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Rejuvenating the Under-Eye Area

The under-eye area plays a crucial role in facial aesthetics, often being one of the first regions to show signs of aging and fatigue. Patients frequently seek treatments to address common concerns such as dark circles, tear trough deformities, eye bags, puffiness, and fine lines. As cosmetic doctors, understanding the nuances of these indications and the appropriate use of dermal fillers is essential for achieving optimal results.

The delicate skin under the eyes requires precise and careful treatment to rejuvenate and restore a youthful appearance. Leading dermal fillers, particularly those in the Restylane, Juvederm, and Belotero families, offer versatile and effective solutions. Each product within these families is designed to target specific under-eye issues, providing tailored options to meet individual patient needs. In this article, we will explore the different under-eye indications and discuss the most suitable dermal filler treatments.

Understanding Under-Eye Indications

The under-eye area is a delicate and prominent part of the face that can significantly influence overall facial aesthetics. Several common indications affect this region, each requiring a tailored approach to achieve optimal rejuvenation results. Understanding these indications is crucial for selecting the most appropriate treatments and achieving patient satisfaction.

Tear Trough Deformity

Tear trough deformity is characterized by a hollowing or indentation that extends from the inner corner of the eye, often creating a tired or aged appearance. This condition can be caused by a combination of factors including aging, genetics, and volume loss in the midface. As the skin and subcutaneous fat thin with age, the underlying bone structure becomes more prominent, further increasing the hollowed appearance.

Key Features:

  • Hollow or sunken appearance under the eyes.
  • Prominent shadowing that contributes to a tired look.
  • Often associated with midface volume loss.

Dark Circles

Dark circles under the eyes are a common cosmetic concern and can result from several different factors. These include thin skin allowing the underlying vascular structures to show through, hyperpigmentation, and lifestyle factors such as lack of sleep or poor diet. The appearance of dark circles can vary from blueish hues due to vascular visibility to brownish tones from pigmentation.

Key Features:

  • Darkened or discolored skin under the eyes.
  • May appear blue or purple due to visible blood vessels.
  • Can also appear brown or black from pigmentation.

Eye Bags and Puffiness

Eye bags and puffiness refer to swelling or bulging under the eyes, which can be particularly noticeable in the morning or after consuming salty foods. This condition is often due to the herniation of fat from the orbital septum, fluid retention, or a combination of both. Aging can exacerbate these issues as the supportive tissues weaken over time.

Key Features:

  • Swelling or bulging under the eyes.
  • Fluid retention that fluctuates in severity.
  • Fat herniation contributing to a persistent puffy appearance.

Fine Lines and Wrinkles

Fine lines and wrinkles around the eyes, often referred to as crow’s feet, are among the earliest signs of aging. These lines can be caused by repetitive facial expressions, sun exposure, and the natural loss of collagen and elastin in the skin. The thin skin around the eyes is particularly prone to developing these wrinkles, which can give a prematurely aged appearance.

Key Features:

  • Small lines and creases around the eyes.
  • Often more noticeable when smiling or squinting.
  • Caused by a combination of intrinsic aging and external factors.

Treatment Options with Leading Dermal Fillers

Hyaluronic acid fillers are among the most popular choices for under-eye rejuvenation due to their effectiveness and safety profile. Below, we discuss specific products from the Restylane, Juvéderm, and Belotero families that are commonly used for treating various under-eye concerns.

Restylane Family

The Restylane family offers a range of products designed to address different levels of volume loss and skin concerns.

Restylane is a versatile filler that provides subtle volume and smooths fine lines. It is particularly effective for treating tear troughs and mild to moderate volume loss under the eyes. The formulation contains lidocaine, which helps to minimize discomfort during the injection process.

Restylane Lyft offers greater lifting capacity and longer-lasting results compared to Restylane-L. This filler is ideal for deeper volume loss and provides structural support in the mid-face area, which can also improve the appearance of the under-eye region. The thicker consistency of Restylane Lyft makes it suitable for patients needing more substantial correction.

Juvederm Family

The Juvederm family includes a variety of fillers that cater to different aesthetic needs, from subtle enhancements to more pronounced volume restoration.

Juvederm Ultra XC is known for its smooth consistency, which provides a natural look and feel. It is commonly used to treat tear troughs and moderate volume loss under the eyes. The inclusion of lidocaine helps to ensure patient comfort during the procedure. This filler integrates well with the skin, offering seamless results.

Juvederm Volbella XC is specifically designed for subtle volume and smooth texture, making it an excellent choice for addressing fine lines and the delicate under-eye area. Its finer consistency allows for precise application, resulting in a naturally rejuvenated appearance.

Juvederm Voluma XC is formulated with a high lifting capacity and is intended for deep injection. This filler is ideal for patients with significant volume loss in the mid-face region. By restoring volume and providing lift, Juvederm Voluma XC helps to improve the overall contour and support of the under-eye area, offering a more youthful and refreshed look.

Belotero Family

The Belotero family of fillers is known for its ability to integrate smoothly into the skin, providing even and natural-looking results.

Belotero Balance is a popular choice for treating fine lines and superficial wrinkles around the eyes. Its smooth formulation allows for even distribution, which is crucial for achieving a natural appearance in the delicate under-eye area.

Belotero Soft is characterized by its softer gel texture, making it suitable for more superficial injections. This filler is ideal for very fine lines and delicate corrections in the under-eye region, providing subtle yet noticeable improvements.

Belotero Volume offers deeper volumizing effects, making it suitable for addressing significant volume loss and providing structural support. This filler is particularly effective for patients with more pronounced under-eye hollows or depressions.

Each of these fillers from the Restylane, Juvederm, and Belotero families provides unique benefits tailored to different under-eye concerns. By selecting the appropriate product and technique, cosmetic doctors can achieve optimal rejuvenation results for their patients.

Detailed Treatment Approaches

The first step in any under-eye rejuvenation treatment is a thorough assessment and consultation. It is crucial to evaluate the patient’s individual anatomy, concerns, and aesthetic goals. This involves a detailed medical history to rule out any contraindications and to understand any underlying causes of the under-eye concerns. During the consultation, it is essential to set realistic expectations and discuss the potential outcomes of the treatment. Customizing the treatment plan based on the patient’s specific needs is vital for achieving optimal results.

Injection Techniques

There are two primary methods for injecting dermal fillers: using a cannula or a needle. Each method has its benefits and considerations.

The needle technique allows for precise placement of the filler and is often preferred for targeted areas. However, it can be associated with a higher risk of bruising and discomfort.

The cannula technique, on the other hand, involves using a blunt-tipped instrument that can navigate through the tissue with minimal trauma. This method is often chosen for its safety profile, as it reduces the risk of vascular complications and bruising. It also allows for smoother and more even distribution of the filler.

Layering techniques are also critical in achieving natural-looking results. By strategically placing the filler at different depths, practitioners can create a seamless blend with the surrounding tissues. This approach helps in addressing both superficial fine lines and deeper volume loss, providing a comprehensive rejuvenation effect.

Combining Treatments

Combining dermal fillers with other aesthetic modalities can enhance the overall outcome of under-eye rejuvenation. For instance, laser treatments can improve skin texture and tone, while microneedling can stimulate collagen production, further enhancing the results of the fillers.

When combining treatments, it is important to tailor the approach to the individual patient. This might involve scheduling the procedures in a specific sequence to maximize the benefits of each treatment and minimize downtime. For example, performing laser resurfacing before filler injections can allow for a smoother canvas for the filler placement, resulting in more natural and long-lasting results.

Patient Education and Aftercare

Educating patients about realistic expectations and proper aftercare is an integral part of the treatment process. Patients should be informed about the typical side effects such as bruising, swelling, and tenderness, and how to manage them. They should also be advised on what to avoid post-treatment, such as strenuous exercise, alcohol, and excessive sun exposure, to ensure the best possible results.

Follow-up appointments are crucial to monitor the patient’s progress and to address any concerns that may arise. These appointments provide an opportunity to evaluate the results, make any necessary adjustments, and reinforce aftercare instructions.

Managing Complications and Ensuring Safety

The most common side effects associated with dermal filler treatments in the under-eye area include bruising, swelling, and tenderness. These side effects are generally mild and temporary, typically resolving within a few days to a week. To minimize these effects, it is crucial to use proper injection techniques and to follow pre- and post-treatment guidelines. For instance, advising patients to avoid blood-thinning medications and supplements before the procedure can help reduce the risk of bruising. Additionally, applying ice packs immediately after the treatment can help manage swelling and tenderness.

Serious Complications

Although rare, serious complications can occur with dermal filler injections. One of the most concerning complications is vascular occlusion, which can happen if the filler is inadvertently injected into a blood vessel. This can lead to tissue ischemia and necrosis if not promptly addressed. Early signs of vascular occlusion include blanching of the skin, severe pain, and a mottled appearance. Immediate treatment with hyaluronidase to dissolve the filler and restore blood flow is essential. Another potential complication is the formation of granulomas, which are small nodules that can develop weeks or months after the injection. These can be treated with corticosteroid injections or, in some cases, surgical removal. It is crucial to have protocols in place to quickly identify and manage these complications.

Patient Education and Aftercare

Educating patients about realistic expectations and the importance of aftercare is vital for ensuring satisfaction and safety. Patients should be informed about the potential side effects and the expected timeline for their resolution. Providing detailed aftercare instructions, such as avoiding strenuous exercise, excessive heat, and alcohol consumption for the first 24 to 48 hours after the procedure, can help optimize results and reduce the risk of complications. Additionally, it is important to schedule follow-up appointments to monitor the patient’s progress and address any concerns that may arise. Clear communication and thorough aftercare can significantly enhance patient outcomes and satisfaction.


Rejuvenating the under-eye area requires a strategic approach, utilizing dermal fillers like Restylane, Restylane Lyft, Juvederm Ultra XC, Volbella XC, Voluma XC, and Belotero products. These fillers address tear troughs, dark circles, eye bags, and fine lines effectively. A thorough patient assessment, customized treatment plans, and expert injection techniques ensure optimal results. By staying updated with advancements and emphasizing patient education and safety, cosmetic doctors can achieve impressive under-eye rejuvenation outcomes.

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