June 3, 2023

Syringes on a gradient background

As we age, it’s normal for the area under our eyes to sink in and potentially look darker. After all, loss of volume and skin darkening is simply part of aging. If, however, you’d prefer to maintain a more youthful appearance, there are injectables that can help. And when it comes to the area under your eyes, nothing compares to tear trough filler.

With that in mind, we asked registered nurse Melanie Speed and board-certified dermatologist Dr. Corey L. Hartman, MD, about everything there is to know about tear trough filler. Read on to determine if the popular cosmetic treatment is right for you.

What Is Tear Trough Filler?

Also known as under-eye filler, tear trough filler is a type of dermal filler (like Restylane and Juvéderm) made with hyaluronic acid to restore lost volume wherever it’s injected. “Under-eye filler, in the right provider’s hands, can have truly transformative results,” exclaims Speed. “By expertly placing HA-based filler (my preferred filler for the under eyes is Juvéderm Volbella), I’m able to smooth under-eye hollowing and address the tear trough deformity. Doing so provides and restores volume to the under eyes for a fresh, youthful, healthy look that brings balance to the face.”

While tear trough filler is still relatively new, given fillers like Juvéderm didn’t come out until 2006, according to the 2020 Plastic Surgery Statistics Report hyaluronic acid fillers are among the most popular minimally invasive cosmetic treatments, with more than 2.6 million patients partaking in 2020 alone. While it’s not clear how many of those patients opted specifically for under-eye filler, the fact remains: Volume-replenishing injectables are heavily sought after.

According to Hartman, interest in this procedure has skyrocketed over the past year. “Patients have sought minimally invasive procedures to enhance the appearance, particularly in the upper face, as masks have increased the importance of the eye area,” he says.

Benefits of Tear Trough Filler

The benefits of tear trough filler include:

  • Temporary refreshed under-eye area
  • Temporary under-eye plumpness
  • Temporary brighter-looking appearance

Under-eye filler is a one-stop-shop for an instantly revitalized under-eye area. “It makes a patient appear as though they have been getting ten hours of sleep every night so even if they’re not, they can fake it,” Hartman says. The wonderful thing about under-eye filler is that in addition to instantly plumping the area (which helps reverse any signs of sunkenness), it helps to brighten it, too. That’s because with fewer sunken shadows, the eyes will naturally appear brighter. “Dermal filler in the tear trough replaces the volume which creates a shadow and darkness that no eye cream will ever be able to correct,” Hartman says.

Best of all, Hartman says that there is virtually no downtime and the filler lasts at least a year in the under-eye area.

That said, not everyone is a great candidate. “People with lower lid fullness should be counseled that a blepharoplasty may be more appropriate for them instead of filler,” Hartman says. As a general rule of thumb, Speed says that typically patients under the age of 60 have the most impressive results and satisfaction with under-eye filler, as anyone with excess under-eye fat or skin is likely better suited for surgery.

Does Tear Trough Filler Hurt?

The idea of needles penetrating some of your most sensitive skin may seem endlessly painful. However, according to Speed, it looks more uncomfortable than it actually feels. “The majority of my patients find it to be totally comfortable,” she says. “The filler product itself contains lidocaine to help numb up the area in addition to the complimentary numbing cream we offer.” Of course, if you’re still concerned about pain, Speed says that some offices (her Las Vegas office included) provide Pronox gas for an additional fee.

How to Prepare for Tear Trough Filler

The most important aspect of under-eye filler prep is booking with the right injector in the first place.

“Research a dermatologist that performs many of these procedures and is well versed in the anatomy of this complicated part of the face,” Hartman recommends. “There are many blood vessels and nerves packed into a small space that consists of just skin, muscle, and bone with very little subcutaneous tissue to hide imperfections.” Additionally, while under-eye filler has gained popularity recently, Hartman says that it’s important to realize that only one filler product has gained an indication in this area in the past six months. “While it is a safe procedure, it is not an area to let someone experiment on,” he says.

Beyond finding a skilled injector, as with any injectable, Speed says to avoid blood-thinners two weeks prior to your appointment.

“That means no aspirin, NSAIDs like ibuprofen, fish oil, melatonin, vitamin E, turmeric, chondroitin, glucosamine, green tea, etc.,” she says, noting to please ask when in doubt. (And definitely make sure to speak to your doctor before you stop taking any prescribed blood thinners.) “Conversely, starting oral Arnica montana tablets a week or so before treatment will aid the recovery process.”

What to Expect During a Tear Trough Filler Treatment

When you arrive at your under-eye filler treatment, the process is much the same as with Botox. The eye area will be cleansed and prepped with topical numbing cream. Once it’s had a chance to set in, your injector will begin injecting. “A small injection with an introducer needle is made to allow entry of the microcannula,” Hartman says. “The cannula is then inserted and the product is administered.” As far as what to expect in terms of feel, Hartman says that mild pressure is common, but pain is unlikely. “The area starts to feel like your mouth feels at the dentist and there is no more discomfort,” he says.

Tear Trough Filler vs. Botox

Filler and Botox often get mixed up, despite doing two very different things. Where filler replaces lost volume, Botox freezes muscles to treat and prevent facial lines. Additionally, where Botox takes up to two weeks to set, filler offers instant results. “Nothing, outside of surgery, will deliver the improvement to the under-eye area and middle of the face that fillers can,” Speed says. “While a great eye cream and daily SPF are necessities, HA fillers deliver instant, apparent results that skincare just can’t.”

Potential Side Effects

Any time a needle is penetrating your skin, injection pain, swelling, redness, and bruising are possible. However, by seeing a skilled injector and following the prep steps, you can avoid these under-eye filler side effects.

To be very clear, it’s imperative that you book with a trained provider. “The risks are great in inexperienced hands and include bruising, nodules, and even blindness,” Hartman says.

The Cost

Tear trough filler cost varies by provider, geographical location, and how many syringes of filler are needed. Overall though, Hartman says that it generally ranges from $800 to $2,500 per treatment.

“Most patients will see the best results with two full syringes (one under each eye), though you’ll see some improvement with just one syringe,” Speed shares.


Injectable aftercare is always pretty simple, and that goes for under-eye filler, too. Hartman says to simply avoid exercises, alcohol, and skincare products in the treatment area for 24 hours, and reach for ice packs and oral, non-sedating antihistamines to help control any associated swelling.

“Results typically last 12 to 18 months depending upon the product used since this is not an area involved in lots of movement, and therefore the product isn’t broken down as quickly as other areas like the lips,” Hartman adds.

The Final Takeaway

If you have sunken areas under your eyes and are looking for ways to address the loss of volume and subsequent darkness, under-eye filler is an unmatched cosmetic option.

That said, and as Hartman points out, “tear trough filler is a procedure that requires an experienced board-certified dermatologist to perform to not only avoid bad outcomes, but also to ensure a natural look.”