue texture and eliminate fine lines. Most commonly used for lip filler, it is found naturally in your body, so it dissolves gradually over time. “HA binds to water, making it an ideal product for correcting wrinkles and folds, as it binds with the skin’s own water,” explains dermatologist Sheila Farhang, MD. It generally lasts from 6 to 12 months depending on the individual and the product used.
Juvéderm comes from the Allergan Aesthetics family and has a few different variations meant to plump different areas. Juvéderm Volbella XC is the smoothest and thinnest of the family. “It is a really nice filler for very subtle hydration of the lips and is now used to soften undereye circles, which is my favorite area to use,” says Kian Karimi, MD, founder of Rejuva Medical Aesthetics.
Restylane is an HA dermal filler Galderma made to correct a wide range of concerns. It’s the second most popular HA filler on the market and has very similar uses and results to Juvéderm. According the brand, Restylane Eyelight targets the tear trough area and minimizes the appearance of dark undereye shadows.
Undereye filler can last anywhere from 6 to 18 months.
According to Kitsos, undereye filler lasts anywhere from six months to a year, or possibly even longer. “Because the area doesn’t get a lot of movement—unlike, for example, the mouth, which talks and eats and moves quite a bit—it’s one of the areas that holds on to filler the longest,” she explains. “The less movement, the longer it lasts.” But of course, everyone’s body metabolizes filler differently.
Undereye filler is reversible, but that can be a long and painful process.
While hyaluronic fillers can be reversed with hyaluronidase, Moran points out that it can be a painful process that will likely have to be performed over the course of a few sessions.
Having needles around your eyes is just as unsettling as you’d expect.
I love filler, but I really hate the process. It doesn’t hurt that much, but the disorienting popping sound and the sensation of something thick being pushed into deep layers makes me feel faint. The good news is that undereye filler requires thinner molecules than the ones used in your cheeks, so I didn’t feel the heavy pressure I’ve come to associate with the treatment. Pain is minimal and lasts only a few seconds, so the main challenge is just staying calm and reminding your brain that nothing is actually going into your eyeball.
You’ll see a difference right away, and there’s no downtime.
There’s no need to reschedule a date or take the afternoon off from work; you can go about your life as usual the moment you leave the doctor’s office. Dr. Liotta prefers to inject under the eyes with a blunt-tipped cannula (instead of a needle) because it requires only one entry point to reach all the areas beneath the skin. This reduces the risk of bruising, swelling, and vascular complications, but there is always the chance that you’ll have slight swelling or bruising for 48 hours after. I had a purplish dot at the cannula’s entry point—made by a single needle puncture—for about a week, but it was easily hidden with makeup. If you’re worried, avoid drinking alcohol and taking NSAIDs like ibuprofen a couple days before, and ask your doctor to ice your skin before and after.
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There are best practices when it comes to aftercare.
“Once you get your undereye filler, my recommendation is to ice the area immediately after treatment and to avoid anything that can increase blood flow to the area,” Dr. DeRosa tells Glamour. “If you feel small bumps, you can gently massage them as long as your injector did not tell you otherwise.”
As for products, Dr. DeRosa recommends using a quality eye cream in your skin care routine that helps to add hydration and build collagen in the area, as it will enhance the filler results. “If you’re bothered by discoloration or dark circles, then consider using a product that has ingredients such as kojic acid and licorice root that can help to breakdown pigment too.”
It’s normal to need a follow-up appointment for some minor tweaking.
“The undereye is the most common place to need to tweak again,” says Dr. Liotta. “The first time someone gets filler there, I’ll ask them to come back in two weeks so I can look at it.” That might mean adding a few more drops of filler or using a pinch of hyaluronidase to flatten out any minor puffiness.
Filler costs anywhere from $800 to $3,000.
Prices vary from doctor to doctor and by geographical location, but in a major city, it’s safe to assume the procedure will set you back at least a grand. According to Dr. Liotta, people who don’t have very deep hollows can use one syringe of filler split between each eye, whereas those with significant hollowing may need one full syringe on each side. The options she offers at her practice cost between $1,000 to $1,500 per syringe.
Undereye filler isn’t as noticeable as other types are (think lips or cheeks), so I didn’t expect to love it as much as I do. After a single session I barely feel the need to use concealer, and I haven’t touched the blurring tool for several months. I’ve already decided that I’ll be back for more the second it wears off, stress balls and juice box in hand.
