Under-Eye Fillers: Side Effects, Costs, & What to Expect

Under-eye fillers can improve the appearance of the area under the eye, lessening dark circles. 

Uses for Under-Eye Fillers

Under-eye fillers are primarily used to plump up the area beneath the eyes, smooth out fine wrinkles, and lessen the appearance of dark under-eye circles.

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Types of Under-Eye Filler (Brands/Products/Ingredients)

The use of eye fillers makes it possible for people to look less tired, as they plump up the area underneath the eye and reduce the look of under-eye shadows. Therefore, people often look younger and more well-rested when they have under-eye filler. The under-eye area is also commonly called the tear trough area.

There is only one under-eye filler that is currently FDA-endorsed. However, they still are used regularly. Only Juvéderm’s Volbella XC filler has FDA approval for use in the under-eye area. This filler is made of hyaluronic acid (HA) and used to fill out the hollows beneath the eyes or smooth the under-eye bags of people who are at least 22 years old.

If you have dark circles, Volbella fills in the tear troughs, provided the area does not have deposits of fat. The filler is also used for under-eye bags, where there is excess fat. The injections can smooth the area from the eyes to the cheeks.

Fillers Containing Hyaluronic Acid

The main ingredient used in many brands of fillers is hyaluronic acid. The body naturally produces hyaluronic acid, but its production dwindles with the aging process. 

HA fillers are created from an artificial gel, which replicates the natural substance. Brand names of HA fillers include Restylane, Juvéderm, and Belotero.

The reason hyaluronic acid works is because it supports the production of collagen, a youth-enhancing substance that plumps up the under-eye area. Some fillers include lidocaine, an anesthetic that numbs the area where a filler is injected.

Patients seeking improvement in the appearance of under-eye dark circles may find a good solution in HA fillers. Circles sometimes emerge because of tear trough deformity (TTD). The fillers, in these cases, restore tear trough volume loss, which reveals itself in sunken and tired eyes.

HA fillers are well-liked as they don’t clump as easily as other products, so they can be smoothed beneath the eyes. While HA fillers do not last as long as other fillers, many doctors believe they provide a more natural appearance.

Poly-L-Lactic Acid Fillers

Poly-L-lactic acid is a synthetic substance that is injected using a process known as linear threading. This type of filler is sold under the brand of Sculptra Aesthetic.

When linear threading is used, a needle is employed to diminish the looks of marionette lines, nasolabial folds, and under-eye wrinkles.

Calcium Hydroxylapatite

Made from calcium and phosphate, calcium hydroxylapatite (CaHA), is an under-eye filler that stimulates collagen production and adds volume. This filler is thicker than hyaluronic acid, and it is usually diluted with an anesthetic before it is injected. 

Some doctors do not use this filler, as it can make the under-eye area appear too white. You can get this filler under the brand Radiesse.

CaHA has a high safety profile and is naturally reabsorbed in the body. Its biodegradability, mechanism of action (MOA), and reabsorption makes it unique to the Radiesse brand. 

An Autologous Fat Transfer

If your tear trough area shows sagging, a doctor may suggest an autologous fat transfer, using the fat from another area of the body to build up the under-eye area. The fat may come from the abdomen, buttocks, hip, or thigh. This is also called periorbital fat grafting.

Possible Side Effects of Under-Eye Fillers

Under-eye fillers may cause side effects, such as swelling, pain or itching, headache, tenderness, or bruising. These side effects usually resolve themselves in 7 to 18 days.

Possible Complications

One of the major complications from HA fillers is hematoma, or bruising. Continual pain and vision changes may result as well as excessive swelling or numbness. Call your doctor immediately if you experience these symptoms.

In addition, ophthalmic artery occlusion (OAC) may occur in some rare instances following an autologous fat injection. One of the most severe complications, visual deterioration, may be irreversible. 

Can an Under-Eye Filler Harm Your Eyes?

An under-eye filler can harm the eyes if it is incorrectly administered. Therefore, you should only have the filler injected by a board-certified plastic surgeon or dermatologist. 

Because the skin beneath the eye is delicate and thin, bruising may be a common occurrence. Though rare, the incorrect administration of an under-eye filler has led to vision loss in some cases.

Preventing Side Effects

The patient should be given a sheet with pre- and post-treatment instructions. Following these instructions will help to prevent and minimize side effects, such as bruising or swelling.

Usual Treatment Costs for Under-Eye Filler

The costs for under-eye fillers can range from $650 to $1,500, according to the American Society of Plastic Surgeons. Fillers are priced by the vial, but many patients require multiple syringes for the under-eye area.

Who Is a Candidate?

You may be a good candidate for under-eye fillers if you meet the following criteria:

• Have mild to moderate under-eye sagging
• Have thicker under-eye skin
• Understand that the results are temporary
• Are in healthy physical condition

Anyone who has excess skin in the tear trough area or has a condition that may lead to complications should avoid fillers. This also holds true if your tear troughs are deep or you have noticeably dark under-eye circles.

The best candidates have tear troughs that feature a good skin tone and reduced excess skin. Usually, it’s best to use fillers, such as Restylane-L, Belotero, and Vollure when a patient meets these criteria.

How Do You Find a Doctor?

To find a qualified doctor, you search for options via the American Academy of Dermatology or the American Board of Cosmetic Surgery.

References

1. Treatment of Dark Circles With the New 15 mg/ml Hyaluronic Acid Filler With Lidocaine. (July–August 2019). Indian Dermatology Online Journal.

2. Putting Injectable Facial Fillers to Their Best Use. (November 2015). Review of Ophthalmology.

3. Calcium Hydroxylapatite: Over a Decade of Clinical Experience. (January 2015). The Journal of Clinical and Aesthetic Dermatology.

4. Ocular Complications Following Autologous Fat Injections into Facial Area: Case Report of a Recovery From Visual Loss After Ophthalmic Artery Occlusion and a Review of the Literature. (February 2017). Aesthetic Plastic Surgery.

5. Understanding How to Prevent and Treat Adverse Events of Fillers and Neuromodulators. (December 2016). International Open Access Journal of the American Society of Plastic Surgeons.

6. Management of Tear Trough with Hyaluronic Acid Fillers: A Clinical-Practice Dual Approach. (May 2021). Clinical, Cosmetic & Investigational Dermatology.