Although it may appear as if under eye filler only just recently became popular, it has actually been one of Hollywood’s best kept secrets for years now.

Referred to by dermatologists as tear trough filler, it helps to smooth the circles that form under the eyes by filling in the hollow, which tends to grow deeper with age.

While it’s easy to see why this type of filler is a popular choice, it’s also important to note the risks associated with it, specifically the risk that comes with injecting near the eyes. Because of that, the procedure should only be completed by certified dermatologists or plastic surgeons.

For more information on the procedure, continue reading below.

The Consultation

While filling in the circles below the eyes may seem appealing, it’s important to have a thorough consultation with an experienced medical professional before going through with the process.

During a consultation, a medical professional should provide a patient with information regarding side effects, risks, maintenance, examples of their work, and pricing options. Although it varies state by state, experts in Los Angeles typically charge between $750 and $950 a syringe, which most people only need one of to start.

A consultation is also crucial because it gives the person treating you a chance to determine whether or not a person is even a candidate for the procedure to begin with.

“People will come in thinking they need under eye filler when they don’t,” board-certified dermatologist Karyn Grossman, MD, says. “Dark circles can be from discoloration or an indent.

“Tear trough filler is best for people who have minor fat pad bulges and can soften, but not erase, more significant fat pad bulges with some layering of filler,” she adds.

Choosing the Right Medical Professional

After a consultation, it’s important that a person chooses the right medical professional to perform the procedure and one whose skills match the desired results.

For example, while many medical professionals offer the service, the process requires one with a wealth of experience in the specific area.

“Many people overfill the under eye,” Dr. Grossman says. “But do you need to look younger than a 12-year-old?”

Ava Shamban, MD, agrees, citing the difficulty of the procedure and noting that a simple mistake can result in unpleasant visual results.

HA Filler

For those having the procedure done for the very first time, only hyaluronic acid dermal fillers like Restylane, Juvederm, or Belotero should be used given that these substances are the only reversible ones. In addition, those three specific kinds typically respond best to hyaluronidase, which is used to reverse the process should the results differ from what was desired.

It’s also important to research each specific kind, as Shamban prefers Restylane while Grossman agrees that Restylane is a smart pick, but notes that Belotero is better for those with thin skin.


Typically, this procedure does cause patients pain, but medical professionals can ease that pain by using numbing cream beforehand. Patients should also look to avoid blood thinners, fish oil supplements and alcohol leading up to the procedure.

Following the surgery, it’s expected that the eyes will be sore but the pain should subside by the following day.

The Process

On the day of the procedure itself, a medical professional will remove makeup and cleanse the skin with both a medical skin cleanser and rubbing alcohol, which is done to prevent infection. Then, the injections will either be made directly or with the help of a cannula, which is a small tube used to make injections above the cheek bone.

Both Grossman and Shamban agree that a needle is more precise, although a cannula is thought to lower the risk of bruising. Skilled medical professionals should go slowly when making the injections, limiting the injection spots while adding a small amount of product at a time.

Experienced injectors also typically shape the product after injecting it before it fully sets to achieve the desired results. Overall, the procedure should take around 15 minutes and should be followed by icing the area to avoid bruising.

The Aftermath

While results may be visible immediately following the procedure, swelling usually delays the process. If swelling doesn’t go down after a few days, it’s important to consult with your provider.

The filler typically lasts between nine and 12 months and could potentially even last up to three years, although many experts recommend getting touch-ups before losing all results.

Side Effects

Following the procedure, bruising is extremely common, which is why patients should ice the impacted area every 10 minutes for the first day. Working out should be avoided as well given that raising the heart rate could increase bruising.

What is known as a “bleb” is also a possibility. This is a welt in the injection spot, which means the product was injected too close to the surface of the skin and needs to be dissolved.

Down the road, more serious side effects can be seen such as the eyes being red, swollen and tender. This can be treated with hyaluronate, antibiotics and oral steroids.


While quite rare, there is the possibility that more serious risks occur.

“Any place that filler is injected can go into a blood vessel then go downstream and block blood flow to an area,” Dr. Grossman says. “If it’s just a skin occlusion, you see a blanching where the skin turns white and then it turns this dusty gray purple color and there are protocols that you do to deal with it.”

Partial blindness in one or both of the eyes is also a possibility, although the chance of that happening is a fraction of a percent.

Ultimately, it’s important to choose a medical professional in Olney, Maryland who’s skilled and can treat a patient in case of emergency.

If you are considering dermal fillers in Olney, Maryland, please call our office today to schedule a comprehensive consultation with one of our highly skilled and talented injectors.