Many of you have asked me whether you should get filler injections to reduce undereye bags and dark circles. The answer: It depends on your skin and your anatomy. It’s not an easy area to treat, so the improvement may not be as dramatic as the smile crease or marionette lines. While filler can soften deep undereye hollows and camouflage dark circles, if not done properly it may worsen undereye bags or look lumpy. The ideal patient for this treatment has relatively firm skin, little crepiness, and mild undereye bags. I perform these injections in selected patients who don’t need a large amount; oftentimes, I refer to ophthalmic plastic surgeons.
Why is this area so tricky to treat? First of all, eyelid skin is very thin, so any filler may be visible. To reduce this risk, it should be injected slowly and carefully, and may need to be done over a few sessions. I only use hyaluronic acid fillers such as Juvederm, Restylane, and Belotero, because any bumps can be smoothed out with a few drops of an enzyme solution called hyaluronidase, unlike Radiesse or fat injections, which can stay permanently lumpy. Of all the fillers available in the US, Belotero and Restylane Silk are the softest and least likely to lump, although I have used Teosyal fillers outside the US and been very impressed. Some doctors prefer regular Restylane, since there’s evidence that it binds less water and therefore may swell less (though it has a firmer consistency). Depending on the amount and specific filler used, it typically lasts at least six months, often longer.
Lastly, there have been rare cases of blindness associated with filler injections around the eyes. Injecting too quickly and forcefully may increase this risk by blocking crucial blood vessels, so choose a doctor who is careful, gentle, and very experienced with filler injections if this is something you are considering.