Under Eye Filler (Tear Trough Filler)

In short: Under-eye filler is the treatment of infraorbital hollow (tear trough) depression with low volume hyaluronic acid fillers. Due to the thinnest skin area of ​​the body (0.5 mm), proximity to the infraorbital artery-venous plexus, and dynamic eye movement, this area carries HIGH RISK. Cannula MANDATORY, supraperiosteal (5-7 mm) depth definitive, low-swell product (Volbella, Restylane Vital) preferred, maximum 0.5-0.7 mL/session. Tyndall effect (blue appearance), vascular occlusion (retinal ischemia/blindness), malar mound (sagging) and periocular edema are critical complications. Effect 9-15 months; Hyaluronidase emergency protocol (200-300 U) should be available. Pigmentation-based dark circles are not an indication — fillers are not the solution and increase the risk of permanent pigmentation.

Description

Under-eye filler is an aesthetic injection procedure performed using hyaluronic acid (HA)-based fillers in order to improve the infraorbital hollow (tear trough depression) and volume loss of the lower eye area. Tear trough is a natural anatomical depression formed on the borderline of the orbit and the top of the cheek — infraorbital hollowing is one of the earliest and most obvious signs of volume loss due to aging. Under-eye filler provides a "rested", "refreshed" appearance by filler this depression with minimal and controlled volumes. However, this site carries the HIGHEST RISK of all facial injections — 0.5 mm skin thickness, dynamic eye muscles, proximity to the infraorbital artery-venous plexus, injection depth close to the periosteum, and retinal artery anastomosis (ophthalmic artery) maximize the risks of vascular embolization (blindness) and the Tyndall effect. The modern technique is based on the principle of “less is more” — conservative volume, optimal product selection and cannula-based supraperiosteal depth form the basis of safety.

Tear Trough Anatomy and Differential Diagnosis of Dark Circles

Anatomical Structure — Critical Risk Factors: Tear trough is a natural channel/depression located in the transition zone between the infraorbital rim (bone around the lower eye) and the malar eminence (cheek mound). Anatomy of this region:

• Skin Thickness: The infraorbital area has the thinnest skin thickness in the entire body — an average of 0.5 mm (dermis + epidermis) (comparison: other parts of the face 1-2 mm, hood 3-4 mm). This thin skin makes the Tyndall effect (blue appearance) maximal in case of superficial injection of HA filler.
• Orbicularis Oculi Muscle: The muscle that consists of the palpebral and orbital lobes, closing the eyelids and smiling periodically. This muscle is in constant motion (blinks 10,000-15,000 times per day) — in the dynamic range of motion of the HA filler, the reabsorption rate is high due to the risk of migration and constant mechanical trauma.
• SOOF (Suborbicularis Oculi Fat): Adipocyte pad located on the periosteum, under the orbicularis oculi muscle. Undereye depression is caused by aging-related SOOF atrophy and inferior descent of the malar fat pad. The optimal injection depth is below the SOOF (supraperiosteal preperiosteal) — that is, placing the filler just above the periosteum through the thickness of the SOOF (5-7 mm depth).
• Infraorbital Artery and Venous Plexus: The infraorbital artery (the branch of the maxillary artery originating from the infraorbital foramen) proceeds horizontally just under the infraorbital rim and is located in a plane close to the periosteum. The venous plexus is distributed around the artery in the form of cells. Superficial injection (<2 mm) increases the risk of direct arterial penetration or compression. Embolization may cause retinal ischemia and blindness through retrograde ophthalmic artery anastomosis.
• Dynamic Structure and Movement: The under eye area is in motion when blinking, smiling and emotional expressions. HA filler is subject to the risk of migration and superior advancement (sagging causing malar mound) in this dynamic area.

Differential Diagnosis of Dark Circles — NEGATIVE INDICATION: Dark under-eye color may result from two mechanisms: (1) Volume loss (depression) — deepening of the infraorbital hollow creates a shadow and gives the perception of "darkness" (this is an indication for filler). (2) pigmentation — actual discoloration (this is NOT a filler solution) due to melanin deposition, hemosiderin (remnant from old blood clot), or vascularity (enlarged capillary visibility). Differential diagnosis is critical: Have the patient gently pull the eye line “up” — if the dark circle is caused by the eye going around, it is depression-based (filler indication). When the foot does not stay pressed or the color does not change, pigmentation is the culprit (counter-indication for filler). In case of pigmentation, laser (fractional, 1550 nm erbium), topical depigmentation (vitamin C, kojic acid, niacinamide) or chemical peeling are options — they are NOT fillers and increase the risk of complications.

Indications (Who is Suitable for?)

• Infraorbital Hollow (Tear Trough Depression) — Primary Indication: SOOF atrophy due to aging and the downward descent of the malar fat pad creates depression (hollowing) in the lower eye area. This depression creates a "hollow", "tired", "older" appearance. The filler minimizes this depression, provides a smooth transition and "rests" the eye area.
• Cheek Sagging Compensation — Secondary Indication: Cheek skin laxity and inferior advancement pull the malar region downward, making the tear trough more prominent. Under-eye filler + cheek filler (combo) provides integrated midface rejuvenation (MD-Codes strategy).
• Asymmetry Correction: From birth or after trauma, one eye is more depressed than the other. Selective filler restores symmetry.
• STRATIFICATION OF AGE-RELATED RISK: Young (20-30 years), minimal depression: often no indication (beware of overtreatment risk). Middle age (40-55 years), pronounced hollow: ideal indication. Elderly (65+ years), severe atrophy + skin laxity: combined filler + surgical blepharoplasty should be considered (filler alone may be insufficient).

Contraindications

• Pigmentation-Based Dark Circle (NOT the First Option): Dark circles due to melanin or hemosiderin pigmentation are not improved by fillers — as the skin thickness is not increased and discoloration occurs. Applying fillers can further suppress the pigmented area and worsen the "grey-brown sunken" appearance. Alternative: laser, topical depigmentation. For this patient group, provide consultation rather than filler.
• Active Infection or Ulceration (Herpes Labialis/Attachment): Active infection in the under-eye area, injection should be postponed — wait for the infection to heal.
• Hypersensitivity to HA (Very Rare): Contraindicated in patients with known granuloma or serious reaction after Prior HA injection.
• Unrealistic Expectations / Pigmentation Expectation: If the patient has the expectation that the "dark circle will disappear completely" (not depression-based), clarification from the beginning and proper expectation management is recommended — otherwise, dissatisfaction is natural.
• Pregnancy and Breastfeeding: FDA category C; safety data is insufficient. The preference is to postpone it until after birth.
• Anticoagulant / Antiplatelet Usage: Increases the risk of hematoma — medication interruption (physician approval) or patient consultation regarding hematoma tolerance should be obtained.

Product Selection (Which HA / Biostim?)

Ideal HA Profile for Under-Custody — "Low G-prime, Low Hydrophilic, Low Swell" Triad: The critical risk profile of this region requires very specific product selection:

• Low G-prime (Modulus of Elasticity): Although high hardness (G' > 200 Pa), projection and long effect are preferred, low-medium G' products are preferred (G' 80-150 Pa) due to thin under-eye skin and Tyndall risk. This minimizes the risk of superficial settlement and provides a "soft", "natural" feel.
• Low Hydrophilicity and Swell Capacity: Hydrophilic HA (high water-holding capacity) causes post-injection swelling. Due to under-eye, thin skin and limited space, the risk of "malar mound" (sagging towards the cheek mound) and periocular edema increases. Low-swell formulations are preferred.
• Tyndall Risk Minimization: A skin thickness of 0.5 mm maximizes the risk of Tyndall (blue appearance) in superficial HA deposits. Product selection and supraperiosteal depth minimizes risk.

Recommended Products — Detention Specific:

Comparison of HA products for under-eye filler — G-prime, swell, indication

Product	G-prime (Pa)	Cross-linking	Swell Capacity	Indication	Effect Duration
Juvéderm Volbella XC	8-12	low	Very Low	Tear trough, thin areas, hydration	9-12 months
Restylane Vital (RF touch)	6-8	linear	low	Periocular, fine lines, tear trough hydration	6-9 months
Belotero Balance	15-18	Medium (Cohesive)	medium	Tear trough, dermis integration, natural support	9-12 months
Restylane Lyft/Volyme (AVV)	15-20	high	medium	Volume support, cheek-tear trough integration	12-18 months
Radiesse (CaHA)	70-100	high	Medium-High	Generally contraindicated (high hardness and swell)	12-24 months

Preference Ranking (Evidence + Safety):

1. Volbella XC (Juvéderm): For GOLD STANDARD tear trough. Intensive research, low G-prime, minimal swell, clinical studies have shown Tyndall's risk to be within the safe range. FDA and EMA approved detention indication. Cena: high (~400-600 TL/syringe in Türkiye, 2026).
2. Belotero Balance (Merz): Cohesive technology (integrated placement) provides tissue level integration, Tyndall risk close to Volbella. Advantage: price is affordable (~300-400 TL), compatable with other Merz products such as Radiesse / PLLA. Disadvantage: less literature (compared to Volbella).
3. Restylane Lyft/Volyme: Medium G-prime, slightly harder. Tear trough is not used alone, but in the cheek + tear trough integration strategy (MD-Codes). Some risk of over-correction (swell) for pure tear trough.
4. Radiesse (CaHA), Sculptra (PLLA) — contraindicated: Their hardness and swell capacity are high, and they are risky for the thin area under detention. High risk of side effects (nodules, granuloma) and malar mound. Alternative methods.

Technique and Approach

Injection Plane — CRITICAL DEPTH CONTROL:

• Supraperiosteal-Preperiosteal Depth (5-7 mm): "Sweet spot" — HA is placed just above the periosteum (preperiosteal, supraperiosteal) by penetrating the SOOF thickness. At this depth, the infraorbital artery (2-5 mm below the rim) remains at a safe distance; The risks of both superficial injection (Tyndall) and deep injection (periosteum penetration, retrobulbar hematoma) are minimized. It is controlled by ultrasound or palpation (periosteum contact sensation).
• PROHIBITED: Superficial Injection (<2 mm): HA deposit on the dermis maximizes the Tyndall effect (blue appearance). It is also close to the infraorbital artery (high risk of penetration). ABSOLUTELY AVOID.
• PROHIBITED: Very Deep Injection (>8 mm, Retrobulbar): Periosteum penetration, progression into retrobulbar space, risk of hematoma and retrobulbar pressure increase (blindness, pain, limitation of eye movement). ABSOLUTELY AVOID.

Cannula MANDATORY — Needle AVOID: Rigid 25-27 G needle increases the risk of over-penetration and artery perforation. 25-27 G blunt-tipped cannula (flexible catheter) provides preference, deep placement and safety. The blunt tip of the cannula has the capacity to divert the artery (reduces the risk of perforation).

Aspiration Control Technique: After cannula/needle placement, it is withdrawn and negative pressure is applied for 3-5 seconds — controlling entry into the vein. If blood returns, the cannula is withdrawn and placed in another spot.

Visual Inspection — Blanching or Livedo Reticularis (Symptoms of Embolism): Sudden blanching or blue-purple reticularis at the injection site during or immediately after injection is a sign of vascular occlusion. URGENT hyaluronidase intervention is required (details below).

Dose and Volume

Maximum Volume Recommendations — Conservative Approach: Due to the small area and limited volume capacity, the "less is more" principle strictly applies:

• First session, virgin patient (who has not had fillers before): Total 0.5-0.7 mL, 0.25-0.35 mL TO EACH EYE (bilateral balance). This conservative dose minimizes the risk of Tyndall and over-correction (malar mound). Patients see a "subtle refresh" — not dramatic, but significant improvement.
• Touch-up session (after 3-4 weeks): 30-40% of patients may prefer more volume. In the second session, maintain a maximum additional dose of 0.3 mL per eye, a total of 0.6-1 mL/session.
• EXCEEDING Maximum Per-Session Limit — AVOID FOREVER: 1 mL per eye / 2 mL total is HIGH RISK — malar mound (sagging), edema, over-filled appearance. Türkiye dermatology consensus is 1 mL/session total target.
• Dosage Adjustment According to Product Selection: Volbella (low swell): 0.5-0.7 mL tolerance. Belotero (mid swell): 0.4-0.6 mL. Restylane Lyft (high swell): 0.3-0.5 mL (less).

Procedure Flow (Step by Step)

Pre-consultation and Photo Documentation: Sitting with the patient, depression depth vs pigmentation screening is performed (differential diagnosis of dark circles). Photograph (frontal, 45° oblique) is taken — for post-operative comparison. Expectation management: "malar mound risk", "Tyndall posibility", "effect 9-15 months", "high energy malar may be problematic" topics are explained.

Anesthesia Protocol: Topical prilocaine-lidocaine cream (EMLA) is applied for 20-30 minutes. Or, the pre-blended lidocaine HA product (Volbella + lidocaine) provides local anesthesia 5 minutes before injection. Advanced practitioners may use supratrochlear nerve block (upper inner eye corner innervation) or infraorbital nerve block (provides additional local anesthesia, but is rare in the routine due to additional invasiveness).

Marking and Inspection: The infraorbital rim and depression depth are localized by palpation. Marking (dermatograph pen) — injection points (just below the rim, in the center of the depression) are determined.

Sterilization: Chlorhexidine 0.5% or benzoyl peroxide solution is applied to the application area.

Injection Technique: 25-27 G blunt cannula, make an entry just below the inferior infraorbital rim (cannula entry point on the lateral edge of the depression inferior). The cannula is advanced in the supraperiosteal plane (5-7 mm depth) and controlled with palpatory feedback (periosteum contact, resistant feeling). Slow injection: 0.1-0.2 mL micro-bolus, we store after cannula retraction. Bilateral balance: 0.25-0.35 mL to each eye. Aspiration control: cannula retracted, negative pressure test (3-5 seconds).

Post-injection Massage — CONTROVERSIAL, CONSERVATIVE: In the under-eye area, massage may trigger the risk of vascular occlusion and HA migration (toward the malar mound). Current recommendation: gentle 30-60 seconds massage, for volume homogenization ONLY, THEN massage is PROHIBITED (in the first 48 hours post-op).

Post-injection Guidance: Patient intervention — ice (20 minutes, quar-6 hours, first 24 hours), elevation (head under pillow), non-anti-inflammatory analgesic (paracetamol, ibuprofen minimal), NO massage (risk of venous thrombosis), exercise/high activity should be postponed for 48 hours, opthalmologo immediate consultation if blindness, pain, limitation of eye movement occur.

Results and Duration of Effect

Ideal Result (Aesthetic Outcome): Infraorbital hollow is minimized, smooth transition tear trough → malar prominence is created. Under-eye "darkness" is alleviated when depression is minimized (unless it is a pigmentation-based dark circle). The "rested", "refreshed" look is the goal — not the dramatic "lifted" look.

Effect Duration and Timeline: HA reabsorption is self-type dependent (cross-linking) and region dependent (dynamic eye area, rapid metabolism). Volbella: 9-12 months. Belotero: 9-12 months. Restylane Lyft: 12-15 months. It is recommended that most patients receive annual touch-up sessions — for sustainable results.

Swelling and Bruising Timeline:

Timeline after under-eye filler

time	Clinical Finding	Patient Running View
0-2 hours	Mild swelling, minimal bruising	Natural appearance, swelling is not obvious
2-24 hours	Swelling is maximum (1-2 mm), bruising may begin	"Puffy" look, mismatched feel
1-3 days	Swelling peak, bruising purple-yellow (ecchymosis)	Can be covered with make-up or the use of glasses is recommended
3-7 days	Swelling decreases, bruising begins to fade	Return to normal activities
1-2 weeks	Swelling mostly gone, bruising minimal	The final result becomes clear
2-3 weeks	Swelling completely gone, bruising mostly resolved	Natural appearance, treatment "integrated"
1 month	HA fully settled, final volume stable	Complete satisfaction, "rested" look

CRITICAL COMPLICATIONS — EMERGENCY MANAGEMENT

1. VASCULAR OCCLUSION (Retinal Ischemia / Blindness) — EMERGENCY, INTERVENTION WITHIN 15 MINUTES:

• Clinical Findings: During or immediately after injection (within 5-60 minutes): sudden blanching (whitening), livedo reticularis (blue-violet web), severe pain, eye pain or "loss of vision" (double vision, blurriness, field defect). Retinal artery occlusion begins with peripheral retinal ischemia and can progress to central retinal artery occlusion (complete blindness within hours).
• Pathophysiology: HA injection compresses the infraorbital artery or intravascular HA deposit triggers thromboembolism. Retrograde flow arrest reaches the retinal contacts due to the ophthalmic artery anastomosis and the retinal arteries are occluded.
• EMERGENCY PROTOCOL (15-30 minutes critical window):
  • Hyaluronidase URGENT (200-300 U, dilute solution): Inject into the injection site at 4-6 points with the "flood" technique (HA dissolution, pressure on the vein is reduced). Alternative: cantonium laterale (lateral canthotomy) — surgical fascia release, intraocular decompression (rare, but may be used if all vitalizations have been tried).
  • Immediate ophthalmology consultation (or emergency room reference) with the patient.
  • Massage: Ocular massage (angled, aiming to provide peripheral retinal perfusion) — compression aims to restore ocular perfusion pressure (non-essential, but supportive).
  • Topical vasodilator: Timolol, dorzolamide drops (reduces intraocular pressure).
  • Systemic agents (IV): Aspirin, pentoxifylline, hyperbaric oxygen (if available) — improve retinal perfusion.
  • Monitor: 15, 30, 60 minutes, 24 hours observation. Vision recovery critical — emergency ophthalmology, angiography, SD-OCT, visual field test (damage assessment).

Prognosis: Rapid diagnosis and hyaluronidase intervention provides 50-70% vision recovery. Delay, risk of irreversible blindness. Therefore, physicians performing detention procedures should ALWAYS have the hyaluronidase kit on hand.

2. TYNDALL EFFECT (Blue Appearance):

• Clinical Finding: 24-72 hours after injection, a bluish-purplish color is observed at the injection site. Not palpable mass, just color.
• Mechanism: Superficial injection (<2 mm) induces HA colloid Rayleigh scattering (blue-ray scattering, red absorption).
• Treatment: Hyaluronidase (15-30 U, local "pulse" technique), 80-100% of the blue color disappears within 24-72 hours. Alternative: natural resorption (6-18 months). Massage minimal benefit (<10%).
• Prevention: Supraperiosteal depth (≥5 mm), low-G-prime product, microcannula, visual inspection.

3. MALAR MOUND (Cheek Hump Sagging) / PERIOCULAR EDEMA LONG TERM:

• Clinical Finding: Under-eye filler moves superior-laterally towards malar prominence (migration) due to dynamic movement. Significant elevation of the cheek mound ("malar mound") may create the appearance of inertia. Periocular edema may persist for up to 2-3 weeks (especially when choosing a hydrophilic product).
• Mechanism: Hydrophilic HA (high swell) absorbs water and swells for weeks post-injection. In dynamic eye area movement, HA advances laterally.
• Prevention: Low-swell product (Volbella, Belotero), conservative volume (<0.5 mL per eye), supraperiosteal placement (shallow lateral migration is reduced).
• Treatment (if persistent after week 2-3): Hyaluronidase (30-50 U, partial dissolution to malar region) or observation (natural resorption).

4. NODULE / GRANULOMA:

• Clinical Finding: After several weeks (4-8 weeks), palpable firm nodule (with mass), without edema. Result of granulomatous reaction (chronic inflammation).
• Treatment: Intralesional triamcinolone (5-10 mg/mL, 0.1-0.2 mL), repeat for 2-4 weeks, or hyaluronidase partial dissolution + steroid.

5. INFECTION (Rare, <0.1%): Sterile technique, oral antibiotics, drainage (if necessary), culture.

Healing Process and Downtime

Although under-eye filler downtime is similar to lip filler, the social impact may be higher due to periorbital localization:

• First 24-48 Hours: Swelling and bruising are evident. Participation in social activities (meetings, events) is limited (part can be covered with glasses or make-up).
• 3-7 Days: Swelling decreases and the bruise can be covered with make-up.
• 1-2 Weeks: Normal appearance, return to social activities.
• Activity Guidance: First 48 hours: AVOID high activity/exercise (risk of local vascular embolism), ice application (20 min, every 4-6 hours), elevation, anti-inflammatory (ibuprofen). Massage is strictly PROHIBITED for the first 48 hours (risk of venous occlusion). Post-72 hours: return to normal activities (glasses, observer risk minimal).

Price and Package in Türkiye (2026)

General Range: Under-eye fillers are priced between 15-30K TL/session on average in Türkiye (depending on product price, clinic location, and physician's experience). Not an easy job (high risk), right technique required → pay is high.

• Budget Option (15-20K TL): Single product syringe (0.5-0.7 mL), conservative dosage, basic technique. In startup clinics.
• Middle Segment (20-25K TL): Quality product (Volbella, Belotero), optimal depth control (ultrasound or palpation), post-op follow-up.
• Premium Segment (25-30K TL+): Advanced technology (ultrasound-guided), bilateral balance, advanced practitioners, hyaluronidase kit included, aggressive follow-up.

Package Recommendations: First session + touch-up session after 3-4 weeks, total of 2-3 syringe HA: 40-60K TL (10-15% discount possible on the package). Annual maintenance (repeat after 12 months): 15-25K TL.

Region-Specific Subtleties

MD-Codes Strategy and Custody Integration: Under-eye filler is often performed in integration with cheek filler (MD-Codes A point - malar prominence + under-eye). Solid midface rejuvenation: cheek filler (1-2 mL Voluma/Volux) + under eye filler (0.5 mL Volbella) combination. This is the goal of "liquid facelift" — ordonner-specific contour and volume restoration.

Laterality and Asymmetry Management: The emphasis is on the medial (inner) side of the eye mass (tear trough medial hollowing is most prominent). The lateral (outer) side is already fulled with malar prominence; Excessive lateral injection, risk of lateral canthus distortion.

Blepharoplasty Surgery vs Filler — Decision Criteria: If elderly patients (65+ years) have severe skin laxity and infraorbital hollowing, filler alone is insufficient. The ideal combination of surgical blepharoplasty + lower blepharoplasty (skin lifting, fat repositioning) + under-eye filler (staged procedures — before surgery, filler after 3 months).

Op. Dr. Hamza Gemici Comment

"Under-eye filler is the injection site with the highest risk profile in my 20+ years of practice. The formula to keep this area safe and effective is: (1) CANNULA MANDATORY, needle PROHIBITED - blunt type, risk of vascular penetration is minimized. (2) Supraperiosteal depth control - with ultrasound or palpation, periosteum contact sensation. (3) Low-swell product preferred - Volbella or Belotero, hydrophilicity minimized. (4) Conservative volume." — 0.5 mL/session total, risk of over-correction malar mound. (5) Hyaluronidase kit is always on my head for emergency intervention. I consult patients with the message 'this area is high risk, do not expect dramatic results, but subtle refresh is provided'. If there is a pigmentation-based dark circle, I say clearly: 'filler is not the solution, laser or topical depigmentation is more appropriate'. Precision is the key to under-eye filler success."

Advanced Details of Tear Trough Anatomy

The anatomical complexity of the under-eye area explains why the injection depth requires millimeter-level precision. There is only 5-10 mm thickness between the inner and outer surfaces of the infraorbital rim — it includes the infraorbital artery, venous plexus, periosteum, and SOOF. It is critical that the injection be performed in the supraperiosteal plane to avoid damaging this “anatomical enamel.” The use of ultrasound (15-25 MHz, high-frequency) shows the skin thickness of the area, artery localization and depth reference points; Advanced practitioners prefer ultrasound-guided injection.

Frequently Asked Questions

1. Can dark circles go away with fillers? Answer: If you have dark circles due to volume loss, yes, fillers will improve it. However, if you have dark circles due to pigmentation (melanin or hemosiderin), fillers are NOT the solution — skin thickness will not increase, color will be an issue. Laser or topical depigmentation is recommended. Differential diagnosis is made by detailed examination (skin pressure test).

2. Does it swell? How much can it inflate? Answer: Yes, edema and swelling are normal for 24-72 hours post-injection. The area under the eye may swell by 1-2 mm, sometimes glasses may be required in the first week. However, hydrophilic product selection and conservative volume minimize swelling. A low-swell product like Volbella keeps swelling minimal (1-2 days). It is possible to return to normal activities in the first week (with glasses).

3. Can the blue appearance (Tyndall) appear? Answer: Yes, the risk of superficial injection is high, especially under the eyes due to the thin skin. Supraperiosteal depth and microcannula technique reduce the risk of Tyndall. If Tyndall occurs, hyaluronidase (15-30 U, pulse technique) provides rapid relief (1-2 weeks).

4. Is there a risk of blindness? Answer: Vascular occlusion (retinal ischemia/blindness) is the most serious complication, but RARE (<0.1% if correct technique is applied). Cannula mandatory, depth control, aspiration test, visual inspection (blanching control) and hyaluronidase emergency protocol keeps the risk minimal. Therefore, under-eye filler should be performed by experienced physicians.

5. Surgical blepharoplasty and comparison? Answer: Blepharoplasty (surgical removal of skin + muscle) is a permanent solution to skin laxity and severe hollowing (may last 20+ years, but surgery is invasive). Under-eye filler is a non-invasive option (9-15 months, reversible) if skin laxity is minimal and depression is mild. If elderly patients (65+) have severe dermatochalasis, choose a staged approach: surgery before, filler 3 months later. For young patients, filler alone is sufficient.

6. Can it be applied during pregnancy? Response: FDA category C (insufficient safety data). The preference is to postpone it until after birth. While HA migration after breastfeeding is rare (if the breast is squeezed by the child) during breastfeeding, the third-trimester or postpartum period is safer.

7. Can massage be done? Answer: Massage is PROHIBITED in the first 48 hours — there is a high risk of HA migration and vascular occlusion. After 72 hours, light massage (for edema drainage) is optional. Rough massage afterwards should be avoided (risk of HA displacement, malar mound).

8. Can lenses be worn? Answer: Yes, lenses cannot be worn for 24-48 hours after the injection (discomfort due to swelling). After 3-5 days, when the swelling subsides, the lens can be reinserted. The contact lens should not exert pressure directly on the injection site.

9. Can I wear make-up? Response: 24 hours after injection, AVOID make-up (risk of infection, HA displacement). After 48 hours, light foundation and concealer can be applied. Vigorous rubbing should be avoided.

10. Why is the price high? Answer: Under-eye filler requires high technical precision, need for an experienced physician, hyaluronidase kit (emergency protocol), superior product selection and detailed post-op follow-up. Therefore, the price is high compared to other filler areas (cheek, lip). Safety and quality cannot be achieved at low cost.

11. How successful will the result be? Answer: With correct patient selection and technique, 90%+ patient satisfaction is achieved. Suitable cases with depression-based dark circles see significant improvement. In pigmentation-based cases, expectation management is critical.

12. Can it be reapplied? (Touch-up) Answer: Yes, after 12 months, touch-up can be performed after HA reabsorption. Subsequent sessions are safe (with tactile and technical adaptation). Annual maintenance is in the price range of 15-25K TL.

Related Terms

Terms related to other tear trough and under-eye treatments: cheek-filler, nasolabial-filler, tyndall-effect, vascular-occlusion, filler-migration, hyaluronidase-injection, filler, hyaluronic-acid.

Resources

Last update: April 23, 2026 · Medical editor: Op. Dr. Hamza Gemici