9 Alternatives to Under-eye Filler

If you haven’t already noticed, we’re always talking about dermal fillers on The AEDITION. To say we’re obsessed might be an understatement. Over the past six years, we’ve covered everything from lip augmentation to liquid rhinoplasties and chin enhancements to filler fatigue. Most recently, we've taken a deep dive into under-eye filler where we laid out all of its benefits and limitations — and we were surprised to learn there’s actually a lot of criteria to be considered a good candidate. So, if you found out that under-eye filler is not for you, you’ll definitely want to read on. We reached out to some of the top plastic surgeons to round up nine filler alternatives to help rejuvenate your under-eyes.

Under-eye Issues and Causes

When it comes to under-eye issues, they usually fall into one of three buckets: dark circles, bags, or hallowing. Dark circles, which are sometimes referred to as “raccoon eyes,” are when the skin under the eyes appears darker. Because the skin under the eyes is so thin, we can see a blue, purple, or red tint when the blood vessels are dilated. Under-eye bags, on the other hand, is an issue when there’s an abnormal amount of swelling or puffiness under the eyes. Everyone actually has under-eye bags, but unless there’s sagging skin of excess fluid, they’re usually not noticeable. Lastly, there’s hallowing, which is usually a result of heredity or aging. Some people are born with a more defined tear trough (the area between the eyelid fat pad and the cheek fat pad) whereas others can experience volume loss as they get older.

While each of these under-eye concerns affects the same area, they each have different causes and treatments. When you meet with your board-certified practitioner, they’ll help you determine the root cause of your under-eye issues. But, these are the main culprits:

• Age: When we age, we tend to lose volume and gravity can cause sagging. 
• Lifestyle: Things like insufficient sleep, alcohol consumption, and smoking can cause a whole slew of under-eye issues.
• Allergies: When allergies cause nasal congestion, they can increase the pressure in the blood vessels under the eyes. This can cause discoloration, known as “allergic shiners.” 
• Health: Under-eye bags, which can be caused by fluid retention, can sometimes be a symptom of an underlying health condition, like hypo or hyperthyroidism, kidney dysfunction, or liver dysfunction. 

Limitations Around Under-eye Injectables

While tear-trough filler is commonly talked about when addressing under-eye issues, it actually isn’t a great solution for most people. For starters, it’s not going to fix dark circles or under-eye bags. In fact, getting filler to correct pigmentation issues or puffiness is only going to make the problem worse; instead of concealing the dark circles or under-eye bags, filler would accentuate it.

Injectables do have a very specific time and place though; they can restore lost volume in the tear trough area. So, the ideal candidate would have hollowness without under-eye puffiness or darkness. Flora Levin, MD, Board-Certified Oculofacial Plastic Surgeon, told us that only a small portion of those with dark circles are actually filler candidates.

Most board-certified practitioners would recommend a hyaluronic acid (e.g. Restylane, Juvederm, Belotero, etc) to treat this area. Meegan Gruber, MD, PhD, Aesthetic Plastic Surgeon, says that this is because hyaluronic acid can be easily dissolved if the results are not as desired or if there has been an excess application.

It’s always important to find a reputable injector, but even more so when targeting the eyes. Because the skin under the eyes is incredibly delicate and full of blood vessels, it’s more prone to bruising and swelling. If injected improperly, patients can develop nodules, experience discoloration (Tyndall Effect), or overfilling. More seriously (but very rarely), improper injections can even lead to tissue damage or even blindness.

9 Alternatives to Under-eye Filler

We spoke to three top plastic surgeons to find out the best filler alternatives to help depuff, conceal, and rejuvenate the under-eyes. Here are nine of their recommendations:

Lifestyle changes

We’ve said it before and we’ll say it again, but having a healthy lifestyle really is a key part of maintaining a youthful appearance. Lifestyle factors like smoking, alcohol consumption, and sleep can all impact our under-eye region.

According to Dr. William Kennedy, MD, board-certified Head & Neck Surgeon and Facial Plastic Surgeon, and Founder of AEDIT MedSpa™; “While the effects of poor habits are usually reversible, they really can impact the appearance of our under-eyes. It’s not a myth that lack of sleep can lead to dark circles. When someone doesn’t get enough sleep, the blood vessels under the eye dilate. This occurs due to decreased oxygen levels in the eyes causing the blood vessels to expand.  The skin under the eyes is very thin and thus translucent, allowing the dilated blood vessels to become more visible and thus can make the under-eye area appear dark or puffy.”

At-home remedies

For those looking to DIY, there are a number of expert-recommended topicals and tools. Dr. Levin recommends cold compresses or caffeine, which will vasoconstrict and depuff. She also likes creams and concealers to temporarily mask imperfections and even out skin tone. One of Dr. Levin’s favorites is iT Cosmetics Bye Bye under-eye Bags Daytime eye cream, which depuffs, tightens, and smooths.

To achieve a more uniform skin tone, Dr. Gruber recommends retinol or formulations with vitamin C, niacinamide, and vitamin K, which effectively address pigmentation and dark circles. For patients who are looking for added hydration or to enhance elasticity, Dr. Gruber suggests serums containing peptides and hyaluronic acid. But, at the end of the day, Dr. Gruber reminds us that although these remedies may offer some benefits, they typically cannot replace professional treatments.

Medication

While it’s hard to believe, allergies can be the culprit of dark under-eye circles, known as “allergic shiners.” Allergies can be from the environment, specific foods, or any type of irritant. To diminish the allergic shiners, doctors typically prescribe some sort of medication, like an antihistamine, nasal spray, or decongestant.

The theory behind "allergic shiners" is the result of a combination of physiological responses to allergens, primarily affecting the nose and region around your eyes.  The process begins when the immune system reacts to allergens, which then causes inflammation and swelling in the nasal mucosa.  This swelling causes a slowing of the blood flow in the veins around the paranasal sinuses.  These veins are close to the surface of the skin under the eyes, and when they become congested, they appear darker and puffier, or in lay terms “Allergic Shiners” says Dr. Kennedy.

Laser

Laser treatments create a managed burn to the skin at a precise depth to remove the dead cell layer. There are several different types of lasers; some focus on pigments, like sun spots or red spider veins, while others target the water within skin cells. For concerns around the under-eye area, Dr. Gruber says lasers can help lighten pigmentation and boost collagen production to improve skin texture and minimize fine lines. While it depends on the specific laser used and the patient’s skin, most people end up needing several sessions to maximize results. However, Dr. Gruber adds that lasers aren’t the best options when it comes to tackling more profound structural concerns, like hollowing or fat prolapse.

Chemical Peels

Peels rely on the application of chemicals to create a gentle, but controlled burn. The micro-injury promotes new skin growth that is typically more rejuvenated with reduced wrinkles. “Peels can assist in achieving a more uniform skin tone and minimize pigmentation concerns that lead to dark circles beneath the eyes,” Dr. Gruber shares with us. “Nonetheless, they don't tackle issues like volume loss, hollowness, or prominent under-eye bags, so they are frequently paired with additional treatments.”

Dr. Kennedy says that: "Dark circles under the eyes appear due to the loss of fat in the under-eye area. The loss of fat allows blood vessels to move closer to the skin and These vessels with their dark color and pigmentation easily appear through the very thin under-eye skin. Any treatment that enhances the thickness of the undereye skin and decreases the pigmentation in the blood vessels, will provide the best opportunity for decreasing the appearance of dark circles under the eye. Although chemical peels are very good at improving skin laxity and wrinkles, it is only 1 part of the equation for the treatment of dark under eye circles. At AEDIT we prefer the dual action treatment approach of lasers, such as the Stellar laser with Optilight handpiece. Lasers will BOTH increase the thickness of your under-eye skin and decrease the blood vessel pigmentation that lurks beneath to give you optimal results."

Microneedling

Similar to the effects of a chemical peel or laser treatment, Dr. Gruber says microneedling uses its needles to create a precise injury that encourages the skin to heal, boosting collagen production and cell turnover. “For under-eye concerns, microneedling can improve skin texture, boost firmness, and address mild pigmentation,” Dr. Gruber shares with The AEDITION. “Nonetheless, its impact on dark circles resulting from vascular concerns or fat displacement is somewhat restricted. It is frequently paired with PRP or topical serums to achieve even better outcomes.”

CO2 Laser

CO2 lasers, also known as carboxytherapy, are excellent for tightening skin and minimizing wrinkles, particularly for rejuvenating the under-eye area. That being said, Dr. Gruber says there are a couple of important considerations: they can have increased downtime and also pose a greater risk of pigmentation changes, especially for those with darker skin tones. Like traditional lasers, they also can’t significantly improve hollowing or under-eye bags.

PRP

Platelet-rich plasma (PRP) is a treatment using the patient’s own blood to promote healing. For the procedure, patients get their blood drawn as they would for a lab test, and then the plasma component is separated by centrifuge. When it comes to cosmetics, PRP is most commonly used for hair restoration and skin rejuvenation where it can enhance texture and volume.

According to Dr. Gruber, PRP works exceptionally well at enhancing skin quality to improve dark circles and slight hollowness beneath the eyes but it is constrained when tackling under-eye bags that are a result of fat prolapse or significant volume loss.

Lower blepharoplasty

A lower blepharoplasty is the most effective route for patients looking to reduce the appearance of their under-eye bags. In the procedure, a board-certified surgeon will entirely remove the fat bags so patients shouldn’t have any under-eye puffiness moving forward. However, it’s important to note that it is a surgical procedure, so there is significant downtime and expenses. Dr. Levin says she often combines the procedure with a CO2 laser to improve the skin quality and sometimes with a fat transfer if there is also facial volume loss in the cheeks and /or midface.