All About Under-Eye Fillers: Types of Filler, Pain Levels, Results and Downtime

While many Eunogo readers are familiar with using fillers for wrinkles and smile lines, most haven’t given much thought to the fact that fillers can be used on another part of the face: the under eyes. Many of us are finishing out 2020 with tired eyes and dark circles, so Eunogo sat down with Dr. Chloe Ho at Mizu Aesthetic Clinic to find out what we can do to improve the appearance of our undereye area.

Dr. Ho, can you tell us about the different causes of dark circles under our eyes?

Well, under eye circles are quite common, and can be caused by a couple of issues.

For some people it can be genetic, meaning, your facial structure does not give you enough support under your eyes. For some it can be caused by allergic rhinitis (allergies), which can cause the blood vessels under your eyes to dilate, which leads to pooling of the blood under the eyes. So for people with allergic rhinitis we would get this condition treated before doing filler so that we are not doing any unnecessary procedures. For some clients it can also be lack of sleep or eye strain from too much screen time, so lifestyle factors. We will suggest that patients try to mitigate these factors to see if their condition improves, including taking regular eye breaks to avoid the strain.

Some patients may have skin conditions which cause them to rub their eyes. We call this Post Inflammatory Hyperpigmentation (PIH), so any injury to the skin which may cause a discoloration of the skin. There are some people who may have more melanin under their eye as well. Many are now also using different lash-growing serums to help stimulate eyelash growth, but a common side effect is a darkening of the skin around the lash area. So some medications can affect your eye area as well. We would recommend addressing the underlying condition first.

The most common, of course, is aging. With aging, we have a thinning of the skin and a loss of volume. That loss of volume can create a hollowing and a shadow under the eyes. Usually, as we get older, this will happen to all of us, so we will realize that, although we didn't have this issue in the past, we have it now. Thinning of the skin also makes the dark circles appear more obvious - the thinner the skin, the more we can see the vascularity under your eyes, and it will appear more purplish.

Who would be a good candidate for under eye fillers?

For most people, the dark circles are usually multifactorial, but definitely the patients coming in with volume-loss or age related dark circles will benefit the most from fillers. If you see a depression in your tear trough, once you can get an appropriate filler in that spot you’ll really see a noticeable change and a brightening of the under-eye area. The filler will also add support under the eye.

What kind of filler is appropriate to use? Is it a combination of different ones or just one kind?

There are many types of fillers on the market, which can be confusing. But you can generally split them into two kinds: hyaluronic fillers and collagen-stimulating fillers. For the collagen stimulating ones you’ve probably heard of Radiesse and Sculptra. For Hyaluronic Acid (HA) fillers there are Restylane, Juvederm, etc. For the under eye area you should use an HA filler, as it is a compound naturally found in your body: your skin, your joints, your eyes. This will give a very natural appearance in your delicate under eye area. If you inject a collagen stimulating filler you may get a granuloma, or a lumpy result, which obviously you don’t want. We want it to look as natural as possible as they are softer and integrate into the under eye area very naturally.

I do like to use a combination of a firmer HA filler and a softer one, but it will always depend on the individual patient and what they need. Every case is different and requires skill and artistry on the part of the doctor.

How painful will this be?

It really should not hurt very much at all. First of all, we will use numbing cream to make you as comfortable as possible. Second, there will only be one or two injection areas (entry points) period. Third, and most important, we usually will use a cannula tip which is blunt and lessens pain, discomfort and bruising. And most fillers come with lidocaine (a numbing medication) so that lessens discomfort as well. Don’t get me wrong, you will feel the needle at the entry point, but it should be very minimal pain.

How long is the entire procedure?

The numbing cream will require about 25-30 minutes to take full effect, and the actual procedure itself is about 30 minutes. I have to inject very slowly and methodically and I want to make sure I am very precise. So about an hour total for the whole procedure.

And how quickly will I see results?

Immediately! This is one of my favorite procedures to do because patients can see the immediate effect and they’re so thrilled. Instant gratification, especially for those patients who have quite dramatic volume loss.

How about downtime?

The entry points are very very small and they will close up completely in one to two days. Also, with the use of the cannula needle the risk of bruising is much lower. We will always advise you not to wear makeup for about 24-48 hours around the entry points, and to avoid strenuous exercise for the next 24 hours, but otherwise you should be good to go.

However, it is important for Eunogo readers to know that we usually will split the under eye filler into two sessions. I would prefer to be more conservative with the amount of filler with the first injection to avoid it looking very puffy. We will have you come back in two to three weeks to see how the filler has settled and whether you need any fine tuning. It’s easier to be conservative at first than overdo it.

Makes perfect sense! How long will my under eye filler last after an injection?

Fillers typically last for 9-12 months, but obviously it's different for every patient. The product labeling will say “up to 12 months” but if you are doing a lot of physical exercise and metabolize the HA filler faster, then we would probably see you back around the 9 month mark. You won’t wake up one morning and all of a sudden have your dark circles back but you will start seeing your under eye look less bright. That’s a sign you should make an appointment.

How about risks?

There are always risks associated with any sort of injectables. Bruising and granuloma are rare but possible. The biggest risk is always occlusion, or hitting a blood vessel and injecting the filler directly, which can cause infection and even necrosis (death of tissue) or blindness. This is why we always urge anyone who is considering any sort of injectable to please make sure you are getting your procedure done by an experienced doctor who knows facial anatomy and blood vessels in the face. To be honest, the cheek and under eye areas are generally considered safer than, let’s say, your nose or your glabella (that space between your eyebrows and above your nose) and we use a cannula so the risk of intravascular injection is even lower.

Is there anything that you feel people should know about before they come in?

YES! This is not a procedure to fix your eye bags! There might be very few people with eye bags for whom filler might reduce its appearance, but eye bags are far more an issue that should be fixed surgically. Also, some Asian patients will come in asking to fill in their aegyo sal band (love band) but we have to explain that it is part of your anatomy. If that is really bothering you we can discuss how to minimize its appearance.

To Dr. Ho: Thank you for taking the time to answer our questions on under-eye filler. It’s been very informative!

For enquiries and quotation of Under-Eye Filler from Mizu, you can get a quote here or contact us at