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  • Chris Thiagarajah MD

Filler under the eye: What are the keys to the technique by a Denver Oculoplastic Surgeon



Undereye hollows are an common concern for patients. There are actually two components that can cause undereye hollows. First is bulging of fat from the lower eyelid and the second is the tear trough.

The bulging of the lower eyelid is from fat that is in the eye socket that comes forward with time. It is what causes “eye bags” in many patients

The tear trough is from the descent or dropping of the cheek over time causing a hollow under the eyes.

Patients can have bulging of the lower eyelids or tear trough or both. If the bulging of the lower eyelids is excessive it may be unrealistic to fill the gap with filler. Surgery is something that is needed by removing the fat of the lower eyelid. This is called a blepharoplasty.

The tear trough is something alone that is relatively easy to fill with filler. The fillers I prefer for the tear trough are

  1. Volbella

  2. Beletero

  3. Restylane

All three are good options but in my hands Volbella is the best. It has a syrupy consistency and is able to be laid and sculpted into the lower eyelids in a great way compared to Beletero and Restylane. All are viable options and really vary based on the surgeon preference.

Volbella also has a concentration of 15mg/ml which gives the lowest chance of causing a Tyndall effect which is a blue swelling of the eyelid after filler injection.

Some keys to the technique for injectors are:

1. Inject deep as opposed to superficial

2. Make sure you do not enter the orbit

3. Avoid eyelid vasculature that could cause retrograde flow and vision issues

Watch the video to see technique that is used for the under eye hollows. The procedure takes about 30 minutes (15 minutes to numb and 15 minutes to do it). The recovery is a couple days from swelling and bruising. Our office focuses on the eyelid and facial appearance. As a result we offer the greatest expertise for procedures in that area.


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