Under Eye Fillers in NYC
Under eye filler places a small amount of hyaluronic acid gel into the hollow between the lower lid and the cheek. It is a technically demanding area to inject and carries serious risks, because the blood vessels here connect with the circulation that supplies the retina.
What under eye filler does
Under eye filler fills a hollow. A small volume of hyaluronic acid gel is placed deep in the groove that runs between the lower eyelid and the cheek, so that light no longer falls into a depression there and casts a shadow.
The complaint patients bring is usually not a hollow. It is looking tired, or looking like they have not slept, or a dark circle that concealer no longer hides. Those descriptions cover several different problems, only some of which filler treats, which is why this is an area where the examination matters more than the request.
The volume used here is small. The skin of the lower lid is the thinnest on the body, and product placed too superficially or in too great an amount shows as a bluish fullness or a visible ridge rather than as a correction. Under-correcting and reviewing is the safer approach in this area, and it is the one Dr. Smith takes.
Why the under eye looks hollow or dark
A tired-looking under eye has several possible causes, and filler only addresses one of them. Separating them is the point of the consultation.
Volume loss and the tear trough
A genuine groove between the lid and the cheek, deepening with age as midface volume is lost, is what filler treats well. The anatomy of that groove is set out on the tear trough filler page, which also explains why the term is used loosely by patients and clinicians alike.
Herniated fat, or eye bags
Fat that has pushed forward from behind the orbital septum produces a bulge rather than a hollow. Filling below a bulge can soften the step, but it does not remove the bulge and adding volume to a full lower lid makes it fuller. Where the fat is the dominant finding, lower eyelid surgery is the treatment that addresses it.
Pigmentation
Some dark circles are pigment in the skin rather than shadow in a hollow. Pigment does not respond to filler at all. It is distinguished on examination by stretching the skin and by changing the angle of the light: a shadow moves, pigment does not.
Skin quality and fine lines
Crepey, thin skin under the eye is a surface problem. Filler placed underneath it does not improve texture, and in thin skin it is more likely to be visible. Skin treatments address this, and they are planned separately.
Fluid and swelling
Puffiness that varies from day to day, is worse in the morning, or fluctuates with salt, sleep and allergies is fluid. Hyaluronic acid binds water, so filler placed into an area that already retains fluid can make the puffiness more pronounced rather than less.
Loss of support in the cheek
In many patients the shadow under the eye comes mostly from the cheek having flattened beneath it. Treating the cheek lifts the junction between the lid and the cheek and can improve the under-eye appearance without anything being injected into the lower lid at all. Where that is the finding, treating the cheek may be more effective and avoids injecting the lower lid directly. Cheek filler also has risks.
Who under eye filler suits
The best candidate has a clear hollow, good skin quality, little or no fat herniation, and no tendency to hold fluid under the eye.
- The depression is a true groove rather than a shadow cast by a bulge above it
- The lower lid skin is reasonably thick and not markedly crepey
- There is no significant morning puffiness or fluctuating swelling
- You understand the result will be partial rather than complete in most cases
Patients who are not good candidates are told so. That is not a preamble to recommending something more expensive; in a number of cases the honest answer is that the under eye should be left alone, or that treating the cheek is all that should be done. Filler placed in a lower lid that did not need it is difficult to live with and, although it can be dissolved, dissolving it is another procedure with its own risks.
Which fillers are used
The practice stocks the Juvederm and Restylane families, both hyaluronic acid fillers. Every filler approved in the United States is available to patients here, and these are the two families the practice keeps in stock.
The under eye calls for a soft, low-swelling gel placed deep. The firm, structural products used in the cheek or the chin are the wrong choice under a thin lower lid, where they would be palpable and visible.
Dermal fillers are implants, regulated by the FDA as Class III medical devices and approved for patients aged 22 and older. Approval is product-specific and area-specific. The under eye is an area where that distinction is worth stating plainly: many hyaluronic acid products in common use are not FDA-approved for the infraorbital region specifically, and use there is off-label. The product proposed for you, and its approval status for this area, is discussed before treatment.
The consultation
The consultation for the under eye is a diagnostic appointment before it is a treatment discussion.
- Examination of the groove, the lower lid fat, the skin and the cheek, with the light changed to separate shadow from pigment
- Assessment of lower lid tone and of any tendency to swelling
- Review of your medical history, medications and allergies, including any history of anaphylaxis and any allergy to lidocaine
- A record of any filler you have had in this area before, what was used and when, since old product under the eye changes what is safe to add
- A plan naming the product, the depth and the amount, and stating whether the cheek should be treated first or instead
- A clear statement of what filler will not fix in your case
The consultation fee is $500 and it is applied toward any procedure you go on to book. It is not waived.
What the treatment is like
Under eye filler is an office treatment and Dr. Smith performs the injections himself.
- The skin is cleaned and the plan is marked out with you sitting up
- A topical numbing cream is applied, and the products used contain lidocaine
- Filler is placed deep, against or close to the bone, rather than superficially under the lid skin
- Dr. Smith uses a blunt cannula in this region in most cases. In a large retrospective study, cannulas were associated with fewer vascular occlusions than needles, but vascular occlusion still occurred with both instruments.
- Small amounts are placed and the effect is reviewed with you sitting up before any more is added
Treatment takes place at the practice at 111 East 57th Street on the Upper East Side, where Dr. Smith also runs a QUAD A accredited outpatient surgical facility.
Recovery after under-eye filler
Bruising, swelling and tenderness after injection are usual, and the lower lid bruises more readily than most of the face.
- A bruise under the eye can be conspicuous and may take longer to fade than elsewhere; plan treatment away from events
- Swelling in the first days can make the correction look greater than it is
- Avoid strenuous exercise, alcohol and heat on the day of treatment
- Ask before taking an anti-inflammatory such as ibuprofen, since medications that prolong bleeding can worsen bruising
- Leave time before judging the result, and before asking for more
Results are not permanent, although hyaluronic acid placed under the eye is often reported to persist longer than in more mobile parts of the face. How long it lasts varies by product, by area and by patient, and the figure for the specific product in your plan is reviewed at the consultation rather than given here as a general number.
Safety, side effects and risks
The most serious risk with any dermal filler is accidental injection into a blood vessel. The FDA states that filler entering a blood vessel blocks the blood supply to the tissue that vessel feeds, and that although the chance of this happening is low, the resulting complications can be serious and may be permanent. They include death of the affected tissue, vision abnormalities including blindness, and stroke.
This is an important risk to understand before under-eye treatment. The vessels running through the tear trough and the surrounding area communicate with the circulation that supplies the retina. Filler forced into one of them can travel backward into that circulation, and the vision loss that follows can be permanent. This is the single most important thing to understand before having filler placed under the eye, and it is the reason the area is treated with a cannula, in small amounts, in a deep plane, by a physician.
The warning signs include unusual or severe pain during or after injection, sudden pain in or around the eye, skin that turns white, gray, blue or mottled, and any change in vision, including blurring, a dark patch or loss of sight. Seek immediate medical attention for these symptoms. For any vision change or signs of stroke, call 911 or your local emergency number immediately. Notify the practice as well, but do not wait for an office reply or watch symptoms overnight.
The common side effects are local. Bruising, swelling and tenderness at the injection site are usual after treatment. Under the eye there are two further problems worth naming: a bluish discoloration where product sits too superficially, and persistent puffiness where hyaluronic acid binds fluid in a lid that was already prone to it. Both are reasons this area is filled conservatively.
Hyaluronic acid fillers are not used in patients with severe allergies marked by a history of anaphylaxis, or in patients allergic to lidocaine or to the bacterial proteins used to make hyaluronic acid.
Tell the practice before treatment about inflamed or infected skin in the area, any bleeding disorder, any medication that prolongs bleeding such as aspirin or another blood thinner, and any medication that suppresses the immune system.
Hyaluronic acid fillers can be broken down with hyaluronidase, which can help manage unwanted filler or some vascular complications. Dissolving filler has its own risks, and it does not guarantee reversal of tissue injury or restoration of vision. Early recognition and treatment may limit harm, but suspected vascular or visual complications still require immediate medical care.
What determines the cost of under-eye filler
Filler is priced by the amount of product used. The under eye uses small volumes, but the plan often involves more than the lower lid alone.
- How many syringes the plan calls for
- Which product is used, since the families are priced differently
- Whether the cheek is treated as part of the same plan, which is common
- Whether the plan is staged, with a small amount placed and reviewed before more is added
You are given an exact figure at the consultation, before anything is booked. The consultation fee is $500 and is applied toward any procedure. Financing is available through CareCredit and Alphaeon Credit. Dr. Smith is out of network with all insurance plans; the practice helps patients use out-of-network benefits toward care.
Common questions about under eye filler
Is under eye filler safe?
Under-eye filler carries a risk of serious complications that should be discussed plainly. The FDA states that filler injected into a blood vessel blocks the blood supply to the tissue that vessel feeds, and that although the chance is low, the complications can be serious and may be permanent, including tissue death, vision abnormalities including blindness, and stroke. The vessels around the eye communicate with the circulation supplying the retina, which is why this area carries the vision risk. It is treated with a blunt cannula, in a deep plane, in small amounts, by a physician, and it is not treated at all in patients for whom the examination says filler is the wrong answer.
Will under eye filler get rid of my dark circles?
Only if the darkness is a shadow cast by a hollow. If it is pigment in the skin, filler will not change it. The two are separated on examination by changing the light and by stretching the skin. Many patients have some of each, and in those cases filler improves part of the appearance and not all of it.
Will it help my eye bags?
Not directly. Eye bags are fat that has pushed forward, which is a bulge rather than a hollow. Filling below a bulge can soften the step between the lid and the cheek, but the bulge remains. Where fat herniation is the main finding, lower eyelid surgery is what addresses it.
Can under eye filler be dissolved?
Yes. Hyaluronic acid fillers are broken down by hyaluronidase, an injected enzyme. This is genuinely reassuring in an area where patients worry most about permanence, though dissolving is itself a procedure with its own risks and is not a reason to be casual about the original treatment.
Why does filler under the eye sometimes look puffy or blue?
Both come from placement. A bluish tint appears when product sits too superficially under very thin skin. Puffiness appears when hyaluronic acid binds fluid in a lower lid that was already prone to swelling. Both are reasons to place small amounts deep, and both are reasons some patients are advised against treatment in this area.
Should my cheeks be treated instead?
Sometimes, yes. When the shadow under the eye comes mostly from a flattened cheek, restoring support in the midface improves the under eye without anything being placed in the lower lid. Where the examination shows that, it is the better plan on both grounds: it works, and it avoids injecting the lower lid directly. Cheek filler also has risks.
Does it hurt?
There is some discomfort. A topical numbing cream is used beforehand and the products used contain lidocaine. A blunt cannula is generally better tolerated than repeated needle passes.
How much bruising should I expect?
Bruising is usual after injection, and the lower lid bruises more easily than most of the face. A bruise here is visible and can take longer to settle than elsewhere, so treatment is best scheduled away from anything you need to look well for.
Is filler under the eye FDA-approved?
Dermal fillers are approved as Class III devices for patients 22 and older, but approval is granted product by product and area by area. Many of the hyaluronic acid products used under the eye are not specifically approved for that region, so their use there is off-label. The product proposed for you and its approval status are discussed before treatment.
How long does under eye filler last?
It varies by product, by area and by patient, and filler under the eye is often reported to persist longer than in more mobile parts of the face. Rather than quote a general figure, the duration studied for the specific product in your plan is reviewed with you at the consultation.
What is the difference between under eye filler and tear trough filler?
They usually refer to the same treatment. The tear trough is a specific anatomical groove; the under eye is the broader region that contains it. Patients and clinicians use both terms loosely. The distinction and what it means for planning is set out on the tear trough filler page.
Who performs the injections?
Dr. Smith performs them himself. He is board-certified by the American Board of Plastic Surgery.