(Procedures)

Everything You Need to Know About Undereye Filler Prior To Your Appointment

From how to prep to cost, the pros break it all down.

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One day last winter, I looked in the mirror after a rare week of eight to ten hours of sleep and realized something alarming — although I was deeply well-rested, I looked anything but. And when I tried to isolate the variable that was making me look so much more tired than I felt, the area I eventually identified as the culprit was my undereyes. There was a sunken quality to them that certainly hadn’t been there a year prior, and was subtly but definitively making the entire cast of my face look less bright and alive than it otherwise would. And this, as it turned out, would make me an excellent candidate for undereye filler, otherwise known as tear trough augmentation.

With a naturally full face, I’d never considered myself one to try filler, but it turns out that even those with full cheeks are susceptible to a loss of volume under their eyes. I went down an Internet rabbit hole of undereye filler before and after photos and was amazed by what I found. Undereye filler seemed to achieve the exact quality I felt I was missing, namely a brightened more awake look that mimicked the look of deep rest.

Curious, and feeling a few trepidations about any procedure that involved injections around my eyes, I set out to figure out as much as I could about undereye filler from some of the best dermatologists and plastic surgeons in the business. Here’s what I found out about the procedure before trying undereye filler myself.

Who Is A Good Candidate For Undereye Filler?

“Someone who has lower eyelid volume depletion, meaning they’ve lost a lot of volume, with good skin elasticity and does not have a lot of lower eyelid fat,” says double-board certified oculofacial plastic surgeon Dr. Robert Schwarcz of the prime undereye filler patient. In other words, what I had noticed in my face was the loss of volume where there had once been plenty. This volume loss can often accentuate other problem areas, such as any puffiness under the eyes (which is another common issue in the undereye area, and can be attributed to water retention, lifestyle choices, and genetics). Luckily, that means patients who undergo tear trough augmentation can address two problem areas at once — the volume loss and puffiness.

And don’t think that hollowness can only develop with age. “It can happen at any age, as lots of aging around the eyes is genetic,” says award-winning board-certified plastic surgeon Dr. Lara Devgan. “So you don’t need to be in a certain age category [to explore undereye filler].”

On the flip side, anyone with too much lower eyelid fat isn’t a great candidate, says Dr. Michele Koo, board-certified plastic surgeon, skin care expert, and founder of Private Practice by Dr Koo. “Someone who really has too much excess skin or very large lower eyelid fat protrusion (malar bags, excess lower eyelid fat) below the hollow of the lower eyelids should consider surgery rather than injections to smooth that area.”

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Courtesy of Dr. Lara Devgan
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Courtesy of Dr. Lara Devgan
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What Are The Benefits Of Getting Undereye Filler?

Getting undereye filler means that you will likely look well rested and brightened, or like you’ve just returned from a long vacation.

“Undereye filler can help brighten and lighten the area,” says Dr. Brian Nourian, Co-Founder of Le Jolie Medi Spa in Los Angeles. “You will look less tired and more refreshed. With filler, you build a barrier and the skins appear thicker. Since the skin is very thin in the area, it illuminates the veins [which can make your undereye area] appear darker.”

When I got my own undereye filler (more on that soon) what I found is that I suddenly didn’t need to wear makeup before leaving the house. As someone who has done so almost every day for twenty years, this was a deeply liberating shift. My entire face looked fresh and pulled together in a way it simply hadn’t before with hollows under my eyes.

How To Prepare For An Undereye Filler Appointment

What you’ll want to do to prep for undereye filler is similar to many other injectables. Dr. Schwarcz recommends avoiding blood thinning agents like Ibuprofen, aspirin, vitamin E, and alcohol a few days before the procedure, as blood thinners can increase the risk for bruising in the aftermath of your fillers. (If you’re particularly concerned about potential swelling and bruising, Dr. Nourian recommends taking arnica to reduce the risk.)

Dr. Devgan (who injected my filler), told me to come to my appointment with a fresh face, sans excessive makeup. She also advises patients to come with a clear set of concerns and realistic expectations. “We do medicine,” she told me. “Not magic. Many people come in thinking with a surgical outcome in mind while being restricted to a nonsurgical modality.” So the mental prep is important too: while undereye filler can truly transform your face, the transformation is more of a subtle tweak than a dramatic overhaul.

What Happens When You Get Undereye Filler?

As she does at the beginning of all her appointments, Dr. Devgan started with facial analysis of the area in question — in my case, undereyes — talked about my concerns, looked at my anatomy together, and ran down the benefits, issues, and potential drawbacks with me. We didn’t find any reason why it wouldn’t be a good fit for me, and so we got started on the procedure.

Dr. Devgan applied some topical numbing cream, sterilized the area, then marked and measured the injection sites. I was a bit nervous to go through with the procedure — needles! eyes! — but found that my fears had been unfounded. I could barely feel the injections, and they were over in less than five minutes total for both eyes. “Tear trough filler is surprisingly comfortable,” Dr. Devgan told me. “The area numbs really well.”

Depending on the patient, doctors will use either a cannula to inject or just micro-droplets of filler, which is typically hyaluronic acid-based. According to Dr. Koo, it typically takes one or two syringes to complete the procedure.

When I took the hand mirror Dr. Devgan gave me once we were done, I was amazed at how quickly my entire face had taken on a fresh and rested appearance. The filler would take about three weeks to fully settle and for the effects to become totally apparent (fillers gradually rehydrate over the course of about three weeks) but I felt the results were dramatic right after the appointment. I hadn’t worn makeup to the appointment and suddenly I didn’t really feel the need for it.

What Kind Of Aftercare Should You Practice?

Dr. Koo advises that her patients ice the area and not exercise or elevate their blood pressure for at least 48 hours, as high blood pressure can increase the risk of bruising or swelling. Dr. Schwarcz also tells patients not to rub or put pressure on the lower eyelid region for 48 hours or have a face down massage for two days as rubbing the area can irritate the skin.

And if you are dealing with bruising or swelling or want to head it off at the pass, you can take arnica, Dr. Nourian advises, as well as icing on and off. As for any redness, Dr. Devgan advises that you can simply cover it with makeup and ice as needed. Most bruising and swelling will go down within one to three days, but it may last up to a ten days.

How Long Does Undereye Filler Last?

According to Dr. Devgan, most people maintain undereye filler for six to twelve months, but theoretically it can last last one to two years. How long fillers last can be attributed primarily to an individual’s metabolic constitution and facial expressions. “Fillers gradually diminish over time,” Dr. Devgan says. “And how fast varies according to your metabolic rate and how much you move the tissues in question.”

What Is The Average Cost Of Undereye Filler?

The average cost of undereye fillers ranges from $800-3,000, with variability for the geographic region of the doctor and doctor’s office, along with the number of syringes used. The number of syringes is often determined in part by the depth of the hollowness under a patient’s eyes, with those with deeper hollows requiring more filler.

Are There Any Risks?

As with all fillers, there are potential risks to the procedure. Dr. Koo reminded me that filler could accidentally be injected into a blood vessel causing tissue necrosis — or worst case scenario, blindness. Although serious, such complications are rare, with one of of every 100,000 patients experiencing necrosis, and only 98 reported cases of blindness out of all the millions of undereye fillers ever administered, and Dr. Nourian hedges against such risks by using tools like Accuvein to see where veins and arteries are and have a more comfortable treatment.

The most important note for minimizing severe risks is to go see a board-certified plastic surgeon or doctor with plenty of experience performing the procedure. “Your injector should be proficient in dealing with complications,” Dr. Schwarcz said. “And it is not sufficient that they have someone to refer a patient to at a hospital for any complications like necrosis, but that they can safely manage it themselves since time could be of the essence.” But by and large, undereye filler is safe, with the overwhelming majority of treatments going off without a hitch.