The area under the eyes is one of the most delicate and sensitive areas of the face, and it requires special attention when it comes to fillers. Hyaluronic acid fillers are the most common type of filler used in this area, as they are transparent, easy to smooth and less likely to cake. Hyaluronic acid provides the shortest result of all fillers, but some doctors consider it to provide the most natural look. There are many different varieties of HA gel fillers, such as the Restylane family, the Juvederm family, and Belotero.
Volbella and Vollure (also known as Volift outside the United States) are newer fillers within the Juvderm family. They cause less swelling than the previous variety of Juvederm products and are good choices for superficial (Volbella) and deeper (Vollure) injections under the eyes. However, a low incidence of inflammatory nodules (bumps) has been reported after 4 months with Volbella. Refyne is a different type of cross-linking than normal Restylane, which makes them more “flexible”, which can be beneficial in areas with a lot of facial movement (especially around the mouth).
Restylane is a popular choice for under-eye fillers because it tends to be firmer and doesn't seem to migrate as much. It is also an acceptable option but, in my opinion, not as versatile as Restylane. Restylane Silk is the thinnest and softest version of Restylane, but it also has the highest swelling capacity. This makes it not the best option when it comes to thin skin under the eyes, which does not cope well with significant swelling.
Platelet Rich Plasma (PRP) is another option for treating bags under the eyes and dark circles. It improves the quality and health of lower eyelid skin affected by pigmentation problems and iron deposits that cause discoloration. Before undergoing any treatment for eye bags, it is important to keep in mind that many doctors who are not surgeons choose filler to treat all cases of eye bags, which means that in many situations, placing the filler can result in larger eye bags. When eye bags exceed a certain level of projection, fillers are not appropriate and surgery is the treatment of choice.
It is also important to note that rarer and more serious side effects can occur with under-eye fillers, such as the Tyndall effect (when the skin turns blue) or death of tissue around the eye. As such, it is important to select a doctor who has experience with this type of procedure. Overall, Restylane is my preferred choice for under-eye fillers because it tends to be firmer and doesn't seem to migrate as much. However, there are other options available depending on your individual needs and preferences.