Treating the delicate under-eye area, or tear trough, is one of the most requested and impactful non-surgical aesthetic procedures. As patient demand for a refreshed, less tired appearance grows, mastering this advanced treatment is essential for clinics. This B2B guide offers a detailed clinical overview of using dermal fillers for under-eye correction, covering patient assessment, product selection, and safety protocols to help your practice achieve safe, beautiful, and consistent results.
Key Takeaways for Your Practice
- Primary Cause: Under-eye hollows are caused by age-related volume loss in the upper cheek, creating a shadow or “tear trough deformity,” not by skin discoloration alone.
- Mechanism of Action: Low-viscosity hyaluronic acid (HA) fillers are carefully placed to restore lost volume, lifting the tissue to create a smoother transition between the lower eyelid and the cheek.
- Product Selection is Crucial: The ideal filler for this area has low cohesivity, low G-prime, and minimal water affinity (hydrophilic properties) to prevent puffiness (edema) and the Tyndall effect.
- Advanced Technique Required: This is a high-risk area due to its complex vascularity. A deep injection technique (supraperiosteal) with a microcannula is the industry standard for minimizing risks.
- Patient Candidacy is Key: The best candidates have good skin elasticity and a true tear trough hollow. Patients with poor skin laxity or large under-eye fat pads (festoons) are often not suitable candidates.
Table of Contents
The Anatomy of Under-Eye Hollows
Effective under-eye treatment begins with a correct diagnosis of the cause. What patients perceive as “dark circles” is often a shadow caused by volume loss, not hyperpigmentation.
- Tear Trough Deformity: This is the primary indication for fillers. It is a depression or hollow extending from the inner corner of the eye down and outwards, resulting from the descent of the cheek fat pads and thinning of the overlying skin.
- Volume Depletion: Age-related fat and bone loss in the mid-cheek and orbital rim removes the structural support for the lower eyelid, causing the hollow to appear more prominent.
- Thin Skin: The skin under the eyes is the thinnest on the body, making the underlying vasculature and bone structure more visible and susceptible to shadowing.
Identifying a true tear trough deformity is the first step in determining if a patient is a suitable candidate for dermal filler treatment.
How Dermal Fillers Rejuvenate the Tear Trough
The goal of under-eye filler is not just to fill a line but to carefully restore the smooth contour between the lower eyelid and the cheek.
- Volume Restoration: A small amount of a specific, low-viscosity hyaluronic acid filler is precisely injected deep beneath the muscle, directly onto the orbital bone. This elevates the sunken tissue, effectively “lifting” the hollow from below.
- Light Reflection: By smoothing the depression, the filler eliminates the shadow that creates the appearance of dark circles. This changes how light reflects off the face, resulting in a brighter, more rested look.
This procedure requires a nuanced understanding of facial anatomy to achieve a natural result and avoid overfilling, which can lead to a puffy or unnatural appearance.
Choosing the Right Under-Eye Dermal Filler
Product choice is more critical for the under-eye area than almost any other part of the face. The wrong product can lead to lumps and persistent swelling.
- Low Water Affinity: The ideal filler is not overly hydrophilic (water-attracting). Products with high water affinity can absorb excess fluid after injection, leading to puffiness (malar edema).
- Low Cohesivity and G-Prime: A soft, flexible, and low-viscosity filler is required. It needs to integrate smoothly into the delicate tissue without creating visible lumps or ridges. Products specifically designed for this area, such as Restylane-L, Belotero Balance, or Volbella, are preferred.
- Avoid Thick Fillers: High G-prime, structural fillers used for cheeks or jawlines are entirely unsuitable for the tear trough.
Stocking fillers specifically indicated for the tear trough is essential for any clinic offering this advanced service.
The Under-Eye Filler Treatment Protocol
Safety and precision are paramount when performing under-eye filler injections.
- Candidacy Assessment: The practitioner performs a “snap test” to check skin elasticity and evaluates for the presence of festoons or significant eye bags, which are contraindications.
- Preparation: The area is thoroughly cleansed. While topical anesthetic can be used, the procedure is minimally uncomfortable, especially when using a cannula.
- Injection with a Cannula: A microcannula is the gold standard for safety. A single entry point is made in the cheek, and the blunt-tipped cannula is then threaded into the tear trough. This technique significantly reduces the risk of piercing blood vessels, leading to less bruising and a lower risk of vascular occlusion.
- Conservative Dosing: The filler is injected in tiny, retrograde threads. It is always better to underfill the area and add more in a follow-up appointment than to overfill.
The treatment requires a slow, meticulous approach, with the patient in a reclined but not fully flat position.
Risks, Side Effects, and Patient Management
Patients must be thoroughly counseled on the unique risks associated with this area.
Common side effects include:
- Swelling and bruising, which can last up to two weeks
- Tenderness at the injection site
More serious but rare risks include:
- The Tyndall Effect: If the filler is placed too superficially, it can create a bluish discoloration under the skin. This requires dissolving the filler with hyaluronidase.
- Lumps and Nodules: Can occur if the wrong product is used or if it is not placed correctly.
- Vascular Occlusion: Though rare, especially with a cannula, this is the most serious risk and can lead to tissue damage or blindness if not treated immediately.
Longevity and Dosing Considerations
Under-eye filler results are often long-lasting due to the minimal movement in this area.
| Factor | Typical Range | Notes for Practitioners |
|---|---|---|
| Longevity | 9 to 18 months, sometimes longer | The longevity is highly dependent on the specific HA filler used and the patient’s individual metabolism. |
| Dosage | 0.25 – 0.5 syringes (0.25 – 0.5 mL) per eye | A conservative approach is mandatory. A total of one syringe is often sufficient to treat both eyes. Overcorrection is the most common mistake. |
Conclusion
Under-eye dermal filler treatment is a highly rewarding procedure that can dramatically improve a patient’s appearance and confidence. However, it is an advanced technique that demands a deep understanding of facial anatomy, meticulous patient selection, and the use of appropriate, high-quality products. By stocking specialized tear trough fillers from our dermal fillers catalog and adhering to best practices for safety, your clinic can successfully provide this popular service, solidifying your reputation as a trusted provider of expert aesthetic care.
FAQs
Who is the ideal candidate for under-eye filler?
The best candidates have good skin elasticity, minimal under-eye fat pads, and a distinct hollow or “tear trough deformity.” They should also have realistic expectations, understanding that the goal is improvement, not perfection.
Is it better to use a needle or a cannula for tear trough filler?
A blunt-tipped microcannula is widely considered the gold standard for safety in this area. It significantly reduces the risk of piercing blood vessels, which leads to less bruising and lowers the chance of a rare but serious vascular occlusion.
What is the Tyndall effect and how can it be prevented?
The Tyndall effect is a bluish discoloration that can appear when filler is injected too superficially under the thin under-eye skin. It is prevented by using a low-viscosity, appropriate filler and ensuring deep, supraperiosteal (on the bone) placement.
Can the treatment be reversed if a patient is unhappy with the result?
Yes. One of the primary advantages of using hyaluronic acid fillers is that they can be dissolved with an injection of an enzyme called hyaluronidase. This allows for the correction of lumps, overfilling, or the Tyndall effect.
When can a patient expect to see the final results?
While some improvement is immediate, the final result is typically visible after two to four weeks. This allows any swelling and bruising to fully subside and gives the hydrophilic filler time to integrate with the surrounding tissue.
Why is a conservative “less is more” approach so critical for this area?
The under-eye skin is extremely thin and unforgiving. Overfilling can easily lead to a puffy, unnatural look that is more noticeable than the original hollow. It is always safer to slightly underfill and schedule a follow-up session to add more if necessary.
Can fillers be combined with other treatments for eye rejuvenation?
Yes. Under-eye filler is often combined with neuromodulators (like Botox) to treat crow’s feet, and with energy-based devices or microneedling to improve overall skin texture and quality for a comprehensive periorbital rejuvenation.
What causes lumps after injection, and how are they managed?
Lumps can be caused by product choice, improper placement, or localized swelling. Most resolve on their own within two weeks. If a lump persists, it can typically be managed with gentle massage or, if necessary, partially or fully dissolved with hyaluronidase.
Does the treatment help with true skin discoloration or just volume?
Dermal fillers primarily address volume loss, which reduces the shadow that makes dark circles appear. They do not change the actual pigment of the skin. For true hyperpigmentation, treatments like chemical peels, lasers, or medical-grade skincare are more appropriate.
How painful is the procedure for the patient?
Discomfort is generally minimal. Most practitioners use a topical anesthetic, and many HA fillers designed for this area are pre-mixed with lidocaine. The use of a cannula, with its single entry point, also tends to be more comfortable for the patient than multiple needle injections.
About the Author: Doris Dickson is a specialist writer for Health Supplies Plus, focusing on the aesthetic medicine industry. She diligently researches cosmetic treatments and products to provide clear, concise information relevant to licensed medical professionals. Her work supports Health Supplies Plus’s commitment to being a reliable informational resource and trusted supplier for the aesthetic community.
Disclaimer: The content provided in this article is intended for informational purposes only and is directed towards licensed medical professionals. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment, nor does it constitute an endorsement of any specific product or technique. Practitioners must rely on their own professional judgment, clinical experience, and knowledge of patient needs, and should always consult the full product prescribing information and relevant clinical guidelines before use. Health Supplies Plus does not provide medical advice.