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What is the best filler for under the eye?


What are the best fillers for under the eyes?


Hollows at the upper cheek or under-eye area can be temporarily improved with Restylane or Juvederm Ultra.  These are non-animal derived hyaluronic acid fillers, which give a soft, natural correction to facial hollows.  Effects typically last approximately six months after the first treatment, but can last even longer after subsequent treatments.  The newer forms of Restylane and Juvederm contain Lidocaine (a local anesthetic), so treatment is comfortably done in the office with no post-procedure down time.  It is helpful to avoid aspirin-containing products for several days prior to the injections, and to ice the area afterward to minimize bruising.  

Pamela B. Rosen, M.D., FACS
Coral Springs, FL


If your question is referring to treating the thinning or hollowing along the inferior orbital rim, I can tell you my most common current choice is Restylane. 

I would recommend you seek in-person consultations with board-certified plastic surgeon members of ASAPS located in your area, and request their opinion based on their examination and their own experience.  Blepharoplasty (eyelid lift) or cheeklift may be more appropriate for you.

I would recommend avoiding permanent filler materials.  I would recommend considering fat graft as an alternative if you are considering other facial surgery at the same time.  Discuss these alternatives with your surgeon.


Any filler can be used under the eye.  Each has advantages and disadvantages. The problem is that the area is very unforgiving.  For this reason, the person administering the filler should be very experienced.  Fillers here should not be put close to the skin except for rare problems. Instead, they should be placed deep near the bone.  Care also needs to be taken not to inject any of the vessels, as the filler could migrate to the vessels of the eye causing blindness. Because of this, I use a blunt injection needle. 


Lower blepharoplasties with transposition of the fat to the hollow areas will likely provide the longest lasting correction.  Short of surgery, any of the fillers can be used.  However, the skin of the eyelid is very thin and may show lumpiness or irregularity.  Thus, make sure the injector is very experienced with using fillers in this area and that the filler is placed deep, near the bone, to try to avoid an unacceptable result, which may take months or longer to resolve.  Also, care should be taken to avoid an intravascular injection, which can lead to skin necrosis (loss) or blindness.  I prefer using Radiesse, which lasts clinically about one year, for augmenting this area. 


Both Restylane and Juvederm are popular options for under the eye fillers. I personally prefer Restylane for under the eyes because it tends to be firmer and doesn't seem to migrate as much. Overall, I've had better success with Restylane than Juvederm. 



In patients who have developed deep 'tear troughs' at the junction of the lower lid and cheek, adjacent to the side of the nose, the meticulous grafting of fat harvested from the patient's abdomen, hips or thighs can build this area back up and nicely restore a more youthful contour.


As with all aesthetic surgical procedures, it is absolutely essential to customize the surgical plan to the specific needs of every patient.


Optimal Fillers for Under The Eye- There are multiple fillers for under the eye that work. Hyaluronic acid fillers are the best including Restylane and Restylane Silk, as they tend to volumize and do not expand significantly after placement. 



The best filler is a hyaluronic acid fillers for the under eyes region. This filler is light, not to firm, and can be dissolved if required. I believe Restylane may be a little better than Juvederm in this area.


There really is no one “best” filler for any particular application. Each filler has advantages and disadvantages which need to be considered in determining which one to use in a particular application. Perhaps among the most common fillers used below the eye, fall into the hyaluronic acid filler category. There are several brand names associated with hyaluronic acid fillers (Juvederm, Resytlane etc.) Personally, I have had great success using Radiesse to camouflage tear trough depressions. The primary consideration is the familiarity, skill and comfort level that your injector has with the products he/she are using.

For the best results seek the consultation of a plastic surgeon certified by the American Board of Plastic Surgery. They have a website listing all the certified plastic surgeons. Members of the American Society of Aesthetic Plastic Surgery will all be board certified in plastic surgery and have demonstrated an interest and competence in cosmetic plastic surgery as well.



Most expert experienced artistic plastic surgeons have a variety of procedures, both non-surgical and surgical, at their disposal to produce excellent cosmetic results in the appropriately selected patient: temporary fillers, micro-fat grafts, blepharoplasties and combination of procedures.  Each has benefits and drawbacks and depends on desired outcome and individual anatomy.

Currently, the best temporary fillers with the fewest potential problems for eyelid hollows are the hyaluronic acid fillers Restylane or Restylane Silk. A longer lasting result can be achieved with artistically performed micro-fat grafts, which is a slightly more involved procedure. Following the advice of anyone who would presume to tell you exactly what to do without seeing photos and without taking a full medical history, examining you, feeling and assessing your tissue tone, discussing your desired outcome and fully informing you about the pros and cons of each option would not be in your best interest. Find a plastic surgeon that you are comfortable with and one that you trust and listen to his or her advice. The surgeon should be certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS). You should discuss your concerns with that surgeon in person. Robert Singer, MD FACS La Jolla, California

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