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Comprehensive Guide to Dermal Fillers for Under Eyes

Advances in aesthetic medicine focus on achieving youthful appearance through minimally invasive procedures like under-eye dermal fillers.

Advances in aesthetic medicine focus on achieving youthful appearance through minimally invasive procedures like under-eye dermal fillers.

The quest for a youthful appearance has driven advances in aesthetic medicine, with a notable focus on minimally invasive procedures. Among these, the application of dermal fillers under the eyes has gained significant traction. This comprehensive guide delves into the specifics of under-eye dermal fillers, exploring their types, mechanisms, procedural techniques, risks, benefits, and post-procedural care.

Anatomy of the Periorbital Region

Understanding the periorbital anatomy is crucial for the effective application of dermal fillers. The under-eye area, or the infraorbital region, comprises several anatomical structures, including the skin, subcutaneous fat, muscles, and ligaments. The skin here is notably thinner than other facial areas, contributing to the visibility of underlying structures such as blood vessels and muscles, often manifesting as dark circles or hollows.

Types of Dermal Fillers

Dermal fillers utilized in the periorbital region are primarily hyaluronic acid (HA)-based, owing to their biocompatibility and reversibility. However, other fillers are also used, each with distinct properties:

  1. Hyaluronic Acid Fillers: These are the most common fillers used due to their natural presence in the skin and ability to attract and retain water, thereby providing volume and hydration. Examples include Juvederm, Restylane, and Belotero.
  2. Calcium Hydroxylapatite (CaHA): Found in Radiesse, this filler is denser and provides a robust lifting effect. It stimulates collagen production but is less commonly used under the eyes due to its thicker consistency.
  3. Poly-L-Lactic Acid (PLLA): Known by the brand name Sculptra, PLLA stimulates collagen production over time, offering a gradual volumizing effect. Its use under the eyes is less frequent due to the precision required in placement.
  4. Autologous Fat Transfer: This involves harvesting the patient’s own fat via liposuction, purifying it, and re-injecting it into the desired area. It provides a natural look but requires a more invasive procedure compared to synthetic fillers.

Mechanism of Action

Dermal fillers work by replenishing volume loss in the under-eye area, smoothing out hollows and reducing the appearance of dark circles. The filler material is injected into specific layers of the skin or subcutaneous tissue, depending on the desired outcome and the type of filler used. Hyaluronic acid fillers, for instance, integrate with the tissue and attract water molecules, leading to immediate and visible improvement in volume and hydration.

Procedural Techniques

Filler is injected into specified areas using techniques like linear threading or serial puncture, with caution near infraorbital foramen to prevent nerve damage.

Filler is injected into specified areas using techniques like linear threading or serial puncture, with caution near infraorbital foramen to prevent nerve damage.

Administering dermal fillers under the eyes requires precision and expertise due to the sensitivity and complexity of the periorbital region. The procedure typically follows these steps:

  1. Consultation and Assessment: A thorough patient consultation is essential to understanding their medical history, aesthetic goals, and potential contraindications. An assessment of the under-eye anatomy, skin quality, and degree of volume loss guides the choice of filler and technique.
  2. Preparation: The treatment area is cleansed and marked. A topical anesthetic may be applied to minimize discomfort. Some practitioners prefer using a cannula rather than a needle to reduce the risk of bruising and vascular complications.
  3. Injection Technique: The filler is injected into the pre-determined areas. Techniques vary but generally involve either a linear threading or serial puncture method. The injector must be cautious of the infraorbital foramen to avoid nerve damage.
  4. Post-Injection Care: Post-procedural care includes applying ice to reduce swelling and bruising. Patients are advised to avoid strenuous activities and certain medications that can increase the risk of bruising, such as aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs).

Benefits of Under-Eye Dermal Fillers

The primary benefits of using dermal fillers for under-eye rejuvenation include:

  1. Immediate Results: Most patients notice an improvement in the under-eye area immediately after the procedure, with full results developing over the following weeks.
  2. Minimally Invasive: The procedure is non-surgical, involves minimal downtime, and is associated with fewer risks compared to surgical interventions.
  3. Natural-Looking Results: When performed by an experienced practitioner, the results can be subtle and natural-looking, enhancing the overall facial aesthetics without appearing overdone.
  4. Reversibility: HA fillers can be dissolved with hyaluronidase if the results are unsatisfactory or if complications arise, providing an added layer of safety.

Risks and Complications

While dermal fillers are generally safe, potential risks and complications include:

  1. Bruising and Swelling: These are the most common side effects, usually resolving within a few days to weeks.
  2. Tyndall Effect: A bluish discoloration may occur if the filler is placed too superficially. This is more common with HA fillers and can be corrected with hyaluronidase.
  3. Lumpiness and Asymmetry: Improper injection technique can lead to uneven distribution of the filler, resulting in lumps or an asymmetrical appearance.
  4. Infection: Although rare, any breach of the skin carries a risk of infection. Aseptic technique and proper aftercare minimize this risk.
  5. Vascular Complications: Inadvertent injection into a blood vessel can lead to severe complications such as tissue necrosis or blindness. This underscores the importance of choosing a skilled and experienced practitioner.

Post-Procedural Care

Proper aftercare is vital to ensuring optimal results and minimizing complications. Recommendations include:

  1. Avoiding Touching or Massaging the Area: Patients should refrain from touching or massaging the treated area to prevent displacement of the filler.
  2. Managing Swelling and Bruising: Applying ice packs intermittently can help reduce swelling and bruising. Arnica or bromelain supplements may also be recommended.
  3. Hydration and Skin Care: Maintaining adequate hydration and following a gentle skincare routine helps in the healing process.
  4. Follow-Up Appointments: Regular follow-up appointments with the practitioner ensure that any complications are promptly addressed and that the results are as desired.


Dermal fillers for the under-eye area offer a highly effective solution for those seeking to rejuvenate their appearance without undergoing surgery. By understanding the types of fillers available, their mechanisms, and the procedural nuances, both patients and practitioners can achieve safe and satisfying outcomes. The key to success lies in a thorough pre-procedural assessment, precise injection technique, and diligent post-procedural care, ensuring that the delicate under-eye region is enhanced with minimal risk and maximum aesthetic benefit.

For optimal results, it’s crucial to select a practitioner who is both qualified and trustworthy. Proper and successful administration of dermal fillers demands the expertise and experience of a licensed medical practitioner.

Dentox offers thorough training for medical practitioners in the effective application of filler injections. Our program equips participants with the necessary knowledge and skills to excel in the field of aesthetic medicine. Enhance your expertise by enrolling in our comprehensive online course, available at For those interested in hands-on patient training sessions, please visit to learn more and secure your place in these transformative sessions.


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