Everything You Need to Know About Eyelid Fillers

• Dermal fillers temporarily improve eyelid area concerns such as hollowness, drooping and tear trough deformities
• Although their use is off-label Belotero, Juvederm, Restylane and Radiesse brands are considered safe for this area
• As this treatment is associated with major risks, choose an experienced, board-certified provider to reduce the likelihood of complications

Dermal fillers are a minimally invasive, temporary solution for wrinkles and volume loss in the face. They’re made of a gel-like substance that plumps the targeted area, creating a fuller, rejuvenated appearance. 

Fillers can be injected almost anywhere on the face, including in and around the eyelid. Eyelid fillers temporarily correct volume loss and other aging concerns related to both upper and lower eyelids. 

What Eyelid Area Conditions Can Be Addressed with Fillers?

Fillers can be injected into the periorbital area (the areas above, below and around the eye) to address several concerns.

Upper eyelid hollowness

As part of the aging process, skin loses its collagen and elastin, proteins that give skin its structure and shape. The skin above the eyes is thin to begin with, so with time it can become thinner and give the impression of sunken eyes. Fillers have been shown to be very effective for people with symmetric or asymmetric hollowness on the upper lids.

Drooping brows and eyelids

Loose, aged skin in the brow area can cause a drooping or hooded effect. This skin laxity is called dermatochalasis.

Dermal fillers can address mild forms of this condition; however, excessive loose eyelid skin must be surgically removed.

Tear trough deformity

The tear trough is the depression that joins the lower eyelid and cheek, just above the lower bone ridge of the eye socket. A tear trough deformity occurs when the skin thins or sags, making the eye socket appear deeper and sometimes causing under-eye bags. These deformities are usually due to aging or genetics.

Fillers in this area work best for people who have only small or no under-eye bags.

Types of Fillers for Eyelid Area Injections

Most dermal fillers are made of a synthetic form of hyaluronic acid (HA), a naturally occurring substance in the body that attracts water and helps skin stay hydrated and plump. As a soft tissue filler, hyaluronic acid temporarily smooths fine lines and wrinkles, and fills out sunken areas.

Currently, only one dermal filler on the market is approved for injection around the eyes. However, multiple studies have demonstrated that other filler brands are safe and effective for this purpose; these products are used off-label by many dermatologists.  

The following fillers are considered the best and most effective options for the eyelids, based on clinical studies and physician experience.

Juvederm

Juvederm Volbella XC is a soft, pliable hyaluronic acid filler recently FDA-approved as an under-eye filler for people aged 21 and up, making it the only filler on the market specifically approved for use underneath the eye. It has not been approved for the upper eye.

Belotero

Several studies have shown that Belotero Balance safely corrects tear trough deformities and fills in under-eye hollows. It’s a highly cross-linked form of hyaluronic acid, meaning that it lasts longer and integrates more homogeneously with skin tissue for smoother results.

Restylane

Restylane is another family of HA fillers. One recent study found the Restylane original formula to safely address volume loss in the upper eye area. Another small trial concluded the pen-style Restylane Vital injector offered more predictable results and fewer adverse effects than other injection techniques in the treatment of tear trough deformity.

Radiesse

Unlike the products above, Radiesse is a calcium hydroxyapatite (CaHa) filler. It consists of CaHa microspheres suspended in a gel carrier. This product immediately plumps the treatment area while also encouraging long-term collagen growth.

In one study, satisfaction was as high as 98% among patients treated for upper eyelid hollowness, with an overall satisfaction rate of 92% that included treatment for dark circles and lower eyelid bags.

Another small study used an alternate treatment with Radiesse using smaller quantities placed deep within the skin and without injecting the solution into the tear trough. Researchers were able to successfully lift sagging tear trough ligaments, treat hyperpigmentation and improve skin quality using this method.

What to Expect from Your Eyelid Area Filler Injections

Getting filler treatments is a relatively simple procedure. You should arrive at your appointment with a clean face that is free of makeup or skin care products. 

First, your provider will cleanse the treatment area, decide where the injections should be placed and apply a numbing cream. They will then administer the product through a thin cannula, moving the product below the skin’s surface to ensure even placement. They may also massage your skin to position the filler. The entire process shouldn’t take more than 10–20 minutes.

Follow all aftercare instructions from your provider, including attending a follow-up appointment. This may include:

• Massaging the treatment area
• Avoiding exposure to heat and sunlight
• Avoiding other cosmetic treatments such as chemical peels or laser therapies

Eyelid fillers don’t require any downtime; however, you may experience itching, redness, pain or swelling for up to 36 hours after your appointment.

Your results will be visible within 1 week and continue to develop over the next month. In the case of CaHa fillers, your skin will continue to improve over several months.

How long can results last?

Hyaluronic acid fillers generally last 6–12 months, depending on the product, while CaHa fillers can last up to 2 years. 

Eyelid Fillers Before and Afters

Disclaimer: The people pictured here may have undergone other cosmetic procedures in addition to eyelid filler injections.

Eyelid Fillers Injections Safety

Although fillers are generally considered safe, they are not without risks, and injecting them in the eye area is riskier than around the mouth or in the cheeks. That’s because the skin there is very delicate with a high number of blood vessels. 

If filler is accidentally injected into a blood vessel, it can cause a vascular occlusion, a reduction or blockage of blood flow. An occlusion can cause tissue necrosis either at the injection site or, if the blockage moves, elsewhere in the body.

Signs of vascular occlusion include white, blue or mottled discoloration at the injection site. It sometimes, but not always, causes pain or discomfort.

If you experience any symptoms of occlusion in the hours after receiving treatment, contact your provider immediately. 

Other possible complications of fillers include:

• Allergic reaction
• Blindness
• Granuloma, a mass or nodule of chronically inflamed tissue
• Livedo reticularis, a red or blue net-like discoloration of the skin
• Infection
• Rash

How to select a provider for eyelid fillers

Because of the risk of complications associated with treatment, it’s important to have a provider you can trust. Lower your risk by choosing an injector with the following characteristics:

• Board-certified plastic surgeon, oculoplastic surgeon or dermatologist
• Practices in a medical, sterile setting (not a spa or resort)
• Able to perform an accurate clinical assessment
• Familiarity with the vascular anatomy of the eye
• Knowledge of products with appropriate injection techniques

Cost of Eyelid Fillers

The total cost of your eyelid filler treatment depends on your provider’s rates, your location and how much product is used. The average cost per vial for hyaluronic acid fillers is $684, while CaHa fillers such as Radiesse cost about $717.

Many patients require only one vial to treat both eyes, but more may be necessary. Additionally, because injectable fillers are only temporary, maintenance treatments will incur further costs.

Alternative Treatments for the Eyelid Area

Fillers aren’t the only solution for eye area rejuvenation. Depending on your eyelid area concerns, another procedure or treatment may be a more effective solution.

Blepharoplasty

Blepharoplasty, or eyelid surgery, is a permanent alternative to eyelid fillers. An upper blepharoplasty lifts drooping upper lids, while a lower one can tighten loose skin below the eye. 

It’s also possible to combine the two into a single procedure. It’s an effective solution for people with moderate to severe skin laxity or for those looking for a lasting solution.

This procedure and upper eyelid fillers can be safely combined to optimize results.

As with selecting an eyelid filler provider, be sure to choose a highly experienced plastic surgeon to perform your procedure. Possible complications following surgery include an uneven eyelid appearance, infection, blurred vision or blindness.

Fat transfer

This procedure involves suctioning fat from an area of the body and transferring it above or below the eye. While the current literature demonstrates fat grafting to be effective with little risk of complications, it’s a relatively new technique without standardized practices and its long-term effects have yet to be studied.

Neuromodulators

A neurotoxin such as Botox can treat drooping brows in what’s known as a Botox brow lift. However, it can’t treat excess loose eyelid skin.

Neuromodulators can also be injected prior to an upper blepharoplasty to allow better surgical planning and to optimize results.

Takeaway

Eyelid fillers are a temporary but effective solution for rejuvenating the eye area. They can firm up drooping lids, reduce upper eye hollowness and plump tear trough deformities for a fuller, younger-looking appearance. 

While only Juvederm Volbella XC is FDA approved for use under the eyes, off-label products generally considered safe for this area are Belotero Balance, Juvederm Ultra, Restylane and Restylane Vital and Radiesse.

Because any procedure around the eye is inherently risky, it’s important to choose a board-certified, experienced provider for your eye fillers.

Other options include neuromodulators, a fat transfer or surgery. These options can also be used in conjunction with fillers for optimal results.