Hyaluronic acid fillers are the most common type of filler used in the area under the eyes due to their transparency, ease of smoothing, and low risk of caking. Hyaluronic acid provides the shortest-lasting result of all fillers, but some doctors consider it to provide the most natural look. There are many different varieties of HA gel fillers, including the Restylane family, the Juvederm family, and Belotero. Hyaluronic acid is popular for under the eyes because it is very forgiving for the injector.
It is not very stiff and does not tend to clump or cause discoloration, but it does not provide a great lift if there is a deep tear. The Juvederm family includes newer fillers such as Volbella and Vollure (also known as Volift outside the United States). These cause less swelling than previous Juvederm products and are good choices for superficial (Volbella) and deeper (Vollure) injections under the eyes. However, there is a low incidence of inflammatory nodules (bumps) reported after four months with Volbella.
The Refyne family of fillers has a different type of cross-linking than normal Restylane, making 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 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, making it not the best option when it comes to thin skin under the eyes. The best filler for the region under the eyes is a hyaluronic acid filler.
This filling is lightweight, not too firm, and can be dissolved if necessary. Restylane may be a little better than Juvederm in this area. 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 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.
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. FDA approved in 2003, Restylane is a leading hyaluronic acid-based dermal filler with long-lasting results in under-eye areas.
Because Restylane products include lidocaine, injections are virtually painless. Restylane may be critical to eradicate dark-colored bags under the eyes as well as hollow tear ducts. Fat injection, also known as fat transfer or fat grafting, is a permanent filler that uses its own fat cells to add volume, similar to injectable synthetic fillers. Currently, the best fillers for the area under the eyes for the vast majority of people are made of cross-linked hyaluronic acid (HA) gel.
Each filling has advantages and disadvantages that must be considered when determining which one to use in a particular application. The classic approach is to use very small needles that come with the filler, which requires several injections of small volumes of filler below the ocular orbicular muscle and directly above the orbital bone. The tip of the cannula can slide between layers of tissue without causing any potential nerve damage near the eyes. Under-eye fillers are usually marketed with a duration of six months to a year, but all experts point out that under-eye fillers tend to last longer than that, close to 18 months because fillers are in an area of the face that moves less than other areas such as lips.
