Under eye filler is a hyaluronic acid filler placed in the hollow between the lower eyelid and the cheek. Doctors call this groove the “tear trough,” which is why the treatment is also widely known as tear trough filler. At our clinic it is also called “under-eye light filler.”

When this area loses volume with age, or is naturally hollow, a visible line forms between lid and cheek; its shadow makes the under-eyes look darker and more tired. Filler aims to soften this hollow and smooth the lid-cheek transition.

A smoother surface reflects light more evenly, which is why the under-eye area can look brighter afterward. Soft, fine hyaluronic acid fillers suited to the thin skin around the eyes are used. Tear trough filler is usually considered for:

• A visible tear trough: A hollow line between the lower lid and the cheek.
• Shadow-related darkness: Under-eyes that look purple or tired because of the shadow cast by the hollow.
• Structural hollowness: People whose under-eyes have been hollow since a young age.

Whether you are a good candidate depends on whether there are prominent fat bags and how elastic your skin is, which is assessed at your consultation.

Not all under-eye darkness has the same cause, so the source of the problem is identified first.

• Tear trough filler: Suits darkness caused by volume loss and hollowness. The effect is visible right away.
• Under-eye mesotherapy: Suits thin, dry skin, fine lines or pigment-related darkness. It is done as a series of sessions and targets skin quality.

Some people have both problems; in that case, filler and under-eye mesotherapy can be combined in the same plan.

Filler is not suitable when the lower lid has prominent fat bags, lid laxity or advanced loss of elasticity, as it may make these more noticeable. In those cases, cheek filler, dark circles and under-eye bag treatments or laser treatments may be considered instead.

Treatment begins with an examination of the hollow’s depth, any bags and differences between the two sides.

Stopping blood-thinning medicines and supplements such as aspirin, high-dose omega-3 and vitamin E for a few days beforehand, after checking with your doctor, lowers the risk of bruising. Please come without eye makeup on the day.

1. The area is cleansed and numbed to keep discomfort to a minimum.
2. The filler is opened in sterile conditions in front of you.
3. Using a special blunt-tipped cannula, the filler is placed slowly just below the lower eyelid. A cannula helps reduce the risk of damage to vessels and tissue.
4. If the two sides differ, a different amount is used on each side.
5. Symmetry is checked and small adjustments are made if needed.

The procedure takes about 15–20 minutes. The effect starts to show during treatment, and the final look becomes clear once any swelling settles.

The skin around the eyes is very thin and rich in blood vessels. Filler placed too superficially can cause long-lasting puffiness or a bluish tint, so this treatment should be done by a doctor who knows the anatomy of the eye area well.

Mild redness under the eyes is common straight after treatment. It usually fades within 4–5 hours, and you can return to normal life the same day.

For the first few days:

• Avoid eye makeup and touching the area for 24 hours.
• Sleep on your back with your head slightly raised on the first night.
• Skip strenuous exercise, alcohol, saunas and steam rooms for a few days.
• Do not rub your eyes or massage the area.

Although a cannula reduces the risk, mild swelling and small bruises can occur and usually fade within a few days. Rarely, prolonged swelling, unevenness or discoloration may develop; hyaluronic acid filler can then be reversed with filler dissolving, using the enzyme hyaluronidase. If you notice blurred vision, increasing pain or whitening of the skin, contact your doctor immediately.

Tear trough filler is temporary. The body slowly absorbs hyaluronic acid over time, and because the under-eye area moves relatively little, results usually last around 1–1.5 years.

How long it lasts varies from person to person. Metabolism, the product used, skin type, smoking and strong sun exposure can all play a part. Check-ups and small top-ups before the filler has fully dissolved help keep a natural look with less product. The timing of your next treatment is decided at a follow-up visit once the hollow starts to return.

When the filler dissolves, the under-eye area returns to how it looked before; the filler does not leave lasting harm in the area.