Under-eye filler injections (also referred to as tear trough filler) are increasingly popular for treating concerns like under-eye hollows and dark circles. According to a study published in the Journal of Clinical and Aesthetic Dermatology, tear trough filler can provide noticeable improvement in under-eye hollows in up to 80-90 percent of patients. However, it’s important to note that this treatment also carries risks for a rare side effect called vascular occlusion. We consulted our top eye experts to discuss the benefits and drawbacks of this popular yet risky treatment.
What is under-eye filler?
Under-eye filler, as explained by Woodbury, NY oculoplastic surgeon David Schlessinger, MD, is a dermal filler treatment utilizing hyaluronic acid-based fillers which attract minimal water. “Under-eye filler is the same dermal fillers we use elsewhere on the face. I recommend an HA-based filler that doesn’t attract water, or non-hydrophilic, such as Juvéderm Volbella, Restylane or Belotero,” says Dr. Schlessinger. “These hollows can be genetic or age-related. Because there is a relative loss of volume, there is a depressed area between the lower eyelid and cheek. Adding volume with a dermal filler can even out the area and create a smooth transition between the lower eyelid and cheek.”
Who is a good candidate?
Not everyone is a suitable candidate for under-eye fillers. Dr. Schlessinger advises that individuals with loose skin, real bags, and a propensity for swelling may not achieve the desired results. However, those with good skin quality and hollowness can benefit immensely from this treatment.
“Unfortunately, any aging to the lower eyelid is considered by some to be ‘under-eye hollows,’ which is simply not so,” says Boca Raton, FL plastic surgeon Steven Fagien, MD, who stresses the importance of patient selection. “These treatments cannot be universally applied and requires careful patient selection and of use of the most appropriate product to improve the appearance with minimal risk of short and long-term unwanted effects. Many times, the best and sustainable solution is surgery.”
What to expect during treatment
During the treatment, patients can expect a thorough evaluation, followed by the placement of a numbing agent under the eyelids. The filler will be injected via a syringe or cannula into the areas where more volume is needed. To minimize discomfort, ice is applied throughout the procedure. The entire process takes a mere 10 minutes.
What are the potential risks?
“All dermal fillers run the risk of bruising and swelling,” says Dr. Schlessinger. “Other rare risks include infections or vascular occlusion which can cause skin necrosis and even loss of vision.” Vascular occlusion can occur if the filler inadvertently enters a blood vessel, leading to the vessel’s blockage. Prompt recognition and appropriate management are crucial to minimize the risks associated with vascular occlusion.
“To minimize bruising, avoid aspirin, NSAIDS and blood-thinning supplements for several days prior to the procedure,” adds Dr. Schlessinger. “Show up to the appointment with a clean face to avoid infections. However, the most important step to protect from complications is to choose an experienced physician with an excellent reputation and a meticulous technique.”
What is the Tyndall effect?
The Tyndall effect can occur if the filler is injected too superficially, close to the surface of the skin,” explains Beverly Hills, CA oculoplastic surgeon Raymond Douglas, MD. “When light interacts with the filler material in this area, it scatters in a way that creates a bluish hue, giving the appearance of a discoloration or a blue cast under the skin.” This effect is typically avoided by ensuring proper injection depth and placement to achieve natural-looking results.
Avoiding an over-filled look
New York oculoplastic surgeon Robert Schwarcz, MD says it’s better to start slowly and conservatively. “I’ve been seeing in my practice patients are overfilled, especially around the eyes and upper cheeks,” he says. “Because of this, I have been removing eye filler from my patients. A better option for a more natural-looking result is a blepharoplasty or eyelid lift, which even though is a surgery, can be combined with fat grafting and other modalities for a long-lasting, very natural result.”
How to ensure best results
“Avoid touching or pressure the area,” says Dr. Douglas. “Avoid alcohol and any strenuous activities or exercise for 24-48 hours. If possible, even sleep on your back to let the product rest into the tissue.” Dr. Douglas adds to avoid eye creams, serums or products with retinols, AHAs, BHAs and vitamin C for 24 hours.
How long does under-eye filler last?
Under-eye filler typically lasts for approximately one year or more. Some patients have reported filler in this area lasting more than five years. However, individual results may vary, and maintenance treatments or yearly follow-ups are recommended to sustain the effects of under-eye filler. “Typically, these fillers last for at least a year, with some patients experiencing results that endure for over five years,” says Dr. Schlessinger. “To maintain the effects, yearly follow-up appointments are recommended.”
With proper care and maintenance, under-eye fillers can offer long-lasting results, erasing the signs of aging and rejuvenating your overall look. However, choosing an experienced and skilled injector who specializes in under-eye treatments and understands the anatomical nuances and can minimize risks is the key to a safe, successful treatment.
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