As an oculoplastic surgeon at Park Avenue Oculoplastic Surgeons, my partner Jerry Popham and myself get a lot of requests for tear trough and lower eyelid filler…a lot. We have a lot of patients who come from other practices, medspas and injectors who want their filler dissolved and replaced by us. There are certain pearls that are great for helping patients understand what to look for when getting filler in the tear trough or under the eyelids.

1. Make sure that you don’t need eyelid surgery

First, make sure that you don’t need eyelid surgery. If a patient has puffiness of the lower eyelid that is excessive, there will be so much filler that needs to be added that the patient is going to be overfilled or feel that they needed a lot of product to get a satisfying outcome. At a certain point, there is just too much puffiness of the lower eyelid that cannot be compensated with injecting a filler and surgery is needed to get a good result. If your injector only injects, they will be advocating only what they have…filler which will lead to a suboptimal outcome.

2. Make sure the injector is comfortable and knowledgeable with injecting under the eyes

Tear trough or under eye filler injection has been associated with blindness. It is critically important to have an injector who is facile in the anatomy, complications and treatment of complications of filler to inject under the eyes. This is more than just getting a good result. Make sure your injector has these qualities and experience under the eyes. This doesn’t mean that they have to be an oculoplastic surgeon (it helps in my opinion but not necessary) but they are very experienced and knowledgeable. Hyaluronidase is a medicine that all injectors should have to dissolve filler. If your injector does not have this filler antidote, run. That’s like flying a plane without a parachute. Very critical.

3. Make sure it is the correct filler

There are certain types of filler that are better under the eyes. They are more moldable, flow better and are less likely to cause a Tyndall effect. Tyndall effect is bluish discoloration under the eyes. These products are:

Volbella

Belotero

Prevelle Silk

Restylane

These products tend to be more moldable under the eyes and less likely to absorb water to create puffiness after injection. I would proceed with caution with other products.

4. Make sure the injector injects the product deep

The best results for filler in the tear trough or under the eyes are when the injections are deep. This is critical for a smooth good result. Superficial injections are more prone to swelling.

5. Undercorrect and come back for more if needed

It is always possible to add a second vial of filler. Patients who are getting filler for the first time under the eyes are encouraged to undertreat and then come back if they need more. It is much better than having too much filler than needs to be dissolved. Remember filler tends to expand 25 to 300% after injection so it is something to think about and treat conservatively. Once a certain amount is established it is possible to know how much is needed and treat appropriately at each visit going forward.

6. Give it a few days to see what the results are like

After injection, the tissue and filler will swell from the injection and then relax with time. Icing will improve this as well over the first few days. With any filler, the final results really take about 6-7 days to see after initial swelling occurs. Be patient after you get filler and give it some time to see how things settle down before going for more filler.

I hope this is a good guide for patients seeking under eye filler. If you are interested in coming for a consult to get your eyes done call us at 303 468 8844.