Dr. Suzan Alp | Under-Eye Dermal Filler

What is under-eye dermal filler?

Under-eye dermal filler is the procedure in which it is assessed whether a change can be made in the hollow appearance under the eye and, where considered suitable, a dermal filler product containing hyaluronic acid is delivered into the area.

The product used is a medical device (opens in a new tab), and in Türkiye medical devices are monitored through the Product Tracking System (ÜTS) (opens in a new tab).

Two things to know first:

1. This is the highest-risk dermal filler area of the face. The under-eye area is adjacent to the region containing the vessels that supply the eye. Vascular occlusion, which may be seen in dermal filler procedures, may in this area lead to loss of vision. It is rarely seen; however, it requires intervention within minutes to hours, and this possibility is explained in detail before the procedure.

2. Not every under-eye appearance is a matter for this procedure. Darkening or swelling under the eye may arise from more than one cause, and some of these require medical assessment. No procedure is planned before the cause has been determined.

Dr. Suzan Alp, Specialist in Internal Medicine, performs the procedure at the practice (opens in a new tab).

Assessment first: what is the cause of the under-eye appearance?

No procedure is planned before the cause of the appearance under the eye has been determined.

This procedure is directed at the appearance of hollowing under the eye.

In these situations, no contribution can be expected from this procedure, or the contribution remains limited:

If darkening of colour is the prominent finding (this may be related to pigment in the skin or to thinness of the skin; dermal filler does not change this presentation and in some cases may make it more marked)
If bagging of the lower eyelid is the prominent finding (this may be related to the fatty tissue coming forward, and dermal filler may increase this presentation; assessment by the relevant surgical specialty may be required)
If excess skin and laxity are the prominent findings (the expected contribution is limited)

In the following situations, a medical assessment comes first:

Swelling that becomes marked in the mornings and lessens during the day (may be related to oedema)
Swelling that appears in both eyes together over a short period
Swelling accompanied by a change in the amount of urine, swelling in the legs or weight gain
Swelling that changes markedly with salt intake and sleep routine
Swelling accompanied by itching, a runny nose or sneezing (may be related to allergy)
Accompanying pallor of the skin and a feeling of weakness
A known or suspected presentation relating to thyroid function
One-sided, rapidly developing or painful swelling (this is not an aesthetic matter; it must be assessed without delay)

This assessment is carried out as part of the Internal Medicine Consultation. Presentations relating to thyroid function are described on the Thyroid Diseases page.

Which factors determine whether the procedure is suitable?

The decision on suitability is made after the medical assessment. The decisive factors are:

Whether hollowing, darkening or bagging is the prominent finding
The thickness of the skin and the support of the lower eyelid
Tendency to oedema; the difference between morning and evening
Whether there is a history of eye surgery
Dermal filler previously applied to the area: its type and when it was given
Which medicines are being used, and whether there is a bleeding tendency

In which patients is the procedure not performed?

In patients with a history of allergy to the product to be used or to its components
In patients with a history of allergy to the dissolving enzyme (intervention would not be possible if it were needed)
In pregnant and breastfeeding patients
In patients under 18 years of age

Situations that require separate assessment

Bleeding or clotting disorder, or use of blood-thinning or anticoagulant medicines
Active infection or febrile illness (the procedure is postponed)
Autoimmune disease in an active phase (the opinion of the relevant specialist physician is obtained)
Treatment that suppresses the immune system (the opinion of the relevant specialist physician is obtained)
Uncontrolled diabetes or uncontrolled high blood pressure (healing and the tendency to bruise may be affected)

Additional conditions specific to this area

The procedure is not performed if the following are present in the area to be treated:

An active infection, a stye or a skin disease

In these situations, the procedure is planned subject to the physician’s assessment:

An under-eye appearance whose cause has not been assessed (the assessment comes first)
A marked tendency to oedema (the cause of the oedema is assessed first; in this area dermal filler may retain water and increase the swelling)
Marked bagging of the lower eyelid (the procedure may increase the presentation; assessment by the relevant surgical specialty may be required)
Weak lower eyelid support
Very thin skin (the risk of the product becoming visible and of a bluish change in colour is higher)
Previous eye surgery (assessment by an ophthalmologist is required)
A non-absorbable type of dermal filler previously applied to the area (the opinion of the relevant specialist is sought)

How is the procedure performed?

Medical assessment. The cause of the appearance is determined; tendency to oedema, the difference between morning and evening, and accompanying complaints are asked about. Where necessary, a laboratory assessment is requested. If the findings listed above are present, no procedure is planned.
Decision on suitability and product check. The ÜTS registration, packaging integrity and expiry date of the product to be used are checked. The dissolving enzyme must be available where the procedure is carried out.
Information and consent. The procedure, the risk of vascular occlusion and of loss of vision, and the possibility of a bluish change in colour and of late swelling are explained in detail; the form is signed. The symptoms for which help should be sought without delay after the procedure are given in writing.
Preparation. There must be no make-up on the area; contact lenses are removed. Antisepsis is ensured.
Application. The product is delivered into the intended layer, in a measured amount.
Observation and follow-up. The patient is kept under observation after the procedure; vision and the area are checked for signs of vascular occlusion. Vital signs and observations are recorded in the file. A follow-up appointment is arranged.

When is the effect seen, and how long does it last?

The appearance seen in the first few days is not the final result. Swelling and bruising are commonly seen in this area; a period of waiting is needed before the result is assessed.

The effect is temporary. The product used is absorbed over time; the duration varies from person to person, by area and by product, and cannot be stated in advance. It has also been reported that in this area the product may remain for longer than expected.

What should you do before and after the procedure?

Before the procedure, report:

A list of all the medicines and supplements you use (in particular blood thinners, painkillers and herbal products)
Your known allergies
Your pregnancy and breastfeeding status

Come with no make-up on the area and no contact lenses in.

For this area, also state the following:

Is the area under your eyes more swollen in the mornings?
Do you have swelling in your legs, a change in the amount of urine, or weight gain?
Have you had eye surgery?
Have you had dermal filler in this area before? When, and of what type?

After:

Swelling and bruising are commonly seen; they may be marked in this area
The area must not be massaged and the eyes must not be rubbed
Paying attention to salt intake and sleeping with the head raised are recommended
The period given for the use of contact lenses must be observed
The period given for hot environments, saunas, sunbeds, swimming pools and intense exercise must be observed
For a time, you are asked to avoid bending forward and remaining head-down for long periods
You are asked to keep the written list of warnings you are given

Recommendations and time periods specific to you are given in writing at the end of the procedure.

Risks and side effects

This is the highest-risk area among dermal filler procedures.

Requiring urgent assessment

Loss of vision or a change in vision. This may develop as a result of vascular occlusion; it is rarely seen, but it requires intervention within minutes to hours
Vascular occlusion. The signs: pain that is more severe than expected and increasing, blanching of the skin, a purple-red change in colour in a net-like or spotted pattern, coldness of the area
Sudden and severe pain around the eye, drooping of the eyelid, double vision
Tissue loss in the skin (necrosis)
Infection and abscess at the site of the procedure

Other risks specific to this area

A bluish change in colour in the skin (reported more often under the eye because the skin there is thin)
Swelling appearing at a late stage, or not resolving (the product may retain water under the eye)
Firmness, irregularity or a raised area that can be felt by hand
Displacement of the product over time
Asymmetry
The expected change not being seen (where darkening or bagging is the prominent finding, the result is limited)

General risks that may occur with any minor procedure

Swelling, bruising, pain and tenderness
Temporary change in sensation
Allergic reaction

Results vary from person to person. No guarantee can be given as to a result or a duration.

When should you see a physician without delay?

If you experience these symptoms during treatment, contact your physician without delay:

Drooping of the eyelid
Increasing redness, increased warmth, swelling or discharge in the area
A high fever
Crusting or the formation of sores on the skin
Widespread rash, itching

In the event of pain that is more severe than expected and steadily increasing, blanching of the skin, a purple-red change in colour in a net-like or spotted pattern, or coldness or paleness of the area, contact your physician at once; if you cannot reach them, go to the nearest emergency department. In the event of any change in vision, blurring, darkening or loss of vision, double vision, sudden and severe pain around the eye, or rapidly increasing swelling of the lips and eyelids, go directly to the emergency department.

Frequently asked questions

What is the most serious risk of under-eye dermal filler?

It is loss of vision as a result of vascular occlusion. The under-eye area is adjacent to the region containing the vessels that supply the eye. It is rarely seen, but it requires intervention within minutes to hours. In the event of any change in vision, consult a physician immediately.

Is dermal filler suitable for the dark circles under my eyes?

If darkening of colour is the prominent finding, there is only a limited place for this procedure; the darkening may be related to pigment in the skin or to thinness of the skin. Dermal filler does not change this presentation and in some cases may make it more marked. Which presentation is prominent is determined at the consultation.

What might be causing the swelling under my eyes?

Swelling under the eye may have more than one cause. Swelling that becomes marked in the mornings and lessens during the day, that changes with salt intake and sleep routine, or that is accompanied by swelling in the legs, a change in the amount of urine or weight gain may be related to oedema, and requires medical assessment first.

I have bags under my eyes — will dermal filler resolve them?

If bagging of the lower eyelid is the prominent finding, the procedure may increase the presentation; this may be related to the fatty tissue coming forward, and assessment by the relevant surgical specialty may be required.

Will the area under my eyes swell even more after the procedure?

Swelling and bruising are commonly seen in this area. Swelling that appears at a late stage, or that does not resolve, is also among the situations reported; in this area the product may retain water. For this reason, tendency to oedema is assessed before the procedure.

Can a bluish colour develop under my eyes?

Yes, this is among the side effects reported for this area, and it is seen more often because the skin is thin. In those whose skin is very thin this risk is higher, and it is discussed before the procedure.

Can under-eye dermal filler be reversed?

With products containing hyaluronic acid, a dissolving enzyme may be used; this enzyme must be available where the procedure is carried out. Non-absorbable types of dermal filler cannot be removed in this way.

I have had eye surgery — can under-eye dermal filler be performed?

In those who have had eye surgery, the procedure is not performed without obtaining the opinion of an ophthalmologist. State the type and date of your operation at the consultation.

Is under-eye dermal filler performed during pregnancy?

No. The procedure is not performed during pregnancy or while breastfeeding.

Sources

Ministry of Health of the Republic of Türkiye, Turkish Medicines and Medical Devices Agency, Tıbbi Cihaz ve Ürün Takip Sistemi (ÜTS). https://www.titck.gov.tr/faaliyetalanlari/tibbicihaz (opens in a new tab)
Ministry of Health of the Republic of Türkiye, Turkish Medicines and Medical Devices Agency, Tıbbi Cihaz Yönetmeliği, Official Gazette 2 June 2021 / 31499 (repeated). https://www.mevzuat.gov.tr/mevzuat?MevzuatNo=38657&MevzuatTur=7&MevzuatTertip=5 (opens in a new tab)
Ministry of Health of the Republic of Türkiye, Ayakta Teşhis ve Tedavi Yapılan Özel Sağlık Kuruluşları Hakkında Yönetmelikte Değişiklik Yapılmasına Dair Yönetmelik, Official Gazette 7 January 2025 / 32775. https://www.resmigazete.gov.tr/eskiler/2025/01/20250107-3.htm (opens in a new tab)

Under-Eye Dermal Filler