Excellent practice! Dr. Griffiths and her staff are top-notch. Thorough eye exams, ample time spent explaining everything, and answers to all questions. Highly recommend NewView Eye Center!
Linda Cummings
Under Eye Fillers for Tear Trough Hollows
How HA Fillers Work in the Tear Trough
Hyaluronic acid is a substance your body produces naturally that holds moisture and gives skin a plump, hydrated look. HA fillers use a carefully formulated synthetic version of this molecule, cross-linked into a smooth gel that holds its shape after injection. Because HA occurs naturally in the body, allergic reactions are uncommon.
Our eye doctor places the gel deep against the bone at the orbital rim (the bony edge of the eye socket), creating a smooth cushion beneath the skin. The filler attracts and holds water molecules, adding volume where the face has lost it. Results appear immediately because the gel fills the hollow as soon as it is placed.
Not all dermal fillers are appropriate for the tear trough area. Our eye doctors use only HA-based products in this delicate region. Options such as Belotero Balance and Juvederm Voluma XC are among the HA formulations suited to periocular (around the eye) use because of their consistency and safety profile.
Non-HA fillers, including RADIESSE (calcium hydroxylapatite), are not used around the eyes. These products cannot be reversed if a complication occurs, and they carry a higher risk of visible lumps beneath the thin skin of the lower eyelid.
HA fillers break down gradually as your body metabolizes them over time. The duration varies depending on the specific product, where it is placed, and your individual metabolism. Under eye filler results generally last in the range of twelve to eighteen months for most patients, though individual results vary.
The Under Eye Filler Procedure
The treatment itself is straightforward and takes place in our office. Knowing what to expect before, during, and after can help you feel confident going into your appointment and get the best possible outcome.
Our eye doctors may ask you to pause certain medications and supplements before treatment. Blood thinners, aspirin, ibuprofen, fish oil, and vitamin E can all increase bruising. Stopping these at least one week before your appointment, unless they were prescribed for a medical condition, helps minimize this risk.
Avoid alcohol for twenty-four hours before treatment and arrive with clean skin and no makeup around your eyes. Let our team know about any previous filler treatments, known allergies, or medical conditions. If you have a history of cold sores near your eyes, please mention this, as treatment timing or antiviral medication may need to be addressed beforehand.
The procedure typically takes fifteen to thirty minutes. Our eye doctor cleans the treatment area and applies a topical numbing cream, or uses a filler formulation that contains built-in lidocaine (a local anesthetic) to keep you comfortable. Most patients feel light pressure or a brief pinch rather than significant pain.
Many of our eye doctors prefer a blunt-tipped cannula (a thin, flexible tube) rather than a sharp needle for under eye filler. The cannula enters through a single small opening and glides beneath the skin, depositing filler along the tear trough. This approach reduces bruising and lowers the risk of accidentally piercing a blood vessel. Small amounts are placed at a time, and your appearance is checked between passes to build volume gradually for a natural result.
Improvement is visible right away. Some mild swelling may make the area look slightly overfilled for the first two to three days, which is normal and settles on its own. Bruising is the most common side effect and tends to be more visible in the thin under eye skin than in other facial areas. Most bruising clears within one to two weeks.
- The final, settled result becomes clear within one to two weeks
- Cold compresses applied gently can help reduce swelling in the first twenty-four hours
- Most patients return to their normal routine the same day
- Makeup can be applied over bruising starting the following day, using clean brushes and gentle pressure
Avoid rubbing or pressing on the treated area for at least twenty-four hours. Skip intense exercise, saunas, and hot baths for the first day, as heat and increased circulation can worsen swelling. Sleeping with your head slightly elevated on an extra pillow for a few nights can also help.
Our eye doctors typically schedule a follow-up visit at around two weeks, once swelling has fully resolved. This gives our team the chance to evaluate your results and make any small adjustments if needed. Most patients do not require a touch-up after their first treatment.
Safety and the Advantage of Reversibility
Safety is the primary reason our eye doctors use only HA fillers in the tear trough area. The unique reversibility of hyaluronic acid makes it the most appropriate choice for treatment this close to the eye. Our team is trained to manage both routine side effects and the rare but serious complications that can arise with any periocular injection.
HA fillers can be dissolved quickly using an enzyme called hyaluronidase, which breaks down hyaluronic acid within hours of injection. If a complication occurs or you are unhappy with your results, our eye doctors have a reliable, fast-acting way to remove the product. Non-HA fillers offer no equivalent antidote, which is why they are not used in this area.
Bruising, swelling, and mild tenderness at the injection site are the most frequent side effects and resolve on their own within one to two weeks. A blue-gray tint called the Tyndall effect can occur if filler is placed too close to the skin surface. This can be corrected with a small amount of hyaluronidase to dissolve the superficial filler.
- Bruising and swelling are common and temporary
- Overfilling can create a puffy or unnatural look, which is why our doctors take a conservative, gradual approach
- Infection is rare but possible with any injection procedure
- Allergic reactions to HA fillers are uncommon
The most serious rare complication of under eye filler is vascular occlusion, which happens when filler accidentally enters a blood vessel and blocks blood flow. This can damage nearby tissue and, in severe cases, threaten vision. Our eye doctors reduce this risk by using cannulas, injecting slowly, and carefully monitoring the treatment area throughout the procedure.
Seek immediate care if you experience sudden vision changes, intense pain that worsens over time, or skin near the injection site that turns white, blue, or purple. These symptoms are rare but require emergency evaluation and treatment without delay. Because time is critical with vascular complications, prompt action significantly improves outcomes.
Frequently Asked Questions
Below are answers to questions our patients often bring up when considering under eye filler treatment for the first time.
Most patients need one syringe split between both eyes, though those with deeper hollows may benefit from a little more. Our approach is always to start conservatively, because overfilling is more difficult to address than underfilling. If additional volume would help after swelling settles, a small touch-up can be added at your follow-up appointment.
Discomfort is minimal for most patients. Numbing cream is applied beforehand, and many HA filler formulations contain built-in lidocaine. You may feel pressure or a very brief pinch, but the procedure is generally well tolerated. If you have concerns about discomfort, let our team know during your consultation so we can plan accordingly.
Filler is ideal for patients whose primary concern is volume loss creating a hollow shadow. It is non-surgical, reversible, and requires little downtime. Lower blepharoplasty (eyelid surgery) addresses structural issues that filler cannot correct, including excess skin, bulging fat pads, and muscle laxity. Our eye doctors will assess your anatomy and help you determine which approach is appropriate for your specific situation and goals.
The Tyndall effect is a blue-gray discoloration that appears when filler is placed too close to the skin surface, causing light to scatter through the thin under eye skin. It is prevented by injecting at the correct depth, deep against the bone rather than superficially. If it does occur, hyaluronidase dissolves the superficial filler and clears the discoloration reliably.
Bruising, swelling, and mild tenderness are expected and do not require urgent attention. However, you should contact our office right away if you notice sudden vision changes, pain that intensifies rather than fades, or skin near the injection site changing color (white, blue, or purple). These symptoms are rare, but they indicate a possible vascular issue that requires immediate evaluation and cannot wait for a routine follow-up.
Yes, many patients combine under eye filler with other cosmetic treatments we offer, such as BOTOX Cosmetic or Xeomin for lines around the eyes, or cheek volume restoration with Juvederm Voluma XC or Belotero Balance in adjacent areas. Our eye doctors plan combination treatments carefully to ensure a balanced, natural-looking result. Timing between procedures is discussed during your consultation.
Schedule a Consultation at NewView Eye Center
Our eye doctors at NewView Eye Center bring surgical-level expertise and a careful, personalized approach to every cosmetic treatment we offer. We take the time to evaluate your anatomy, discuss your goals honestly, and recommend the treatment plan that is right for you. We invite you to schedule a consultation at our Northern Virginia offices and take the first step toward looking as rested and refreshed as you feel.
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