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Is Restylane really safe in the tear troughs?


Is Restylane use safe in the tear troughs?  I have been considering this procedure for some time for chronic dark circles under my eyes but I know it is considered an "off label" use of Restylane.  Is it really safe and effective?


You are right - the FDA has not approved the use of Restylane for the tear troughs.  A lot of practitioners use this filler in this location with success.  As with any procedure, it does carry risks.  See a plastic surgeon with experience and consider the potential complications before having any injections.  Experience counts in this area of the body in avoiding complications.

Aldo Guerra, M.D.
Scottsdale, AZ


Restylane has a proven track record of safety; however, like any other procedure it has its own set of potential risks.

A few common risks are infection, lumpiness, and scarring.  The important thing is to choose a qualified Board Certified Plastic Surgeon for an evaluation and appropriate use of the filler.


Injections into the tear trough area is considered an "off-label" use for Restylane or any of the various hyaluronic gel fillers.  It requires experience, and does have some degree of potential complications associated with it.

I prefer Prevelle Silk in this area, rather than Restylane (other opinions may vary).

I usually use it to improve the crescent-shaped depression known as the tear trough, not for "dark circles."  See a qualified plastic surgeon to determine what the best treatment would be for your particular situation.

All the best,

Thomas G. S. Fiala, M.D.M.D., F.R.C.S., F.A.C.S. - View Other Answers by this Doctor
Altamonte Springs, FL


I have had good success in treating the tear troughs with Restylane and Juvederm.  The key is to slightly under-correct and be conservative.  Serious complications are uncommon in experienced hands.  However you may experience minor lumpiness or bruising even in experienced hands.  It is a non permanent filler so complications will usually improve and resolve with time, if you are unlucky enough to get one.

David Berman, MD



This is an "off label" use, but can be quite effective.  Care must be used in the injection technique in this area, so as to avoid an intravascular injection which can cause serious problems.


Restylane can be used in an "off label" manner to improve the hollows under the eyes - this will help with the dark shadow created by the hollow BUT it will not change the color of the skin...... (UNLESS it is injected superficially - then it can cause a blue color making the dark circle appear worse).  My wife, Dr. Lisa Airan and myself have performed this procedure for nine years (with no serious complications).  The results (which are immediate) can last one to two years.  There is a risk of bruising (up to 10 days).  However, there are individuals where there is little or no benefit in doing this procedure.

With Warm Regards,

Trevor M. Born, MD

Toronto, ON


I prefer fat grafting to other fillers under they eyes and in  the tear trough area. One guiding principle of reconstructive plastic surgery is short and simple: "Replace like with like." Specifically, where tissue is missing, restore the defect with the same tissue whenever possible. If bone is missing, use a bone graft. If muscle is missing, use a muscle flap. So if fat is missing, the ideal solution is obvious. Fat Grafting.

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. In some blepharoplasty patients this depression or 'hollow' extends horizontally across the entire junction of the lower lid and cheek, and this must be corrected to obtain the ideal postoperative result.

When selecting a physician, look at many , many before and after photos as part of your decision making process.



I would not recommend restylane in the tear troughs. A patients' own fat by means of structural fat grafting if the only material I would use for under eye fillers. Look at many before and after photos before electing to have a surgeon make a permanent change to your appearance. 

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