What Are Dermal Fillers Under Eyes? Costs, Risks, Results

Under‑eye (tear trough) dermal fillers are tiny amounts of hyaluronic acid gel placed just beneath the skin at the lower eyelid–cheek junction. By restoring volume and smoothing the lid–cheek transition, they soften hollows and reduce shadowing that makes eyes look tired, offering a fresher look without surgery. They won’t treat true pigment, and product choice and technique are critical in this delicate area.

This guide sets out the benefits and limits of under‑eye filler, who is (and isn’t) a good candidate, why hyaluronic acid is safest, and what to expect step by step. We cover risks, side effects, results and longevity, UK costs, aftercare, and when alternatives such as skin treatments or surgery are better. You’ll also learn how to choose a qualified injector and get clear answers to common questions.

Benefits and limitations of under-eye fillers

When under-eye hollows are the culprit, dermal fillers under eyes can soften the lid–cheek junction and reduce shadowing so you look fresher fast. Results are often visible immediately with little to no downtime, and hyaluronic acid (HA) fillers can be dissolved if needed. They can sometimes camouflage mild puffiness (pseudoherniation), but they won’t fix true pigment—and poor product choice or technique can make things worse.

• Key benefits

  • Immediate, subtle refresh: Softens hollows and tired-looking shadows.

  • Minimal downtime: Especially when placed via a blunt cannula, which can reduce bruising and vascular risk.

  • Reversible: HA can be dissolved with hyaluronidase; typical longevity is around 6–18 months.

  • Strategic support: Pairing with cheek filler can mean less product directly under the eye for a smoother result.

• Important limitations

  • Pigmentation persists: Filler doesn’t treat colour; it may accentuate dark pigment.

  • Risks exist: Bruising, swelling, lumps/nodules, Tyndall effect; very rare risk of blindness from vascular occlusion.

  • Malar oedema: HA can impede lymphatic drainage, causing prolonged puffiness that may require dissolving.

  • Not for everyone: Marked skin laxity or true fat herniation may need other treatments; tweaks or staged sessions are common, and dissolving can take multiple visits.

Who is a good candidate (and who isn’t)

The best candidates for dermal fillers under eyes are people whose “dark circles” are mainly caused by hollows (volume loss) rather than pigment. A quick clue: look up into bright lighting—if the shadow fades, it’s a hollow; if the colour stays, it’s pigment. Suitable patients usually have mild to moderate tear‑trough hollowing, realistic expectations, and are open to staged tweaks and, where needed, cheek support to minimise product directly under the eyes. Treatment is commonly performed from the 20s/30s onward, depending on anatomy.

• Good candidates

  • Hollows with minimal skin laxity: Shadowing from volume loss rather than colour.

  • Mild bags (pseudoherniation): Can sometimes be camouflaged with careful HA placement.

  • Open to cheek optimisation: Supporting the midface first/also can improve outcomes.

• Not good candidates

  • Pigmentation‑driven circles: Filler won’t help and may accentuate colour.

  • Marked laxity or true fat herniation: Often better served by other treatments or surgery.

  • High‑risk/unsuitable context: Anyone unwilling to see a qualified, experienced injector in this higher‑risk area, or with persistent undereye swelling that needs medical assessment first.

What filler is safe under the eyes (why hyaluronic acid only)

The tear trough is a delicate, vein‑rich, high‑risk area. For safety and predictability, only hyaluronic acid (HA) fillers should be used under the eyes. HA integrates softly, is adjustable in tiny amounts, and crucially can be reversed with hyaluronidase if there’s puffiness, lumps, a Tyndall (bluish) hue, or a vascular issue. Thin, smooth HA gels formulated for delicate areas (for example, Volbella‑type or Restylane Eyelight‑type products) are typically chosen here.

• Reversible: HA can be dissolved, giving a vital safety net in this danger zone.

• Natural feel: HA mimics soft tissue and binds water for subtle smoothing of hollows.

• Lower complication burden: Compared with biostimulators (poly‑L‑lactic acid) or calcium hydroxylapatite, which should not be used here and can’t be easily undone.

• Formulation matters: Softer, low‑swelling HA placed precisely helps reduce risks like Tyndall and persistent malar oedema.

What the treatment involves: step by step

Because the tear trough is delicate and vein‑rich, great results come from tiny, precise steps rather than lots of product. Expect a calm, measured appointment that focuses on diagnosing the cause of your “dark circles” and placing the right hyaluronic acid (HA) filler in exactly the right plane.

• Consultation and assessment: Your injector checks whether darkness is due to hollows or pigment (bright‑light “shadow test”), examines skin laxity and any bags, and may suggest cheek support. Photos, consent and a bespoke plan follow.

• Preparation: Avoid aspirin/NSAIDs and alcohol beforehand to reduce bruising. On the day, the skin is cleansed, marked, and a topical anaesthetic may be applied.

• Placement: Using a blunt‑tipped cannula via a single entry point (to reduce bruising and vascular risk), micro‑aliquots of a thin, smooth HA are placed slowly under the eye; some cases use a fine needle. Treatment typically takes around 30 minutes.

• Shaping and symmetry check: Gentle smoothing, then you’ll sit up so lighting reveals any tiny tweaks needed. Less is more in this area.

• Immediate review and plan: Results are visible straight away with possible mild swelling. You’ll get aftercare (ice, avoid vigorous activity/NSAIDs; massage only if advised) and a routine follow‑up in about two weeks for small adjustments—or, if needed, dissolving with hyaluronidase.

Risks and side effects you should know

Because the lower eyelid is thin, vein‑rich and close to vital vessels, dermal fillers under eyes carry more risk than many other areas. In expert hands HA fillers are adjustable and can be dissolved if needed, but you should understand what’s common, what’s less common, and the red‑flag symptoms that need urgent help.

• Common, short‑term effects: Bruising, swelling and tenderness for a few days are typical. Small bumps or subtle asymmetries can occur and are often reviewed and tweaked at a two‑week follow‑up.

• Aesthetic issues: The Tyndall effect (a bluish/grey hue) can appear if filler sits too superficially, and overfilling can look puffy. Both are usually managed by tiny adjustments or dissolving with hyaluronidase.

• Malar oedema (prolonged puffiness): HA can impede lymphatic drainage and cause persistent swelling under the eye/upper cheek. Management may include dissolving old HA and, in some cases, devices to encourage drainage as guided by your doctor.

• Nodules/irregularities: Palpable lumps can form; these are commonly treated with gentle massage if advised or small amounts of hyaluronidase.

• Vascular complications (rare): If filler blocks a vessel, skin blanching, severe pain or livedo may occur; blindness is a very rare but documented risk when ocular vessels are affected. Treat this as an emergency—contact your injector immediately or seek urgent medical care.

A skilled, frequently practising, board‑certified injector who uses cautious technique (often a blunt cannula) helps reduce—though not eliminate—these risks.

Results and before-and-after: what to expect and when

Most people see a noticeable softening of hollows straight away—dermal fillers under eyes reduce the “tired” shadow and smooth the lid–cheek transition. Expect mild swelling or a small entry‑point bruise that can make things look a touch uneven at first; this typically settles quickly. Because colour from true pigmentation won’t change, the end result is a subtle refresh rather than a dramatic makeover, and many find they need less concealer once healed.

• What you’ll see: a smoother contour, fewer shadows, and a less sunken look without obvious “filler”.

• Immediate vs final: improvement is immediate, but judge results after swelling subsides; your injector will often review you around two weeks for tiny tweaks.

• If tweaks are needed: a few extra micro‑drops—or occasionally a pinch of hyaluronidase to flatten puffiness—can perfect symmetry and finish.

For accurate before‑and‑afters, compare photos in the same lighting and head position; the most telling change is the gentle, continuous curve from lower eyelid into the upper cheek.

How long under-eye fillers last and maintenance

Under‑eye hyaluronic acid fillers typically last longer than many other areas because there’s less movement—most people enjoy results for around 6–18 months, and some see effects closer to two years. Longevity varies with your biology, product choice and precise placement. Rather than “stacking” filler too soon, a conservative, staged approach keeps the lid–cheek transition smooth and natural over time.

• Typical timeline: Expect 6–18 months of improvement; some cases persist up to two years before a refresh.

• Top‑up strategy: Plan a review at two weeks, then reassess around 9–12 months; use micro‑top‑ups and consider cheek support first so less product sits directly under the eyes.

• When to reset: If you develop puffiness, a bluish hue or irregularities, your clinician may dissolve HA with hyaluronidase before any retreatment.

• Red flags: Persistent swelling (malar oedema) warrants prompt review—don’t keep topping up over it.

Costs in the UK: what affects price

In the UK, pricing for dermal fillers under eyes varies by clinic and location. As a guide, London clinics commonly charge around £350–£600 per 1 ml syringe. How much you personally spend depends on anatomy and plan: some patients can split one syringe between both eyes, while deeper hollows may need more product or supportive cheek filler.

• Location and clinic calibre: Central/London locations and highly credentialled injectors typically cost more.

• Product choice: Premium HA options (e.g., smooth, low‑swelling gels tailored for tear troughs) affect price.

• Amount needed: One shared syringe vs. one per side; cheek support may be advised first.

• Technique and safety: Cannula use, longer appointments, and comprehensive reviews add value.

• Follow‑ups/adjustments: Minor top‑ups or hyaluronidase to refine results may be separate fees.

Many reputable clinics, including ours, offer 0% finance to spread the cost.

Aftercare and recovery: do’s and don’ts

Recovery after dermal fillers under eyes is usually quick. You’ll see an immediate softening of hollows, with mild swelling or bruising that often settles within 48 hours. Simple aftercare helps minimise bumps, Tyndall risk and prolonged puffiness, and keeps your results smooth while you wait for your two‑week review.

• Ice promptly: Apply cool compresses in short intervals after treatment to reduce swelling.

• Keep blood flow calm: For 24–48 hours, avoid heavy workouts, hot baths/saunas and anything that “flushes” the face.

• Hands off (unless advised): Don’t rub or press the area; massage only if your injector specifically recommends it for tiny bumps.

• Skip irritants: Avoid alcohol and NSAIDs around treatment if possible, as they can worsen bruising.

• Makeup with care: You can generally resume normal life straight away; if you use concealer, apply gently and keep the entry point clean.

• Watch for red flags: Sudden vision changes, severe pain, skin blanching or swelling that persists for weeks need urgent review—contact your injector immediately.

• Follow up: Attend your two‑week check for any fine‑tuning or, if needed, dissolving with hyaluronidase.

When filler isn’t the answer: effective alternatives

If darkness comes from pigment, thin crepey skin, or true fat bags/skin laxity, dermal fillers under eyes may not help—and can sometimes make things look worse. A tailored plan that targets the real cause is safer and more effective.

• Target pigment: Use eye products with ingredients like kojic acid and liquorice root to help break down colour.

• Regenerate skin quality: Polynucleotides can boost collagen/elastin, hydration and evenness, improving under‑eye texture and pigmentation over time.

• Build collagen: Microneedling or CO2 laser resurfacing can thicken the dermis, soften fine lines and reduce the “see‑through” look that exaggerates dark circles.

• Fix persistent swelling: For malar oedema after filler, dissolving HA and, in some cases, radiofrequency to promote lymphatic drainage may be advised.

• Address true bags/laxity: When bulging fat or loose skin is the issue, lower‑eyelid surgery (fat removal/repositioning) may be the right option.

Your consultation should identify which of these will genuinely solve your concern—without overfilling the tear trough.

How to choose a safe, qualified injector

The tear trough is a high‑risk, anatomy‑intense area where tiny errors show and rare complications can be serious. Your result depends less on the brand of filler and more on the hands that place it. Choose someone who treats under eyes frequently, explains limits as well as benefits, and will steer you to alternatives if filler isn’t right. Don’t price‑shop—do your due diligence.

• Qualifications and experience: A properly qualified, frequently practising injector; ask how often they treat tear troughs.

• Proof of outcomes: Standardised before‑and‑afters and realistic expectations; willing to say “not suitable”.

• Right product, safety net: Uses hyaluronic acid only under eyes; never Sculptra/CaHA; hyaluronidase on site.

• Safe technique and setting: Blunt cannula where appropriate, micro‑aliquots, sterile, medically led clinic—not a non‑medical back room.

• Transparent risk discussion: Covers bruising, Tyndall, malar oedema and the rare risk of vascular occlusion/blindness, with an emergency plan.

• Follow‑up culture: Routine two‑week review, conservative top‑ups, and readiness to dissolve if needed; avoid “deal” days and rushed appointments.

Common questions about tear trough filler

If you’re weighing up dermal fillers under eyes, these quick answers cover what most people want to know about safety, results and practicalities. Always remember: outcomes depend on anatomy and on choosing a cautious, highly experienced injector.

• How long do results last? Typically around 6–18 months; some people retain improvement longer due to low movement in this area.

• Will it fix dark circles? It helps hollows (shadowing). It won’t treat true pigment and may accentuate colour if pigment is the cause.

• Is it reversible? Yes—hyaluronic acid can be dissolved with hyaluronidase, often over more than one session.

• Does it hurt and is there downtime? Discomfort is usually minimal; you’ll see an immediate change. Expect mild swelling/bruising for up to 48 hours.

• Cannula or needle? Many clinicians prefer a blunt cannula to reduce bruising and vascular risk; fine needles are used selectively.

• What are the risks? Bruising, swelling, lumps, Tyndall effect, malar oedema; very rarely, vascular occlusion/blindness—seek urgent help for red‑flag symptoms.

• How much product will I need? Some can split 1 syringe between both eyes; deeper hollows may need more and/or cheek support first.

• How much does it cost? In London, a guide price is roughly £350–£600 per 1 ml syringe, varying by clinic, product and plan.

Key takeaways

Under‑eye HA fillers can subtly smooth hollows and lessen shadows with little downtime. They won’t fix true pigmentation, and this vein‑rich area carries specific risks, so the safest plans are conservative and bespoke: hyaluronic acid only, placed precisely, reviewed at two weeks—and dissolved if needed. Expect immediate softening, final judgement at two weeks, and typical longevity of 6–18 months. Ready to see if you’re a suitable candidate? Book a friendly consultation with Wigmore Smiles & Aesthetics in Luton; our experienced team offers flexible 0% finance.