The loss of volume under the eyes is a common problem that can be addressed with the help of fillers. Hyaluronic acid (HA) fillers are the most popular choice for this area, as they are lightweight, not too firm and can be dissolved if necessary. The list of HA fillers includes Restylane, Belotero Balance, Juvederm Volbella and Juvederm Vollure, Restylane Refyne and Restylane Defyne, and Restylane Silk. Each of these fillers has its own advantages and disadvantages, so it is important to choose the right one for your needs.
Restylane is a leading hyaluronic acid-based dermal filler with long-lasting results in under-eye areas. It is very forgiving for the injector and does not tend to clump or cause discoloration. However, it does not provide a great lift if there is a deep tear. Juvederm Volbella and Juvederm Vollure are newer fillers within the Juvderm family.
Volbella is softer and Vollure (also known as Volift outside the United States) is thicker. 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. Restylane Refyne and Restylane Defyne have 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).
There are benefits to using Refyne in the “crow's feet” area, but so far no benefit has been demonstrated over normal Restylane for the area under the eyes. Restylane Silk is the thinnest and softest version of Restylane, but it also has the highest swelling capacity. Not the best option when it comes to thin skin under the eyes, which does not cope well with significant swelling. It's important to note that fillers are not able to solve all problems under the eyes. Fillers are great if you need to fill the lost volume, which means you have noticeable tears and physical gaps under your eyes, but they're not necessarily an instant solution to all dark circles.
If you're not sure if you've experienced volume loss under your eyes, hold a mirror in front of your face and look up so that the light reaches directly to the area under your eyes. If the color remains, pigment and filler are unlikely to be beneficial. So far, under-eye filler is an off-label treatment, meaning it hasn't received FDA approval. That doesn't mean it's illegal to put a filler under your eyes or anything, but it's still smart to go into the process knowing that there are some risks (even if they're rare). That said, rarer and more serious side effects can also occur, such as the Tyndall effect (when the skin turns blue) or death of tissue around the eye. Injections are virtually painless because Restylane products include lidocaine.
Restylane may be critical to eradicate dark-colored bags under the eyes as well as hollow tear ducts. A more permanent option is to have a board-certified dermatologist or plastic surgeon perform a fat grafting procedure, which involves collecting fat from any part of the body (usually the side or hips) and injecting it under the eyes to fill in the skin and correct the vacuum. Under-eye filling is non-invasive, has little or no downtime, and many patients continue their regular days after. Bruises may last longer, but they should go away within a week. Other than that, no real aftercare is required. If you don't like the appearance of wrinkles, fine lines, dark circles or bags under your eyes, fillers will help you look younger by minimizing your appearance.
Some are very soft and thin (such as Restylane Refyne) and are excellent for filling in fine lines and gaps under the eyes, while stiffer and thicker formulations, such as Restylane Lyft, are better at lifting cheeks and filling deeper creases. It is important to note that currently the Food and Drug Administration (FDA) has not approved any fillers for the under-eye area. In addition, a quick warning that there is usually a slight bursting noise during injection.
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