Key points
- Filler works well for under-eyes with a hollow or shadow caused by structure. For pigmentation, under-eye fat bags and under-eye fluid swelling, filler usually helps little or makes things worse.
- Good candidates have a mild to moderate tear trough, skin that is not very thin, and no laxity of the lower-eyelid skin. If the fat bags protrude clearly or the skin is very lax, surgical fat repositioning usually gives a better result.
- A review of 2,048 patients found satisfaction of about 85–90%, but common side effects were swelling in 24% and a bluish tint under the skin (Tyndall effect) in about 5.6%.
- Many people need support from the upper cheek first, so the under-eye looks less hollow without much filler placed in the tear trough itself.
1. Five under-eye types that look alike
Most people lump them together as “dark circles” or “hollow eyes”, but medically there are several types, and each is treated differently.4
| Type | What you see | Does filler help? | Usually a better option |
|---|---|---|---|
| Structural hollow / shadow | A deep groove between the lower eyelid and the cheek, casting a clear shadow under overhead light | Helps well | Soft filler in a deep layer, or support from the cheek |
| Under-eye fat bags | A bulge under the eye, making the area below it look like a groove | Limited help | Surgical fat repositioning or removal3 |
| Pigmentation | Brown colour under the eye that does not fade when the skin is stretched | Barely helps | Creams, laser and skincare4 |
| Vascular darkness / thin skin | Purple or bluish colour under the eye that becomes more visible when the skin is stretched | Partly helps, but risks a bluish tint under the skin | Assess skin thickness first; inject in a deep layer only |
| Under-eye / upper-cheek fluid swelling | Puffy bags on the upper cheek, often worse in the morning | Often makes it worse | Find the cause of the swelling first5 |
Many people have more than one type at once, for example both a hollow and pigmentation. Filler addresses the hollow; the colour needs to be treated separately.
2. A simple self-check
These checks only give a rough idea. They are not a diagnosis, and a doctor still needs to examine you in person.
- Gently stretch the under-eye skin: if the darkness fades, it is usually a structural shadow; if brown colour remains, it is usually pigment; if purple becomes more obvious, it is usually thin skin and blood vessels.4
- Look upwards: if the bulge under the eye becomes more prominent, it may be a fat bag.
- Notice the timing: if it is very puffy on waking and settles by the evening, fluid swelling is more likely than a hollow.
- Look under different lighting: a structural hollow is most obvious under overhead light and less visible when light comes from the front.
3. Who suits under-eye filler
A review comparing filler with surgical fat repositioning concluded that filler suits a mild to moderate tear trough, and younger patients who prefer a non-surgical option.3 A 2021 clinical-practice guideline adds that patients whose under-eye skin snaps back well when gently pulled and released, and who have no prominent fat bags, respond most favourably.1
- The tear trough shows as a shadow, without a clearly bulging fat bag
- The under-eye skin is not very thin and not lax
- No recurring under-eye puffiness
- You understand that results last a limited time and small top-ups may be needed over time
4. Who should not have it, or should choose another option
- Prominent under-eye fat bags: filler has limited effect, and surgical fat repositioning is usually the better choice, especially for a severe tear trough or excess skin.3
- Existing swelling under the eye or on the upper cheek: under-eye filler may make the swelling worse, because gel placed too superficially can obstruct lymphatic drainage.5
- Very thin under-eye skin: there is a risk of the gel showing as a bluish tint or a lump. Reviews advise avoiding it or taking particular care.2
- Mainly pigment-related darkness: filler does not change skin colour.24
- Very lax skin: filler alone is usually not enough, and the review found that older patients tend to be less satisfied.2
Saying “this isn't right for you” is part of good treatment. The 2021 guideline describes the tear trough as one of the most difficult areas to treat with filler.1
5. Numbers from the research
A systematic review in Facial Plastic Surgery in 2022 pooled 23 studies covering 2,048 patients, with a mean age of 46.2
| Outcome | Finding |
|---|---|
| Satisfaction | 85–90% |
| Mean duration of HA filler | 10.8 months |
| Mean volume used | 0.47 ml per side |
| Swelling | 24% |
| Bruising | 19% |
| Contour irregularity | 7.6% |
| Bluish tint under the skin (Tyndall) | 5.6% |
| Needed hyaluronidase to correct | 5.2% |
The volumes used are very small, less than half a cc per side, yet the side-effect figures show how much technique and patient selection matter. Under-eye swelling can also appear late, even long after treatment. Read more in Filler lasts longer than you think.
6. Many people need to start at the cheek, not under the eye
Many tear troughs result from volume loss in the upper cheek, which makes the lower rim of the eye socket more visible. The 2021 guideline therefore describes two approaches: injecting the tear trough directly, or first restoring support from the cheek and then refining the details.1
The authors caution that filling the tear trough superficially without deep support can make the under-eye look unnaturally puffy.1 This is consistent with the principle of layered injection. Read more in our article on the 5 layers of facial anatomy.
How we assess under-eyes at Vinfinity
- Identify the under-eye type first: hollow, fat bag, skin colour or fluid swelling, viewed from the front, from the side and while looking upwards.
- Assess skin thickness and laxity to decide whether to inject the tear trough, start at the cheek, or not inject at all.
- If it isn't suitable, we'll tell you plainly and recommend a better-suited option, including a referral when surgery is the better route.
- If it is suitable, we use a soft, low-swelling gel in a small volume, placed in a deep layer, and review the result at about 2 weeks.
See real cases and details on our Tear Trough Filler in Udon Thani page, or send your photos on LINE and type “Face analysis” for the doctor to read your face layer by layer.
References
- Urdiales-Gálvez F, Farollch-Prats L. Management of Tear Trough with Hyaluronic Acid Fillers: A Clinical-Practice Dual Approach. Clinical, Cosmetic and Investigational Dermatology. 2021;14:467–483. doi:10.2147/CCID.S301117
- Trinh LN, Grond SE, Gupta A. Dermal Fillers for Tear Trough Rejuvenation: A Systematic Review. Facial Plastic Surgery. 2022. doi:10.1055/s-0041-1731348
- Christodoulou S, Tzamalis A, Tsinopoulos I, Ziakas N. Surgical and Non-Surgical Approach for Tear Trough Correction: Fat Repositioning Versus Hyaluronic Acid Fillers. Journal of Personalized Medicine. 2024;14(11):1096. doi:10.3390/jpm14111096
- Sarkar R, Ranjan R, Garg S, et al. Periorbital Hyperpigmentation: A Comprehensive Review. Journal of Clinical and Aesthetic Dermatology. 2016;9(1):49–55. jcadonline.com
- Mehta P, Li J, Zhang-Nunes S. Non-ischemic complications of dermal fillers. Plastic and Aesthetic Research. 2023;10:41. doi:10.20517/2347-9264.2022.28
This article is for general education and is not personal medical advice. Results vary from person to person. Always consult a doctor before deciding on any treatment.