What to Know Consistent with Derms

If you’ve scrolled through your feed in the last, I don’t know, five minutes, you’ve probably gathered that under-eye fillers are having a moment right now. The #UnderEyeFiller tag on TikTok has more than 12.5 million views, and yeah, the videos are a bit graphic. But they’re also super appealing—especially if you’ve slathered eye creams and color-correctors over your dark circles to no avail. In a few seconds, the fillers smooth out eye hollows and circles like they were never even there. It’s like the best concealer in the world you never have to wash off.

The only catch? The actual procedure isn’t as easy as a 15-second vid. Under-eye fillers are a big deal, and not just because you’re changing the shape of your face. That’s why I caught up with Rachel Maiman, MD, a board-certified dermatologist at Marmur Medical who actually performs the procedure herself, to find out everything there is to know.

What is under-eye filler?

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First, a little context: According to Dr. Maiman, the word “filler”—also referred to as “dermal filler” or “dermal volumizers”—is an umbrella term for the gel-like substances that are injected into the skin to correct volume loss. You’ve probably heard of two of the most common fillers—Juvederm and Restylane—which are both made with hyaluronic acid. “Hyaluronic acid fillers are the most common for treating the under-eye area, since it’s compatible with the very thin and delicate tissue in this part of the face,” she says.

“Although Juvederm and Restylane are the most commonly recognized HA fillers, the latter is more popular among injectors for under the eyes, since it carries a lower risk of both immediate and delayed swelling,” adds Dr. Maiman. Another interesting thing about HA fillers? They can be dissolved with a hyaluronidase enzyme, which means you’ve got options if you don’t end up loving your look.

Who is an ideal candidate for under-eye filler?

What to Know Consistent with Derms, dermalfillerbeforeandafter

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Okay, it’s important to keep in mind that fillers aren’t capable of fixing every under-eye concern. Dr. Maiman says that under-eye fillers are great if you need to fill up lost volume—meaning you have noticeable tear troughs and physical hollows beneath your eyes—but they aren’t necessarily an instant fix for all dark circles.

“Filler won’t help pigmentation. If your dark circles are caused by increased pigment in the skin, as is very common in people with darker skin tones, filler will only accentuate them,” Dr. Maiman explains. “But for some people, dark circles are actually a shadow effect that comes from volume loss, which can be corrected with filler.

Not sure if you’ve experienced under-eye volume loss? Dr. Maiman suggests holding a mirror in front of your face and looking up so the light hits your under-eye area directly. “If the shadow under your eyes disappears in the light, the dark circle are likely caused by hollowness and may be amenable with filler. If the color remains, it’s pigment and filler is unlikely to be of benefit,” she says.

How long does under-eye filler last?

Shocked at how your shadows look? Uh, same. But here’s some good news: Dr. Maiman says that under-eye filler can last between 12 to 18 months on average, thanks to the fact that the area doesn’t move around a lot (i.e., the opposite of how lip injections dissolve quickly because of all the movement that comes with talking, chewing, and breathing). “The effect of the filler will slowly dissolve over time,” Dr. Maiman adds. That means you won’t have to worry about your under-eye filler disappearing overnight.

How much does under-eye filler cost?

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Remember when I said under-eye filler lasts a while? Okay, keep that in mind for this next part. Although the cost of under-eye filler depends on the type of filler you choose, how much your dermatologists uses, and where you’re located, you can expect prices to range from $1,000 to $3,000. And while you can find under-eye filler for cheaper than that, Dr. Maiman stresses the importance of always seeing a legit, board-certified dermatologist or plastic surgeon for the procedure—even if costs a bit more.

“It’s critical to choose a well-trained injector with an in-depth knowledge of anatomy, since injecting the under-eye area requires a fine balance of trying to camouflage volume loss while simultaneously preserving the natural appearance of a dynamical facial area,” she says. TL;DR: No matter how good that Groupon deal is, it’s always safer to see a professional—it is your face, after all.

Is under-eye filler safe?

On to the fun part. As of now, under-eye filler is an off-label treatment, meaning it hasn’t received FDA approval. That doesn’t mean it’s illegal to get under-eye filler or anything—but it’s still smart to go into the process knowing that there are some risks (even if they’re rare). “By far the most common side effects in the under-eye area are bruising and swelling, due to the fact that it’s a highly vascular location with robust blood supply,” says Dr. Maiman.

That said, rarer and more serious side effects can also occur, including the Tyndall effect (when the skin turns bluish) or death of tissue around the eye. “This occurs when the filler is inadvertently injected into a blood vessel, which then obstructs essential blood flow,” says Dr. Maiman. “It’s even more rare, but there have also been reports of vascular occlusion resulting in blindness due to blockage of the retinal artery.” Is that scary? 100 percent—and it’s even more of an incentive to find a certified professional if you choose to get fillers, not the first person you see online or the cheapest option.

“Compared to some other areas, like the nasolabial folds or glabella (the area between your eyebrows), the under-eye area is generally considered to be lower risk for serious complications,” Dr. Maiman adds. “Still, all filler injections come with the possibility of adverse reactions, the risk of which is reduced significantly by doing your homework and going to an injector with appropriate credentials.”

Do under-eye fillers hurt?

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Most of Dr. Maiman’s patients choose to go with a topical anesthetic, which is left on for 20 to 40 minutes before the injection area is sterilized and the procedure takes place. This cuts way, way back on any potential pain, though your mileage is going to vary here, of course. (Do you cry when you stub your toe? You might not love this.)

“The injection itself is typically done in one of two ways—a needle or a cannula. The classic approach is to use the very, very small needles that come with the filler, which requires several injections of small volumes of filler below the orbicularis oculi muscle and directly above the orbital bone,” says Dr. Maiman. “Cannula, the alternative approach, generally carries a lower risk of swelling and bruising because its longer length requires only a single injection and its semi-rigid nature reduces the likelihood of damaging vessels.”

Also, a quick heads up that there’s usually a slight popping noise during the injection. “Some patients find the popping sound unsettling,” says Dr. Maiman. “It’s also normal to feel the sensation of slight pressure as the volume of filler is slowly injected into tissues.”

What’s the downtime for under-eye fillers?

You’re not going to spend all day at the derm or all week in your bed after this one. Dr. Maiman says that under-eye filler is non-invasive, has little to no downtime, and a lot of patients keep going on with their regular days afterwards. “Swelling tends to peak 24 to 48 hours after injection and typically resolves within three days. Bruising can last longer but should resolve within one week,” says Dr. Maiman. “Icing a few times after the procedure, on the day of injection, can help reduce both swelling and bruising, as can sleeping with an extra pillow under your head that evening. Aside from that, there is no real aftercare required.”

The final word

It goes without saying that there are a lot of things to keep in mind when determining if under-eye filler is right for you (think: the cost, the potential side effects, the pain level). But if you’re a good candidate—remember: under-eye filler is the move for people with volume loss, not increased pigment—take the time to find a certified pro with lots of experience. And if you’re still on the fence, there’s no harm in booking a consultation with a dermatologist to walk through all of your options.

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