January 16, 2022

Are Tear Trough Fillers Effective for Undereye Bags?

Here’s why you may want to consider getting a filler for those pesky bags under your eyes

A person receiving injections in a doctor's office

Maybe you enjoyed one too many all-nighters in your youth. And now, those heavy bags under your eyes are packed and you seem to be carrying around the evidence of those late nights years later.


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But if those dark circles and bags aren’t going away on their own, even when you’re well-rested, chances are — you’ve lost a little volume in your face.

As we age, the bones in our face thin and widen, so we lose some of the fat, or padding, around our eyes. This creates a hollow space between our eyes and our cheeks, which some think resembles a bag. This space is called our tear trough. Other factors like genetics, diet, increased sun exposure and smoking can also thin out facial bones over time.

But if you’re unhappy about that extra luggage under your eyes, you might want to consider treatment. In order to replace some of that lost volume, you can get what’s called a filler, a gel-like substance made of hyaluronic acid, which is a naturally occurring molecule found in our skin. Dermatologist Shilpi Khetarpal, MD, breaks down how fillers work, why you might want to consider them and any potential risks.

What are fillers?

There are more invasive procedures where you can have your own fat injected into your tear troughs or have your fat repositioned around your eye. But hyaluronic acid fillers are far less invasive, and less time consuming. Hyaluronic acid fillers come in prefilled syringes and there are several different brands and types.

“Some fillers can be very firm and stiff like Jell-O, others are going to be very water-like and thin,” says Dr. Khetarpal. “The filler you pick will depend on your anatomy, your goals and how much volume you’ve lost.”

What happens when tear trough fillers are injected?

The procedure takes about five to 10 minutes. First, your healthcare provider cleans the surface of your tear trough with alcohol and ices the area. Then, using a tiny needle or a blunt-tipped cannula (a thin tube), your healthcare provider places several small injections of the filler along your tear troughs.


Your eyes will look full right away, and you may experience minor redness or swelling in the first 48 hours, but that typically goes away on its own. During the first 48 hours, try not to sleep face down and avoid touching your eyes. If you’d like, you can use ice or a cold compress to help with any swelling.

How long do fillers last?

The full effect of fillers is noticeable after about two weeks. Fillers can last for a couple of years but vary for every person based on their anatomy and the kind of filler used. On average, you may need to get injections every one to two years to maintain the full effect of the filler.

Are tear trough fillers safe?

Because a small needle or blunt-tipped cannula is used, it’s normal to experience some redness, swelling or bruising in the weeks after the injection. There’s a very low risk of infection, too, so it’s important to make sure you don’t have any dental work for two weeks before or after the injection, and don’t undergo the procedure if you’re feeling sick.

“An infection could occur weeks to months later. The tear trough area might feel hard, warm and just tender,” says Dr. Khetarpal. “These are all warning signs that you should go back to your provider and have them look into it.”

Extreme pain, loss of vision or seeing floaters at the time of your injection are signs that something could be wrong. Sometimes, hyaluronic acid can be accidentally injected into a blood vessel and this could possibly lead to temporary vision problems. Hyaluronic acid is entirely dissolvable, though, so if this happens, your healthcare provider can dissolve the filler by injecting a watery substance that clears it from your system. When the procedure is reversed, there’ve been few reports of any permanent damage.

Dr. Khetarpal stresses that while risks are typically low for this procedure, it’s important to see a licensed dermatologist, plastic surgeon or oculoplastic surgeon instead of going to a med spa because med spas often require fewer qualifications and carry an increased risk for infection and other problems.


Natural solutions

While Dr. Khetarpal says this procedure is good for anyone who might be noticing undereye bags in their 20s up through their 60s, not everyone is a good candidate for fillers. Sometimes, your body may not respond the right way. You could experience any number of risks or your eyes could get puffy when subjected to fluid.

For those interested in more natural solutions, there are topical eye creams that contain caffeine to reduce swelling, as well as cosmetics that can help with pigmentation. Dr. Khetarpal recommends using sunscreen every day to help reduce the risk of sun exposure — even during the winter — and using topical antioxidants like vitamins C and E to help brighten the skin under your eyes. When choosing which products to use, make sure they’re safe for undereye use.

“At my practice, we do at least a dozen tear trough fillers a week, and if it’s done safely and correctly, it can really make someone look refreshed, younger and just the best version of themselves,” says Dr. Khetarpal. “If someone is considering it, make sure you know your provider, know their credentials and see pictures of their past work. That’s the best way to judge someone’s experience with this procedure.”

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