Filler can be an effective tool for brightening tired eyes, softening hollows, and restoring a subtle, youthful volume to the face. However, when it comes to the delicate periorbital area, not every concern can, or should, be addressed with injectable products. Some patients achieve a beautiful, refreshed appearance with carefully placed hyaluronic acid fillers, while others may experience puffiness, increased shadows, or results that do not suit their unique facial anatomy.
At New York Eye & Face, your care is led by Dr. Anaïs Carniciu, one of fewer than 750 surgeons worldwide certified by the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS). As the current President of the Westchester County Medical Society and a respected author and educator in oculoplastic surgery, Dr. Carniciu provides an exceptionally informed perspective on a common question many patients have: When is filler the right choice for eye rejuvenation, and when is it better to avoid it?
Filler Is a Tool, Not a Fix-All
- Dermal fillers can be a powerful tool when used correctly, especially in experienced, oculoplastic-trained hands
- Most hyaluronic acid (HA) fillers are formulated with a molecule naturally present in the skin and known for providing hydration, elasticity, and volume
- HA attracts and binds water, supporting soft tissue volume and creating a smoother surface appearance
- Other injectables, like poly-L-lactic acid (Sculptra), stimulate collagen production over time, offering structural rejuvenation for deeper hollowing
- However, even the best filler is only effective when the right anatomic problem is being treated
When Filler Works Beautifully
Mild to Moderate Tear Trough Hollowing
- Hollowing under the eyes caused by volume loss, not excess skin, can improve with the careful placement of soft, reversible HA fillers
- These fillers blend subtly with the surrounding tissue to lessen shadowing
- Studies show that HA fillers can effectively improve infraorbital hollowing with appropriate patient selection and skilled technique
- The best candidates have minimal or no under-eye puffiness
Cheek Support to Lift Shadows Indirectly
- Sometimes, the issue isn’t the tear trough itself, it’s midface volume loss
- Restoring structure in the cheeks can lift the lid-cheek junction, softening under-eye shadows without injecting directly into the trough
- This approach aligns with anatomical studies showing how midface aging contributes to periorbital changes
Subtle Wrinkle Softening in Carefully Selected Patients
- Fine lines related to dehydration or early collagen decline may benefit from HA fillers, which draw moisture and restore gentle plumpness
When Filler Is Not the Right Choice
Prominent or Long-Standing Under-Eye Bags
- Filler cannot fix herniated fat pads
- In fact, adding volume around bulging fat can make puffiness worse, mask shadows artificially, and create a swollen appearance
- Surgery: lower eyelid blepharoplasty, is often the appropriate option, as it addresses the actual anatomical cause
Excess Skin or Skin Laxity
- If the primary concern is crepey skin, looseness, or wrinkles due to tissue laxity, filler cannot tighten that skin
- Skin laxity is primarily caused by decreased collagen and elastin, which fillers alone cannot restore
- Options such as laser resurfacing, skin-quality treatments, or surgical eyelid tightening are typically more effective
Swelling-Prone Skin or Lymphatic Obstruction
- Some patients naturally retain fluid under the eyes due to a looser lymphatic network
- This often leads to persistent puffiness, the Tyndall effect (bluish hue), and water retention around the product
- These patients often benefit from non-filler solutions such as lasers, skincare interventions, or surgery
Very Deep Tear Troughs from Structural Issues
- If the tear trough is caused by bony deficiency rather than soft tissue volume alone, filler may help
- However, it often produces only a partial, temporary improvement
- Sometimes, surgical augmentation is more appropriate
Anyone Who Has Had Complications From Prior Fillers
- Prior filler migration, lumps, prolonged swelling, or vascular concerns require an oculoplastic surgeon’s evaluation, and often dissolving product to restore a natural appearance
- The periorbital area is one of the highest-risk injection zones, given its proximity to the ocular arterial network
Prioritize a Specialist’s Perspective on When to Choose Filler, and When to Consider Other Options
The under-eye area is one of the most technically challenging regions in aesthetic medicine. The safest and most natural results are achieved by a provider who has dedicated years to working exclusively with eyelid and periorbital structures.
Dr. Anaïs Carniciu brings extensive experience to every evaluation. Her qualifications include a rigorous residency in ophthalmic surgery, advanced microsurgical training, and a two-year subspecialty fellowship focused solely on eyelid, orbital, and facial procedures. She has handled a wide range of cosmetic and reconstructive cases, including complex tear trough corrections and revision treatments for patients who have faced complications elsewhere.
You deserve the level of care and respect for which we are renowned. If you are considering treatment for hollowing, bags, shadows, or overall eye rejuvenation, we invite you to schedule a private consultation at New York Eye & Face.
Additional Sources:
Hyaluronic acid: A key molecule in skin aging - PMC
Application of PLLA (Poly-L-Lactic acid) for rejuvenation and reproduction of facial cutaneous tissue in aesthetics: A review - PMC
Optimizing Infraorbital Hollows Treatment With Hyaluronic Acid Fillers: Overview of Anatomy, Injection Techniques, and Product Considerations - PMC
Periorbital Injectables: Understanding and Avoiding Complications - PMC
