How to get rid of the Bags under my Eyes?
posted: Feb. 16, 2021.
Which under eye (Tear trough) filler is best?
As we age, we commonly become concerned with the dark circles under our eyes. A concern I hear from my patients quite frequently is that they look tired all the time. They want to know if there is anything they can do to decrease the appearance of the bags under their eyes without surgery.
With so many fillers on the market, which one works best for correction under the eye?
In this blog posting I discuss off-label applications for FDA-approved fillers. This post represents my opinion and is based on my professional experience and specialized training in the fields of dermatology and clinical research. Every patient is different, and you should consult with your physician to decide on the best treatment for you. If you select a physician who is experienced in under-eye filler treatments, he or she will select a filler that works best for them as a result of their training and expertise.
BEST tear trough fillers
Cross-linked hyaluronic acid (HA) gel fillers currently lead the pack for the best under-eye fillers. They have characteristics that make them great for the job, such as good pliability as well as the right balance of softness and lift. And best of all, they are reversible. If there is ever a problem with an unwanted lump, bump, or discoloration of the skin surface due to poor placement (tyndall effect), the filler can be dissolved by injecting an enzyme called hyaluronidase which breaks down the filler almost immediately.
A number of HA gel fillers are on the market today, and the list grows larger every year it seems. The majority of these fillers are members of the Restylane family and the Juvederm family. Belotero is another filler on the market which is made by a different manufacturer.
These fillers are each inherently different based on their flexibility, stiffness, dispersion, and propensity to draw in water and swell when placed under the skin. Choosing the correct combination of characteristics is necessary to optimize the chances of a good outcome when placing filler under the eyes.
REcommended HA gel fillers for under-eye correction
For most of my patients, Restylane-L remains my favorite filler for tear trough treatment. This HA filler has been on the market for quite some time but in my opinion it’s still the best filler for treating the tear troughs. It has the right balance of characteristics that provide the desired amount of lift for the delicate under-eye area while minimizing unwanted swelling. The duration of effect is great also, and it lasts close to 1 year after placement.
Typically, 1 syringe is plenty of product to achieve the desired effect in this area, and it is usually split evenly between both sides of the face provided the volume loss is symmetrical at baseline. I usually inject this product deep (on top of the bone of the orbital rim), but placement for each patient can vary. Bruising is more common after injection of filler into the tear troughs (can look like a “black eye”) as compared to some other areas of the face. If bruising occurs, it typically resolves in 7-14 days and can be partially hidden by makeup until resolved.
This is another popular filler for under-eye treatment. It’s not very stiff and it’s not prone to lumping up or causing discoloration after placement. A drawback to this filler is that it does not provide great lift which may make it not the best choice for a deeper tear trough. Overall, it’s a good filler for under-eye treatment, but not quite as all-purpose as Restylane-L.
JUVEDERM VOLLURE & JUVEDERM VOLBELLA
These two HA fillers are members of the Juvederm family. One advantage of these newer fillers in the Juvederm line is that they don’t swell as much as the older Juvederm products. Volbella tends to be softer while Vollure is stiffer. Therefore, Volbella is better for shallow injections under the eye, and Vollure is better for deeper injections. There is a low incidence of inflammatory nodules (bumps) that have been reported a few months after treatment with Volbella. While the risk is low, I haven’t seen this complication with Belotero or Restylane-L.
RESTYLANE REFYNE & RESTYLANE DEFYNE
These two fillers are newer members of the Restylane family, and they have a different type of crosslinking which makes them more flexible than traditional Restylane-L. This increase in flexibility makes them better suited for treating areas of the face that move a lot (e.g. mouth). They can both be used successfully to treat the under-eye area. However, there is no current study showing them to be more beneficial when treating the tear troughs over the older Restylane-L.
OTHER HA gel fillers I DO NOT RECOMMEND for under-eye correction
This member of the Restylane family is thin & soft, but it has the highest propensity for swelling. When treating the under-eye area, too much swelling can be a bad thing. Because of this, Restylane Silk is not the best choice for filling the tear troughs.
This is the newest member of the Restylane family and received FDA-approval to treat the lips in April of 2020. I have not yet used this product off-label to treat any other areas of the face including the tear-troughs. Only time will tell whether it may be a good choice for off-label use in the under-eye area. For now, I would recommend holding off on having your tear troughs filled with this particular filler until we learn more about its unique injection characteristics and long-term safety.
JUVDERM ULTRA AND JUVEDERM ULTRA PLUS
These are two very popular members of the Juvederm family for filling many areas of the face. In the past these fillers were more commonly used in the under-eye area. I have moved away from using these fillers to fill the tear troughs because they tend to swell more and can migrate (move) a little after placement. This lack of accuracy after placement leads me to prefer Restylane-L over these two Juvederm products. However, these fillers still remain popular among many providers and are a better choice than several other fillers for treating the under-eye area.
This filler is one of the thickest fillers in the Juvederm family which makes it great at providing lift for areas such as the cheeks, but not the best for filling the delicate areas under the eyes. When placed under the eyes it can look lumpy and lead to unwanted swelling. Also, due to the nature of Juvederm Voluma, it is resistant to being dissolved with hyaluronidase. If there is ever a problem (e.g. unwanted lumps), after injection with Juvederm Voluma you may require multiple in-office treatments to totally dissolve the filler.
PERmanent fillers I DO NOT RECOMMEND for under-eye correction
There are several permanent fillers on the market today. They are permanent in the sense that they cannot be dissolved with hyaluronidase if there is a problem after injection. I do not use permanent or semi-permanent fillers to treat the under-eye area. These fillers include Radiesse, Bellafill, Sculptra, and Silicone (e.g. Silikon 1000). If lumps or bumps develop after permanent filler placement, it can be very difficult to correct them, and may even require surgical treatment. With so many other good filler choices available, in my opinion it’s not worth the risk to inject a permanent filler for under-eye correction which could lead to permanent problems.
Other treatment options for the under-eye
There are a number of other treatment options for people with discoloration and/or volume loss under the eyes. This blog post specifically focuses on filler treatment options, but I want the reader to be aware that fillers aren’t the only treatment option available for this area. A quick overview of other commonly available options includes many different topical skin care line treatments (e.g. Neocutis Micro Eyes), surgical treatment (e.g. blepharoplasty), fat injections (aka fat transfer or fat grafting), chemical peels, and laser or light therapies (e.g. Sciton Halo – Hybrid Fractional Laser). Choosing a provider that is knowledgeable regarding all of these different treatment options can be beneficial in allowing them to tailor the best treatment choice for you.
Many of these different treatment options for dark circles and volume loss under the eye (tear troughs) are available at our clinic. To discover which treatment is best for you, schedule a consultation with one of our providers at Feinstein Dermatology & Cosmetic Surgery by calling (561) 498-4407.