Image Credit: Adam Hale @the.daily.splice

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](https://aedit.com/aedition/what-its-like-to-get-lip-filler) to [liquid rhinoplasties](https://aedit.com/aedition/facts-about-liquid-rhinoplasty) and [chin enhancements](https://aedit.com/aedition/best-chin-augmentation-enhancement-procedures) to[ filler fatigue](https://aedit.com/aedition/dermal-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](https://www.drfloralevin.com/), 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](https://www.drmeegangruber.com/?gad_source=1&gclid=CjwKCAiA9bq6BhAKEiwAH6bqoJXjGRtMQBk6cShOn_UiQ52T1VE0D5I9ejpySe8hvQmfrbtYYzdL-hoCXBYQAvD_BwE), 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](https://aedit.com/provider/william-kennedy-md-26292), 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](https://www.itcosmetics.com/skincare/skincare-products/eye-cream/bye-bye-under-eye-bags-daytime-treatment/ITC_1171.html?dwvar_ITC__1171_size=0.5%20US%20fl.%20oz%2F15%20ml&gad_source=1&gclid=Cj0KCQiA_9u5BhCUARIsABbMSPu6m9TrvWI1aGj70yk7mmquV_SzYGY-LyswV3HF5OIlaxa8-CdXgDEaAsuhEALw_wcB&gclsrc=aw.ds), 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.


Expert Opinion

If you’ve realized that under-eye fillers aren't your match, don't fret. We've consulted with leading plastic surgeons to bring you nine compelling alternatives for rejuvenating your under-eyes.

Invasive and Non-Invasive Alternatives to Under-Eye Filler

9 Alternatives to Under-eye Filler

Sahand Hoseini for Unsplash - Under-eye Filler

sahand-hoseini-RnCLtXEouJE-unsplash-min (1)-min

You’ve likely seen the before and after pictures on social media of people who seemingly had all of their under eye concerns erased thanks to a bit of strategically placed filler in the tear trough region. For the right patient, under eye filler can have a transformative contouring, smoothing, and brightening effect. But depending on the cause of your dark circles, hollowing, and skin quality concerns, under eye filler can actually make matters worse.

So, how can you tell if you are a candidate for under eye filler? We’re talking to top dermatologists and plastic surgeons about the pros and cons of the minimally invasive procedure and the factors that go into determining whether or not it’s right for you.
## **The Benefits of Under Eye Filler**
When we talk about under eye concerns, it's often in general terms. How many times have you heard someone say their eyes look 'tired'? Or that they want them to appear more ‘awake’? The reality is that there are a number of smaller factors that contribute to the eye area looking a little sleepy. 

One of the biggest culprits of 'tired' under eyes is a lack of volume in the under eye area either due to anatomy or age. “In some patients, aging leads to the loss of fat under the eyes, giving a hollow or skeletal appearance,” says [Nigar N. Ahmedli, MD,](https://www.montefiore.org/doctors/profiles/1790164341/nigar-n.-ahmedli) a board certified otolaryngologist in New York City who specializes in facial plastic and reconstructive surgery. Those hollows can then create the illusion of darkness in the region. "They worsen the appearance of dark circles under the eyes by creating a shadow that accentuates the darkness," she notes.

Additionally, the volume loss draws attention to the tear trough. “The ‘tear trough’ area refers to the separation between the lower eyelid and the upper cheek,” says [Elizabeth Callahan, MD,](https://sarasotadermatologist.com/) board certified dermatologic surgeon in Sarasota, FL. Coupled with changes in skin quality, the result is fine lines, dark circles, a general loss of contour, and, yes, an overall 'tired' appearance. 

Injecting a hyaluronic acid (HA)-based filler into the under eye area can be an effective treatment for this. “Under eye filler is best for providing volume to the hollows beneath your eyes,” says [Melissa Doft, MD,](https://aedit.com/provider/melissa-doft-md-63) a double board certified plastic and reconstructive surgeon in NYC. "Adding filler to the under eye area will help with shadows and also act as a wonderful moisturizer to help with dehydrated and crepey skin."

It can also be used to improve the contour of the upper face. "Under eye fillers can address the hollows created beneath the eyelid and at the junction of the cheek and lower eyelid," says [Kenrick Spence, MD,](https://www.mynewbeauty.com) a board certified plastic and reconstructive surgeon in Orlando, FL. "Asymmetry can be corrected and dark circles can be softened with the help of under eye fillers."

## **The Misconceptions About Under Eye Filler**

Here’s the thing, under eye filler “can address aesthetic concerns like hollowness, volume loss, and shadows,” says [Kami Parsa, MD,](https://www.oculoplastic.info/) a board certified oculoplastic surgeon in Beverly Hills. And here comes the ‘but.’ “A misconception is that filler can help everyone,” Dr. Callahan notes. This is because “under eye filler is not a blanket intervention that addresses all under eye-related concerns,” Dr. Ahmedli adds.

With that in mind, we asked our pros to break down some of the most common misconceptions about under eye filler:
### **1. Under Eye Filler Treats Eye Bags**
For starters, under eye filler does not treat what we colloquially refer to as ‘eye bags’ and puffiness. “Puffiness is due to excess fat or lack of proper lymphatic drainage,” Dr. Doft says. “Both of which will not improve with fillers.” Regardless of the cause, the appearance of puffiness is “the opposite of having hollows,” Dr. Ahmedli notes. 

In the case of puffiness caused by excess fat, “the under-eye fat protrudes forward instead of retracting into the eye socket,” Dr. Ahmedli explains. Filler will only exacerbate this. “Adding filler to an area that’s already puffy just makes it worse,” Dr. Parsa says. This can be true even if you simultaneously have both depressions and puffiness as a result of displaced fat. “In some people, there are under eye bags, which create a relative bulge followed by a hollow,” says [Lesley Rabach, MD,](https://lmmedicalnyc.com/dr-lesley-rabach/) a double board certified facial plastic and reconstructive surgeon in NYC.
### **2. Under Eye Filler Erases Dark Circles**
You’ll be hard pressed to find someone who hasn’t dealt with dark circles under the eye. And while under eye filler can help brighten the area by lessening the shadowing caused by hollowing, it does not directly treat discoloration. “Filler will not improve dark circles or discoloration of the skin,” says [Oren Tepper, MD,](https://orenteppermd.com/) a board certified plastic and reconstructive surgeon in NYC. 


The reason? Dark circles are not one size fits all. “Dark circles and hollows under the eyes can be caused by various factors, including lack of sleep, genetics, aging, allergies, sun exposure, dehydration, various lifestyle factors, and other medical conditions,” Dr. Callahan shares. And remember: “Everyone has some degree of darkness under the eye,” Dr. Rabach emphasizes.
### **3. Under Eye Filler Is Risk Free**
Getting HA filler in any part of the face can seem like a ‘quick fix’ that offers immediate results with little to no downtime. But the reality is that injecting filler – especially to the complex under eye area – requires a great deal of training and understanding of facial anatomy. “There is a misconception that placing filler under the eye is completely safe,” Dr. Doft cautions. 

As she explains, under eye filler can have a tyndall effect when it’s injected too superficially, leading to a blue tint under the skin. It can also cause “scarring of the lymphatics leading to malar bags and possible blindness,” she says. For these reasons, “this is a procedure I would only have a board certified plastic surgeon or dermatologist perform,” Dr. Doft shares. 

Technique is also vital to ensure a safe, effective, and aesthetically pleasing result. “Many providers place tear trough or under eye filler in the wrong spot,” Dr. Rabach notes. “It is a very delicate area, but it is most of the time placed too low – almost over the orbital rim – instead of high into the tear trough.” Seeing a board certified provider who regularly performs the procedure can help mitigate this risk.
### **4. Under Eye Filler Is Like a Filter**
Even in the best hands, it’s also important to keep your expectations in check. “The most common misconceptions about under eye filler are that it is a simple intervention that improves under eye hollows, bags, dark circles, and skin texture,” Dr. Ahmedli explains. “It is crucial to understand that dark circles are due to the deposition of pigment into the thin skin of the eyelid, and lower eyelid skin tends to become like crepe paper – crinkled with fine lines – with aging.” 

And no, you are not going to look perpetually Facetuned. “People think under eye filler will completely make under eye hollows or darkness go away, and that you will look like a heavily filtered Instagram model after treatment,” Dr. Rabach says. “No one looks like this.”
## **Are You a Candidate for Under Eye Filler?**
Now that you know the benefits and limitations of under eye filler, it’s time to determine if you are a candidate. During a consultation with a board certified dermatologist or plastic surgeon, the provider will be studying the under eye region to determine the root cause of your aesthetic concerns. "There are so many factors when we discuss the under eye hollows because they happen for so many reasons," Dr. Rabach notes.

As she explains, it is important to look at skin tone and what is behind any darkness or discoloration. “The skin is so thin, so we can see tiny blood vessels under the skin,” she shares. “The skin is also more prone to pigmentation due to the hollow and being so delicate.” Additionally, darkening under the eyes can be caused by “light reflecting off the concavity making a shadow,” she notes. Only the latter can be improved with filler.

And then there is the contour of the under eye region. “In some people, there are under eye ‘bags’ that create a relative bulge followed by a hollow,” she says. “We also need to consider the relationship and general anatomy of where the orbital rim is related to the eyelashes and the direction of the hollow.” These factors and more, she notes, “need to be weighed for candidacy for under eye filler.”

Here are some general guidelines for what makes someone an ideal candidate for under eye filler:
### **Ideal Candidates for Under Eye Filler**
The ideal candidate for under eye filler “is a patient who has hollows under the eyes without puffiness and without heavy dark circles,” Dr. Ahmedli says. “This allows for filler to be placed in the hollow to correct the depression and to restore the natural slope of the under eye-to-cheek transition found in a youthful face.”

When it comes to volume loss and puffiness, there is a fine line between how much is too much. “An ideal candidate for under eye fillers is someone that has a modest loss of volume, mild bulging of fat pads, and modest skin laxity under the eye region,” Dr. Spence says. This means age will be a factor. Dr. Rabach says ideal candidates for under eye filler are generally “younger” – meaning twenties, thirties, and forties. 

Skin quality matters as well, Dr. Tepper notes. “Thicker skin,” Dr. Rabach says, is better suited for filler because it usually blocks any visible under eye vessels that can cause discoloration. Additionally, she said the region should have little to no pigmentation (another common cause of dark circles). 

Last but not least, under eye filler can be an option for “people who are not ready for surgery,” Dr. Parsa says. In such cases, however, it’s important to know what you are signing up for. “There is definitely a limitation on how much they work,” he notes. “And the key here is to understand that fillers are not a permanent solution.” Though they may hang around longer than expected. “Fillers last many years, even though we are told they last only six months,” he cautions. 
### **Non-Candidates for Under Eye Filler**
Generally speaking, “someone who is older with larger bags, lots of excess skin, pigmentation, and/or very thin skin” would not be a good candidate for under eye filler, Dr. Rabach says.

As it relates to most dark circles, filler is not a fix. “Filler cannot correct issues such as genetic hyperpigmentation or blood vessels shown under the eyes,” Dr. Callahan shares. Similarly, it can’t necessarily contour away puffiness. “Some patients lack under eye hollows and instead have more fullness or ‘bags,’” Dr. Ahmedli says. “This creates a bubbling look in which the under-eye bulges forward and accentuates the tear trough groove underneath leading to a harsher separation between the under eye and cheek.” Filling the area can exacerbate this.

It’s also important to consider the anatomy of your entire face – not just the under eye. “If the patient lacks cheek fat, then filling the tear trough groove becomes tricky,” Dr. Ahmedli cautions. “A provider cannot fill the groove to maximal correction because the lower lid will appear even puffier, creating the dreaded ‘chipmunk’ look.” Dr. Spence agrees that those with “severe volume loss from the cheek are not going to be the ideal candidates for under eye filler.” Ultimately, Dr. Callahan says you need to identify the actual culprit of your aesthetic concerns. “Filler will not help if the real problem is lack of volume in the cheeks just below the dark circles,” she notes.

Another thing to keep in mind? Your health. “A bad filler candidate is someone who suffers from chronic/seasonal allergies (itchy swollen eyes), puffy lower eye bags, fluid retention syndrome (eye bags that swell in the morning or based on what you eat), and those who have a significant amount of loose skin under the eyes,” Dr. Parsa shares. “Adding volume with HA filler to the undereyes will make things look worse in these situations.”
### **Do You Actually Need a Blepharoplasty?**
We’ve talked a lot about why you might not be a good candidate for under eye filler if you have under eye bags, puffiness, and skin laxity. What may be a solution, however, is a surgical blepharoplasty. “Blepharoplasty is a surgical procedure aimed at rejuvenating the eyelids,” Dr. Callahan explains. “It involves the removal of excess skin, fat, and sometimes muscle from the upper and/or lower eyelids.” 

When it comes to the lower lid, the eyelid surgery can address eye bags and skin laxity concerns. “Lower eyelid blepharoplasty, or lower eyelid lift, allows for excess skin to be removed and for the fat pockets to be contoured and repositioned to improve the appearance of the puffiness and the tear trough groove,” Dr. Ahmedli shares. As Dr. Tepper explains, a blepharoplasty is the preferred treatment if “tear trough deformity is moderate to severe” and “there is excess fat protruding in the lower eyelids.” While “filler will not correct or address this,” he says, “the fat can be removed or transposed” surgically.

For some patients, under eye filler is a gateway to blepharoplasty. “It is more common for younger patients to begin with under eye filler given the lack of excess skin,” Dr. Ahmedli notes. But that is not always the case. “A lot of our patients think the best way to treat their under eye concerns is by adding volume with filler,” Dr. Parsa says. “We have had countless patients come to us to remove their under eye filler and proceed with a blepharoplasty for long-term results.” In such cases, the under eye filler must be completely dissolved before proceeding with surgery, he adds.

For others, surgery is the best and only option. “If the real problem is fat pad herniation (a.k.a. eye bags) then surgery is the best choice,” Dr. Callahan says. Additionally, “if a patient has excess lower eyelid skin that is bunching, then blepharoplasty is a better option than filler,” Dr. Ahmedli shares. Ultimately, “a patient with significant skin laxity and bulging fat pads with volume loss to the cheeks is better served with a surgical approach,” Dr. Spence says. “The procedure actually removes excess skin and fat rather than filling in any hollowness.”
### **The Takeaway**
Under eye filler can be a rejuvenating treatment that instantly revitalizes the eye area, but it is important to understand that it has its limitations. Fillers will add volume to an area and are great for problems due to a loss of volume such as dark circles. For under eye issues due to abnormally enhanced volume, such as eye bags or festoons, under eye fillers are not appropriate and can exacerbate your problem. Says fellowship trained Facial Plastic Surgeon, [Dr. William A. Kennedy, MD](https://aedit.com/provider/william-kennedy-md-26292). If you are interested in under eye filler and think you may be a candidate, The AEDITOR — the patented 3D Aesthetic Simulator available exclusively in the AEDIT iOS app — allows you to ‘try on’ the procedure and instantly visualize medically accurate results. Download the app here, and, once you give it a try, consult with a board certified dermatologist or plastic surgeon to determine if under eye filler is the right treatment option for you.

Now Trending

Are You a Candidate for Under Eye Filler? 

Are You a Candidate for Under Eye Filler? Here’s How to Tell

carlos-martinez-jVHNm1Tf46Q-unsplash

The ever-popular [blepharoplasty](https://aedit.com/procedure/blepharoplasty-eyelid-surgery) (a.k.a. eyelid surgery or eye lift)  procedure corrects signs of aging on the upper eyelid, lower eyelid, or, in some cases, both, including loose skin, upper lid hooding, under eye bags, and more. Younger blepharoplasty patients (think: those in their [twenties](https://aedit.com/aedition/best-cosmetic-procedures-plastic-surgery-to-consider-in-your-20s) and [thirties](https://aedit.com/aedition/best-cosmetic-procedures-plastic-surgery-to-consider-in-your-30s)) often undergo surgery to address and/or change the structure of the eyes. When asymmetries, lack of definition in the upper lid, and persistent bags are long-standing complaints, the procedure can be a long-term fix.

But not everyone is ready for, nor needs, an eye lift to improve the look of the eyes. That's why non-surgical treatment options like thread lifts, fillers, neuromodulator brow lifts, lash extensions, and even contouring makeup are considered the next best things. Here, we’re rounding up the top four ways to rejuvenate and enhance the look of the eyes – sans surgery.

## **1. Accentuate the Lashes**
One of the quickest and most painless ways to accentuate and enhance the appearance of the eyes is with [eyelash extensions](https://aedit.com/procedure/eyelash-extensions). By adhering the correct lash extension style to the eye, attention is drawn away from droopy or puffy eyelids for a more youthful and lifted appearance, says Clementina Richardson, a celebrity lash expert and founder of [Envious Lashes](https://www.enviouslashes.com/). Unfortunately, there are a lot of women walking around with thick, unnatural-looking extensions or without a design that complements the natural shape of the eye, which makes them appear heavy and even droopy. Richardson shares that for extensions to open up the eyes, you should ask for longer extensions in the center of the upper eyelid. “Stay away from longer ends, which pulls the eyes downward,” she notes.

Opening the eyes via lash extensions is an art, not a one-size-fits-all treatment – especially if the objective is to take years off and camouflage tired, sagging, or hooded lids ([check out our guide to lash extensions for monolids and hooding](https://aedit.com/aedition/lash-extensions-for-monolid-hooded-eyes)). “Lashes frame the eyes and can do a lot of good for people who want to add lift, volume, and texture,” she explains. “[They] act as an enhancement of your natural lashes.”

An almond-shaped eye is the most requested look. “When you have almond eyes, there is more versatility in shaping,” Richardson says. However, regardless of the shape of the eyes, a custom approach is always best. A universal tip: [Lash extensions](https://aedit.com/aedition/what-its-like-to-get-eyelash-extensions) should always boast a nice curl. When the extensions appear too straight or too long, they can pull down on the eyes. “This can make the eyes appear smaller and weighted,” she cautions.

### **Lash Serums & Mascara**
If lash extensions or false strips — we're into the reusable [Good Janes J-Lash](https://go.skimresources.com?id=170670X1638612&xs=1&url=https%3A%2F%2Fgoodjanes.com%2Fcollections%2Fmink-lashes%2Fproducts%2Fjlash), made from mink fur collected from shedding — aren't for you, there are ways to coerce the natural lashes to grow longer and thicker. A peptide-packed [lash growth serum](https://aedit.com/aedition/eyelash-growth-serum-benefits-safety-results), like the [Beverly Hills MD Lash Enhancing Serum](https://go.skimresources.com?id=170670X1638612&xs=1&url=https%3A%2F%2Fbeverlyhillsmd.com%2Fproduct%2Flash-enhancing-serum%2F) from board certified plastic surgeons [John Layke, DO](https://aedit.com/provider/john-layke-645), and [Payman Danielpour, MD](https://aedit.com/provider/payman-danielpour-md-797), will flood the lashes and follicles with the ingredient (each product has its own mix of ingredients, which can pair [peptides](https://aedit.com/aedition/guide-to-topical-peptides-in-skincare) with [hyaluronic acid](https://aedit.com/aedition/guide-to-hyaluronic-acid-in-skincare-dermal-filler), vitamins, and more). After consistent use for about 12 weeks, the lashes will appear noticeably longer, stronger, and more fluttery.

There are also [mascaras](https://aedit.com/aedition/best-lengthening-curling-volumizing-mascaras) that have nourishing ingredients within the formula to improve eyelash health. The [Freck Beauty Lashrocket Mascara](https://go.skimresources.com?id=170670X1638612&xs=1&url=https%3A%2F%2Ffreckbeauty.com%2Fproducts%2Flashrocket-mascara%3Fvariant%3D41169332076730) pulls double duty as a mascara and lash serum in one thanks to its blend of powerful peptides that help weak lashes look and feel fuller and longer in about one month. It’s a buildable matte black formula that doesn’t clump or smudge. 

## **2. Fill in the Hollows**
When dark shadows and hollowing have you reaching for concealer morning, noon, and night, it may be time to consider [under eye filler](https://aedit.com/procedure/under-eye-filler). Injecting hyaluronic acid (HA)-based filler into the depressions where the top of the nose and orbital rim meet can be a game-changer for those who are concerned about the effect the tear troughs are having on their eye area as a whole. “Hollows can also make someone look older and more tired with a darker appearance due to a shadow effect,” says [Robert Schwarcz, MD](https://www.naturalfacedr.com/), a board certified oculofacial plastic surgeon in New York City. 

It's normal, with age, for the fat under the eyes to descend further down the face and for the bone or orbital socket to dwindle in density. These combinations, plus changes to the texture and thickness of the skin, make it more common for the signs of aging to quickly surface under the eyes and send patients running to their doctor's office to fix them. The way filler works in this area is pretty simple. The addition of volume plumps up the depressions to create a more pillowy and smooth appearance. The filler also plumps up the skin so that light can better reflect off the area. “Addressing the contour deficit fills the area,” Dr. Schwarcz explains. If the texture of the under eye skin is a concern, he suggests [microneedling with radiofrequency](https://aedit.com/procedure/microneedling-with-radiofrequency), [lasers](https://aedit.com/procedure/nonablative-laser-skin-resurfacing), and [chemical peels](https://aedit.com/procedure/medium-depth-chemical-peels).

HA-based filler isn’t the only injectable that can be used under the eye. [Angela Lamb, MD](https://aedit.com/provider/angela-lamb-md-34643), a board certified dermatologist in NYC, likes to mix filler with platelet-rich fibrin (PRF) in some cases. “If the problem is true volume loss, those are my go-tos,” she says. As she explains, under eye filler works better for correcting an indent or hollowness and perhaps a mild bag, whereas surgery is best suited for more prominent bags and redundant skin.

Often, it requires taking a holistic approach and considering all aspects of the face to create a natural and harmonious appearance. With age, the cheeks can start to sag, which causes ligaments in the area to pull down on the outer corner of the eye, says [Julis Few, MD](https://aedit.com/provider/julius-few-md-15580), a board certified plastic and reconstructive surgeon in Chicago. The strategic placement of filler can address this. “Returning the [cheeks](https://aedit.com/procedure/cheek-augmentation-with-fillers) to a more elevated position also lifts the outer corner of the eye so that it appears more like a cat eye,” he explains. And don't be surprised if your doctor also injects some filler into the [temples](https://aedit.com/aedition/cosmetic-forehead-procedures), which is a prime target area for volume loss. The brow's tail gets a little boost, too, to make the temples appear less sunken and the eye area smoother overall.

## **3. Don’t Neglect the Brows**
In situations where the [eyebrows](https://aedit.com/concern/aging-and-tired-eyes) are behind the changes to the shape and appearance of the eyes, addressing the positioning of the brows can make a world of difference. Over time, the tails of the brows tend to drop and fall downward, decreasing the distance between the upper eyelid and the eyebrows. In addition, a low brow position can add weight to the upper eyelid. In severe cases, it can encroach on the eyelid space, Dr. Schwarcz shares. There are both in-office and at-home solutions to address this:

### **Botox Brow Lift**
One of the best ways to give a visible – albeit temporary – lift to the brows is with the so-called [Botox brow lift](https://aedit.com/procedure/chemical-brow-lift). It involves injecting small amounts of neuromodulators (read: Botox®, [Dysport®](https://aedit.com/procedure/dysportr), [Jeuveau®](https://aedit.com/procedure/jeuveau), or [Xeomin®](https://aedit.com/procedure/xeomin)) to improve the position of the brows for three to four months at a time. To further complement newly lifted arches, many doctors inject the crow's feet and glabellar lines that form at the outer corners and in between the eyes to smooth the skin and make everything in the area appear refreshed and youthful. Keep in mind that using neuromodulators to lift the brow won’t do anything to address loose skin. 

### **Thread Lift**
The Botox brow lift is effective for achieving some lifting and shaping but is less dramatic than other options, like a [thread lift](https://aedit.com/procedure/thread-lift), Dr. Few notes. Thread lift procedures are pretty much downtime-free – save for some minor swelling – and involve placing absorbable sutures for an instant and long-term (they stimulate collagen over the coming months) lift in those with mild brow and eyelid sagging. “The threads go underneath the skin's surface to gently lift the area via small hooks that grab and hold the skin in place,” Dr. Lamb explains. Threads can also benefit those who are beginning to notice a ‘heavy’ forehead and drooping eyes and desire a little refresher before surgery down the line. 

Precise placement of threads can help hoist the outer part of the brow, making the outer corners of the eyes appear more lifted. “I like to use threads in an upside-down ‘U’ configuration going up to the hairline to lift the outer corner of the outer third of the brow,” Dr. Few says.  As he explains, this technique helps remove unwanted hooding of the upper eyelid while gently elevating the outer corner of the eye and brow. In these cases, neurotoxin injections are necessary to relax the forehead muscles and reap the full benefits of the threads. “Otherwise, the threads will pull through the tissue and cause the brow to drop again,” he notes.

Doctors can also use threads to tweak the shape of the eyes, but it doesn't always need to result in the now-popular [fox eye look](https://aedit.com/aedition/canthoplasty-canthopexy-eyelid-surgery-for-fox-eye-trend), a term that Dr. Few coined years ago during a lecture. “The goal should not be a hyper-elevated, unnaturally appearing cat look, but rather a natural elevation that enhances the appearance of the brow and upper eyelid,” he says. “The threads should create a pleasing appearance while being more exotic in a younger person and restoring natural positioning in someone experiencing age-related changes.” This is why selecting the right provider to perform the procedure is of the utmost importance — you want their before and after results and overall aesthetic to match the look you are trying to achieve. 

Keep in mind that while threads can provide some improvement, the skin in the brow and upper eyelid area is sensitive and thin. During the first few days, it may look pleated or bunched up due to overcorrection. “Surgery is the gold standard and would be my first choice for anyone wanting a predictable, long-lasting result,” Dr. Few says. Non-surgical solutions, like the combination of threads and neuromodulators, last about six to 12 months and require maintenance to retain the results. Since the benefits are relatively temporary, it’s essential to have realistic expectations and understand what threads can and cannot fix, Dr. Lamb says.

### **Makeup**
Brow powders and pencils can be just as important as doctor-administered treatments. With age, the brow hairs tend to become patchy and thin, and their once-crisp arch melts into an unorganized silhouette. Yet, redefining the arch with expert shaping ([check out our tips for how to shape your brows at home](https://aedit.com/aedition/how-to-shape-tweeze-define-eyebrows-at-home)) and filling them in with a good brow product ([we’ve rounded up the best powders, pomades, pencils, and gels](https://aedit.com/aedition/best-eyebrow-pomades-powders-pencils-gels-tools)) can make a significant difference. “The eyebrows lend structure to the face and frame the eyes, and, when properly filled in, they can create the effect of a brow lift," says Dani Kimiko Vincent, a celebrity makeup and brow artist and founder of [KIMIKO](https://go.skimresources.com?id=170670X1638612&xs=1&url=https%3A%2F%2Fwww.google.com%2Furl%3Fq%3Dhttps%3A%2F%2Fwww.kimikobeauty.com%2F%26sa%3DD%26source%3Ddocs%26ust%3D1649198110615954%26usg%3DAOvVaw3AG3e_Yk13aNbSFMC5ngPD). 

To create the illusion of a more lifted brow, start by filling in the upper outer arch instead of the front of the brows. “This will concentrate the filling in the area that lifts the brows and draws them up and outwards for a more open eye,” Kimiko Vincent explains. Avoid drawing down at the end of the brow. “You’ll want to keep the front of the eyebrows light and always feather the product through with a spoolie brush to blend and soften,” she shares. The trick here is to use a soft yet precise brow pencil, like the [KIMIKO Super Fine Eyebrow Pencil Automatique](https://go.skimresources.com?id=170670X1638612&xs=1&url=https%3A%2F%2Fkimikobeauty.com%2Fcollections%2Fbrows%2Fproducts%2Fsuper-fine-eyebrow-pencil-automatique), so that the product looks natural and not colored in or penciled on. Finally, set the brows with a long-wear gel, like the [KIMIKO Brow Sensei](https://go.skimresources.com?id=170670X1638612&xs=1&url=https%3A%2F%2Fkimikobeauty.com%2Fcollections%2Fbrows%2Fproducts%2Fthe-brow-sensei).

## **4. Use the Right Eye Makeup**
Applying the right eye makeup – using appropriate colors and proper technique – adds visible contrast and draws attention to the eyes. Everyone's eye shape is unique and, while there are specific ways to enhance different shapes, this basic principle always applies: bring light forward and recede what's dark, Kimiko Vincent says. Similarly, using liner and mascara to [lift the eyes](https://aedit.com/aedition/face-lifting-sculpting-makeup-tips) is a universal solution.

When using makeup to enhance the eyes and make them look more youthful, Kimiko Vincent says to concentrate darker shadows on the lash line and towards the outer sections of the lid. “Sometimes, I contour with shadow to help the eyes appear more doe-eyed and, when necessary, I'll use a lighter shade of shadow on the lid so that they don't appear as sunken,” she shares. One thing to be aware of is mixing crepey skin with shimmery shadows, which has the potential to accentuate laxity. Instead, a matte neutral shadow, like the ones in the new [GXVE by Gwen Stefani Eye See in Color Clean Multidimensional Eyeshadow Palette in Simple Kind of Life](https://go.skimresources.com?id=170670X1638612&xs=1&url=https%3A%2F%2Fwww.sephora.com%2Fproduct%2Fgxve-by-gwen-stefani-eye-see-in-color-clean-multidimensional-eyeshadow-palette-P481997%3FskuId%3D2568152%26icid2%3Dproducts%2520grid%3Ap481997%3Aproduct), is a better option.  

If a sagging upper lid is bothersome, focus on using darker shadows and placing them on the upper, outer portions of the eyelids. “From there, use lighter colors in the inner and middle sections of the lids,” Kimiko Vincent explains. She also recommends applying eyeliner on just the top lid and keeping the liner's tail (the end) lifted.

The classic cat eye is a favorite for creating a lifted outer corner. To do it, Kimiko Vincent recommends using liquid liner, pencil liner, or a deep eyeshadow and a smudger brush or tool. “A kitten eye starts from the center outwards and is slimmer than a traditional cat eye,” she explains. “You can subtly extend the inner corners with eyeliner to add a more feline eye shape.” Shadows are also helpful in contouring the eyes. Again, keep the darker tones towards the outer portion of the lid and concentrate mascara on the outer portion to draw the eye shape up and out.

Speaking of mascara, don't forget about the lashes. Kimiko Vincent says to curl the eyelashes first because “the eyes always benefit from a lift.” It makes them “appear instantly more youthful,” she adds. Before [swiping on mascara](https://aedit.com/aedition/mascara-tips-from-celebrity-makeup-artists), layer on a lash primer for extra volume and staying power. Then, coat the lashes with a volume and lengthening formula. Kimiko Vincent says to focus on lifting the lashes while sweeping on the mascara, paying extra attention to the outer corners of the eyes.

## **The Takeaway**
While a [blepharoplasty and/or brow lift](https://aedit.com/aedition/combining-blepharoplasty-and-brow-lift) may be the gold standards for rejuvenating the upper third of the face, they are not for everyone. Whether you are looking to delay going under the knife or are not a candidate for surgery, there are minimally invasive solutions and even at-home makeup tips that can refresh the lids, brows, and lashes.

*All products featured are independently selected by our editors, however, AEDIT may receive a commission on items purchased through our links.*

From Botox brow lifts and under eye filler to eyelash extensions and mascara, experts share their tips for enhancing the eye area.

Non-Surgical Eye Rejuvenation: In-Office Procedures And Makeup Tips For Eyelids, Lashes, Brows 

How To Enhance And Rejuvenate Your Eyes Without Surgery

ernesto-norman-R5CX8XDQLV0-unsplash

A seemingly quick fix treatment that has caught on like wildfire, your social media feed may have you thinking that [under eye filler](https://aedit.com/procedure/under-eye-filler) is a universal solution for common aesthetic eye concerns. While the treatment can be very effective for the right candidate, it – like just about every other cosmetic procedure – is not for everyone. 

Until recently, under eye filler was an ‘off label’ (read: not approved by the United States Food and Drug Administration) use of hyaluronic acid-based dermal fillers. Earlier this year, the [FDA approved](https://aedit.com/aedition/fda-approves-juvederm-volbella-xc-under-eye-filler) Juvéderm® Volbella XC for the improvement of infraorbital hollows in adults over the age of 21. As part of this new indication, Allergan Aesthetics will be providing training programs, including how to assess facial anatomy holistically and the identification and management of [potential complications](https://aedit.com/aedition/guide-to-cosmetic-surgery-complications), to anyone who wishes to inject. This is because injecting the tear troughs and hollows beneath the orbital rim is not without risk.

Good under eye filler can be transformative, but it can be hard to get it right. Not everyone wielding a needle is well-versed in the procedure, and not everyone who thinks they want the procedure is actually a candidate. Here, we investigate the under eye filler craze and why it's not a singular solution for all under eye concerns.

## **How Under Eye Filler Works**
For some, under the eyes lives a slight depression in the skin that absorbs light rather than reflecting it. When darkness casts a shadow on this inner part of the eye, known as the tear trough, a crease between the upper cheek and the lower eyelid becomes evident. Most patients who desire under eye filler complain of a hollow, dark, tired-looking eye that does not seem to go away, no matter what [skincare they use](https://aedit.com/aedition/best-eye-serums-for-fine-lines-dark-circles-puffiness) or do or how much concealer they layer on.

Blame your genes and the natural aging process for the cause of shadowing under the eyes. “The tissue structures supporting the eyelids weaken from aging or genetics,” says [Michele Green, MD](https://aedit.com/provider/michele-green-md-34642), a board certified dermatologist in New York City. “This weakening causes a hollowness and sagging of the skin in the under eye area, but hyaluronic acid fillers replenish volume to the area.” Although remediation with fillers is a relatively quick process, the procedure relies on dermal fillers placed into the deep hollows to replenish lost volume. Putting HA filler into deep under eye creases plumps them up so that the skin is smoother and can reflect light properly.

That, in turn, addresses more than just the tear trough. Injections can also help alleviate dark circles, which sometimes develop from volume loss in the lower eyelid fat pads, creating hollows, explains [Snehal Amin, MD](https://aedit.com/provider/snehal-amin-md-308), an NYC-based  board certified dermatologist. “By correcting underlying volume loss, shadows under the eye reduce,” he shares. “Volbella is FDA-approved for this indication, but it is imperative to seek out an experienced, qualified provider.”

Well-injected filler under the thin skin of the eyes are a great way to brighten up the eyes and reduce hollowness and that tired appearance from some of the tissues underneath the eye, says [Usha Rajagopal, MD](https://aedit.com/provider/usha-rajagopal-md-1330), a board certified plastic and reconstructive surgeon in San Francisco. She adds that smoothing out the grooves under the eye helps to improve the overall contour of the lower eyelid and, secondarily, reduce discoloration.

Since not all discoloration is an effect of shadowing and hollowing, it is crucial to identify the cause of discoloration before jumping into the under eye filler pool. For example, Dr. Amin says discoloration under the eyes can also be caused by rubbing the skin in cases of [eczema](https://aedit.com/aedition/comparing-eczema-vs-psoriasis) or allergies. And, for this type of darkness, filler isn't the answer. “Instead, [chemical peels](https://aedit.com/aedition/guide-to-superficial-medium-deep-chemical-peels) or [lasers](https://aedit.com/aedition/guide-to-ablative-laser-skin-resurfacing) best address this discoloration,” he says. 

With no downtime, the effects of under eye injections using hyaluronic acid-based filler are immediate (save for some minimal and typical [bruising](https://aedit.com/aedition/how-to-treat-prevent-bruising-after-lasers-filler-botox) and swelling). Within minutes of injecting the under eyes, patients can see a smoothness to the area, less darkness, and no more shadowing. The results generally last about a year.

## **Choose Your Injector Wisely**
This is where it starts to get a little dicey. The array of providers offering under eye filler treatment ranges from board certified dermatologists and plastic surgeons to your strip mall med-spa injector. And because those who don't hold a medical degree or have years of experience don't know the pitfalls of injections around the eye or facial anatomy, you may be putting yourself in a dangerous position by not going to a qualified provider. “The success of under eye fillers is not solely dependent upon the product used, but also the skills of the injector, their experience, and their comfort level using the filler product,” Dr. Green says. “There is an increased risk for developing unwanted side effects when performing injections with an inexperienced or unqualified injector.” 

All filler should be injected by a highly trained provider, but the under eye presents its own unique set of challenges. “This is not a med-spa procedure,” Dr. Amin cautions. “This is a medical procedure because of the complexity of the anatomy and the dangers of complications.” Additionally, the injector must be able to suss out who is a candidate and [manage expectations](https://aedit.com/aedition/how-plastic-surgeons-balance-patients-cosmetic-surgery-desires-and-safety) accordingly. For example, filler is an acceptable treatment option when a patient has a bothersome hollowness without large under eye bags, says [Jonathan Cabin, MD](https://aedit.com/provider/jonathan-cabin-md-956), a double board certified facial plastic and reconstructive surgeon in Arlington, VA. However, the addition of filler to bulging under eye bags (caused by protruding or displaced fat pads) will not do much of anything to correct the hollowness. “Patients must have realistic expectations of what can and cannot be corrected with filler and understand that filler will not improve wrinkles or primary dark circles,” Dr. Cabin explains. 

In most cases, filler cannot correct excess skin or [pigmentation-related](https://aedit.com/aedition/under-eye-hyperpigmentation) color changes to the skin. Also, people with fluctuating lower lid and mid-cheek swelling (known as malar edema) are usually not fit for filler treatment since injections can exacerbate this condition.

## **The Issues with Under Eye Filler**
Under eye filler is tricky because, as Dr. Rajagopal explains, volume deficits under the eye exist in many layers. “It can be deep and right next to the bone, just above the bone, or in the muscle layer or the skin layer,” she shares. “All these areas may need to be addressed differently in different patients.” Generally, the deeper the injection, the less visible the product. Furthermore, doctors must use a very thin filler in patients who require more superficial placement. If not, lumps, bumps, and even discoloration (i.e. the infamous blue tint) can ensue.

The most important takeaway with under eye fillers is that less is more. “A tiny amount of filler goes a long way,” Dr. Rajagopal says. “And the result should be an improvement of the area and not full correction because full correction leads to overcorrection, [overfilling](https://aedit.com/aedition/how-to-correct-overfilled-facial-features), a lumpy look, and often swelling underneath the eye.” It is important to remember that it is entirely normal to have mild depressions and some lines under the eyes. Attempting to eradicate them with too much smoothness can lead to an unnatural look.  

Overcorrection is, unfortunately, a common mistake. It creates less distinction between the cheek and the tear trough, which causes the eye to get smaller from above, says [Doris Day, MD](https://dorisdaymd.com/), a board certified dermatologist in NYC. Too much filler makes the eyes appear small and squinty and, conversely, the cheeks look disproportionately big. “When you keep filling and adding layers, the eyes can look off-balance,” she explains. “Instead, the eyes may require opening and the skin may need some tightening, but the key is not to erase those points of distinction.” When you do, “the face looks distorted, and it's a look that everyone is walking around with,” she adds.

But the aesthetic concerns related to overfilling are just the half of it. There are also more serious issues to be aware of, including:

- **Swelling**: Mild swelling for 24 to 48 hours after treatment is to be expected, but long-term [swelling](https://aedit.com/aedition/how-to-treat-minimize-swelling-after-cosmetic-surgery) that never goes away can occur. Patients with poor lymphatic drainage tend to hold onto more water and fluid in the eye area, so the addition of HA filler (which attracts water to plump) causes lasting fluid retention. Since certain fillers are more hydrophilic (meaning it holds onto water) than others, this presents the potential for the filler to puff a bit. Dr. Green adds that patients who present with bulging from water retention or sagging skin due to loss of elasticity should avoid under eye filler. 
- **Filler Migration**: Filler that moves under the eyes isn't atypical. As Dr. Day explains, migration partially occurs because of constant movement in the area and ligaments that push the filler around a bit. When filler migrates, it can shift downwards or to the side and even take on a bumpy or lumpy appearance depending on the filler used and how much of it there is. “Sometimes, we don't see the effects for months or even years later,” she notes.
- **Visible Product**: Known as the Tyndall effect, a bluish tint to the skin can occur from placing the filler too close to the surface of the skin. Some fillers are more prone to this than others. “I prefer using [Belotero®](https://aedit.com/procedure/belotero) for the tear troughs because there is no Tyndall effect,” Dr. Amin says. Although this discoloration can technically happen in any area of filler used, Dr. Cabin says it is most commonly seen under the eyes because the skin is fragile. However, he adds that your provider can prevent the Tyndall effect by injecting filler in the deeper areas (over bone) and only injecting small amounts per injection while keeping the cannula moving.
- **Vascular Occlusion**: One of the more severe complications that can arise, [vascular occlusion](https://aedit.com/aedition/risk-of-vascular-occlusion-after-dermal-filler) refers to accidentally injecting into an artery. When not immediately corrected (via HA-dissolving [hyaluronidase injections](https://aedit.com/procedure/hyaluronidase)), an occlusion can result in skin necrosis or skin death. While vascular occlusion and necrosis are rare, they do happen. Injection techniques that involve a pulling-back effect are critical, as is the correct type of injection tool (more on that below).
- **Blindness**: Blindness from filler injections is the most serious byproduct of an occlusion or blood clot that arises and blocks the typical blood flow pattern throughout and around the eyes. It's crucial to understand facial anatomy when injecting this area because there are far more blood vessels around the eye than other areas in the face. Although blindness from under eye fillers is the rarest complication, it is nothing to take lightly. A 2015 [study](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6554164/) found 98 cases of blindness related to the use of filler.

Your injector should use only [hyaluronic acid-based filler](https://aedit.com/aedition/hyaluronic-acid-filler-vs-biostimulatory-injectables) under the eyes. “Non-hyaluronic acid fillers, like [Sculptra®](https://aedit.com/procedure/sculptra) and [Radiesse®](https://aedit.com/procedure/radiesse), are too thick for this area,” Dr. Cabin says. "Also, Sculptra® and Radiesse® work over time by stimulating the body's collagen creation mechanisms, and movement around the eye can create irregularities as these fillers settle in.” While lumpiness as a result of HA filler is dissolvable with hyaluronidase, biostimulatory injectables are not reversible.

## **The Right Way to Inject Under the Eyes**
When injecting under the eyes, your injector has the choice between two different tools to prevent less-than-ideal results and complications: a [blunt-tipped cannula](https://aedit.com/aedition/guide-to-injectable-techniques-needles-for-botox-filler) (a soft plastic catheter that cannot interrupt a vessel) or a [needle](https://aedit.com/aedition/guide-to-needles-used-for-cosmetic-injectables-botox-filler). Both have their place, and it's up to your provider to choose the best one.

“The use of a blunt-tipped cannula to access the treatment area from below and just to the side of the lower eyelid is the gold standard for under eye treatment,” Dr. Cabin says. It nearly eliminates the risk of [bruising](https://aedit.com/aedition/how-to-treat-prevent-bruising-after-lasers-filler-botox), significantly reduces post-injection swelling, and also dramatically lessens the chance of a rare complication by preventing entry into the veins or arteries around the eye. “With all filler injections, injecting small aliquots while actively withdrawing the cannula helps reduce the risk of lumping or clumping and vascular or lymphatic disruption,” he adds.

All you have to do is think of how many times a day you blink to know the under eyes are an area of movement. They're anatomically complex, thin, and delicate, with an intricate network of several blood vessels and lymphatic drainage pathways. This makes filler placement more taxing than other parts of the face. “Therefore, under eye filler needs to be placed deep, just over the bone (periosteal), to be in an area that corrects the hollowness without causing any injury or disruption to the delicate structures of the under eye,” Dr. Cabin explains. “Placing the filler in a deep plane, just under the bone, also minimizes the risk of filler migration over time and will lower the risk of the Tyndall effect.”

Perhaps the best way to ensure good results (in addition to seeing a board certified dermatologist or plastic surgeon) is to make sure your injector has a deep understanding of facial anatomy, especially the periorbital area. “Many doctors inject filler as they withdraw the needle out of the skin; in other words, they push the plunger on the syringe as they pull the syringe backward,” Dr. Amin says. This technique prevents cannulation of blood vessels and limits the risk of intravascular filler injections.

## **Taking a Holistic Approach**
The features of the face live in [harmony](https://aedit.com/aedition/facial-harmony-in-aesthetic-medicine), not isolation. To ensure that the under eyes look natural and not artificially augmented, Dr. Rajagopal says to look at the face as a whole. “When you look at a beautiful face, it's the entire face,” she shares. “Generally, not just one area makes someone beautiful, but rather a complement of how one area flatters the other.” Selectively filling the under eye and failing to treat the surrounding areas, like the [cheeks](https://aedit.com/aedition/cosmetic-procedures-to-define-cheekbones), isn't usually the best approach. “Often, the eyelid-cheek conjunction is in continuity,” she shares. “So, to give the best results, it's important to inject part of the cheek along with the lower lid.”

A higher cheekbone or zygoma will pull the skin taught under the eyes. “Your doctor can inject filler into the cheek area to improve the under eye area,” Dr. Amin says. Plus, injecting directly into the cheeks instead of under the eyelids is safer. “Filler placement in the cheeks lasts a lot longer than the fillers used in the periorbital area,” he adds. Beyond the cheeks, the [temples](https://aedit.com/aedition/cosmetic-forehead-procedures) also need to be considered. 

Sometimes, addressing the neighboring features is all it takes to create the effect of more refreshed eyes. “That’s why I address everywhere around the eyes before correcting them because it may just be an adjustment to the cheeks or brows that a patient needs instead,” Dr. Day says.

## **Does the Recent FDA Approval Change Anything?**
As we mentioned, under eye filler was an off-label use (meaning it did not hold an FDA-approved indication) until the recent approval of Juvéderm® Volbella XC. “Volbella is a hyaluronic acid dermal filler with an innovative combination of low and high molecular weight technology, which improves the cross-linking efficiency of the hyaluronic acid chains,” Dr. Green explains. “In addition, this new Vycross technology delivers an ultra-smooth gel that is malleable, which results in a natural look and feel to improve the appearance of under eye bags.”

However, just because there’s now an FDA-approved filler for use under the eyes doesn’t equate to every dermatologist and plastic surgeon jumping on the Juvéderm® Volbella XC bandwagon. Some physicians, including Dr. Day, do not use like to use it under the eyes. “In general, I think it’s a problematic product,” she explains. “It can be somewhat unpredictable, and Juvéderm® tends to swell under the eyes.” While she concedes that the data from Juvéderm® Volbella XC “doesn’t show issues with it,” she prefers [Restylane®](https://aedit.com/procedure/restylane) and Belotero® for correcting under eye hollows.

So, does a new FDA indication mean that everything we know about under eye filler and its safety go entirely out the window? No. Like all aesthetic treatments, patients must weigh risk and reward. Dr. Cabin says whether a treatment or specific product is categorized as on-label or off-label has very little to do with safety and efficacy. “Receiving FDA approval is a very complicated and expensive process that can take years, so some filler manufacturers have to decide which on-label indications to pursue given these constraints,” he explains. “When a filler (or other aesthetic treatments) is not on-label, it doesn't mean they are less effective or more dangerous.”

Aesthetics

Dermatologists and plastic surgeons weigh in on why the popular procedure isn’t for everyone.

The Pros And Cons Of Under Eye Filler

The Truth About Under Eye Filler

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Beauty

Everything you need to know about the benefits of eye serums and the best ones to treat every aesthetic eye concern.

The Best Eye Serums For Crow's Feet, Dark Circles, Puffiness, And Crepey Skin

The 12 Best Eye Serums For Fine Lines, Dark Circles, And Puffiness

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Surely you're familiar with [dark circles](https://aedit.com/aedition/best-aesthetic-procedures-to-minimize-dark-circles), infamous for cropping up after a restless night. To prevent them, there's a strong chance you slather on [eye cream](https://aedit.com/aedition/eye-creams-serums-to-treat-crows-feet-dark-circles-puffiness) and go through [under eye patches](https://aedit.com/aedition/best-under-eye-patches-masks) like it's your job. But, if all of that work is to no avail, you could be dealing with under eye hyperpigmentation, which may require robust means of treatment — likely at the hands of a board certified dermatologist or plastic surgeon. 

Under eye hyperpigmentation refers to discoloration of the under eye area, particularly excess pigment that's darker (usually dark brown or tan) than the surrounding skin, says [Marisa Garshick, MD](https://aedit.com/provider/marisa-garshick-md-313), a New York City-based board certified dermatologist. Medically referred to as periorbital hyperpigmentation (POH), these darkened skin patches result from an increase in melanin production due to anything from sun exposure to genetics. 

If you are underwhelmed by your current under eye treatments, it might be because you are trying to correct the wrong concern. Ahead, we break down the difference between traditional dark circles and under eye pigmentation, what causes the latter, and how you can treat it with the insight of three leading dermatologists. 

## **What Causes Hyperpigmentation Under the Eyes?**
Many factors can cause hyperpigmentation (a.k.a. pigmented dark circles) under the eye, ranging from uncontrollable factors like genetics or allergies to controllable ones like sun exposure and excessive eye rubbing. Determining what's causing your dark circles will help ensure the best course of treatment — because treating [hyperpigmentation](https://aedit.com/aedition/guide-to-hyperpigmentation-dark-spots-melasma) isn't one-size-fits-all. 

One common cause of under eye hyperpigmentation is “sun damage over time,” Dr. Garshick says. Because the eye area is so “[thin and delicate](https://aedit.com/aedition/how-to-treat-the-skin-around-the-eyes-with-skincare-and-non-surgical-cosmetic-procedures),” excess pigment “can give the overall appearance of darkness under the eyes,” she adds. The simplest way to prevent it? Double down on your sunscreen routine. We’ll use this as yet another chance to remind you that you should be using a minimum of SPF 30 every single day. While you can simply take your go-to face formula ([here are some dermatologist favorites](https://aedit.com/aedition/dermatologist-approved-sunscreen-for-face-body)) up the lower lid, there are eye-specific formulas that are less likely to cause irritation. We’re fans of the [SkinCeuticals Physical Eye UV Defense SPF 50](https://go.skimresources.com?id=170670X1638612&xs=1&url=https%3A%2F%2Fwww.skinceuticals.com%2Fphysical-eye-uv-defense-spf-50-3606000400504.html). 

But UV rays aren’t the only culprit. “What can also occur is some people can experience something known as post-inflammatory hyperpigmentation (PIH),” Dr. Garshick explains. PIH can occur any time the skin experiences inflammation or irritation. As it resolves, it heals with some discoloration. This is particularly common in individuals prone to chronic eye rubbing, skin allergies, and/or [eczema](https://aedit.com/aedition/best-skincare-products-to-treat-eczema-flare-ups-in-the-winter) around the eyes, says [Joshua Zeichner, MD](https://www.mountsinai.org/profiles/joshua-zeichner), a board certified dermatologist in NYC.

## **Who Is Most Prone to Under Eye Hyperpigmentation?** 
Under eye hyperpigmentation is more common in darker, melanin-rich skin tones, says [Corey L. Hartman, MD](https://skinwellness.com/providers/dr-corey-l-hartman/), a board certified dermatologist in Birmingham, Alabama. Why? ‘If you don't have that much pigment to begin with, then you can't really have melanin dropping into the dermis, causing discoloration,” he explains. “But, if you do and those cells get damaged, it deposits into the dermis.” That's how hyperpigmentation develops.

Even so, Dr. Zeichner still deems it “very common” across all skin tones and ages. Interestingly, he observed an increase in patients concerned about under eye hyperpigmentation amid the COVID-19 pandemic. “Now that people are wearing masks and are covering the lower face, they have become [fixated on the upper face](https://aedit.com/aedition/popularity-of-eyelid-surgery-cosmetic-eye-procedures-during-covid-19),” he explains. 

## **How Do You Distinguish Dark Circles From Hyperpigmentation?**
The best way to diagnose the cause of your dark circles and develop a treatment plan is a [consultation](https://aedit.com/aedition/skin-care-questions-for-your-dermatologist) with a board certified dermatologist. But, if you're unsure about whether your dark circles are a shadow or true hyperpigmentation, Dr. Zeichner recommends the following at-home test: “Go into the bathroom or another very well-lit area with forward-facing light and a mirror. Directly facing the light, take your thumb and index finger and gently pull the skin out towards the mirror. If the pigmentation in the skin improves, then it's a shadow. If, when you pull the skin away, it remains, it is true pigmentation.”

If this test shows that your skin isn’t *actually* discolored, you probably aren’t dealing with hyperpigmentation. Instead, it’s probably a shadow effect creating the appearance of dark circles due to volume loss, or, because the skin under the eyes is thinner, the darkening you’re seeing may be due to your “blood vessels peeking through,” Dr. Garshick notes. This is usually the case when the dark circle “doesn't necessarily look tan or brown, but has more of a purple or blue hue,” she says.

## **How to Treat Hyperpigmentation Under the Eyes**
Now that you know what causes pigmentation under the eyes to develop, it’s time to talk about how to treat it. As we mentioned, your go-to eye cream or patches may not do the trick, as most are formulated to address puffiness, crepey skin, or blue-tinted circles. But that’s not to say there aren’t both at-home and in-office treatment options. 

### **Skincare Ingredients That Address Under Eye Pigmentation** 
When shopping for over-the-counter eye treatments to target hyperpigmentation, brightening and lightening ingredients are the name of the game. With that in mind, Dr. Zeichner 
recommends looking for products with [vitamin C](https://aedit.com/aedition/guide-to-topical-vitamin-c-in-skincare), which “helps block the production of abnormal pigment,” and [retinol](https://aedit.com/aedition/guide-to-vitamin-a-retinol-retinoids-in-skincare), “which enhances cell turnover and therefore helps the skin shed cells that are darkly pigmented.” Dr. Gatrshick is a fan of [kojic acid](https://aedit.com/aedition/guide-to-kojic-acid-in-skincare), licorice root, and [niacinamide](https://aedit.com/aedition/guide-to-topical-niacinamide-vitamin-b3-in-skincare), while Dr. Hartman recommends [hydroquinone](https://aedit.com/aedition/giude-to-hydroquinone), cysteamine, and [tranexamic acid](https://aedit.com/aedition/guide-to-topical-oral-tranexamic-acid-in-skincare).

These are all powerhouse pigmentation-fighting actives, but they can do more harm than good if not used properly. Dr. Hartman warns ingredients that can be very effective in treating the under eye area can also be irritating (and said irritation can lead to PIH). That's why it's important to use an under eye specific formula, and not “the same thing you're using on the rest of your face.” The skin of the face has oil glands, "which can help withstand the side effects of some of active ingredients.” The under eye area – you guessed it – does not have sebaceous glands.

Whenever you start a new product, keep in mind that patience is necessary and consistency is key. It’s important to know that OTC formulations aren’t for everyone and offer “limited benefits in severe cases” that require in-office intervention, Dr. Zeichner cautions. For most, a multi-modal approach will be needed. Consider this analogy: “Think of an in-office treatment like getting a personal trainer, and think of your eye creams as going to the gym every day,” he says. “It's important to do both for the best outcomes.” That leads us to…

### **In-Office Treatments for Under Eye Pigmentation**
If hard-working skincare isn’t enough, your dermatologist or plastic surgeon may recommend one (or more!) of the following courses of treatments. 

- **Under Eye Filler**: If volume loss is part of the reason for your dark circles, Dr. Hartman recommends [under eye filler](https://aedit.com/procedure/under-eye-filler), which helps reduce shadowing. Those commonly used in this area are hyaluronic acid-based products like [Juvéderm®](https://aedit.com/procedure/juvederm) and [Restylane®](https://aedit.com/procedure/restylane).
- **Chemical Peels**: Dr. Garshick explains that chemical peels can make great strides in improving discoloration. Certain types, such as a [TCA peel](https://aedit.com/procedure/tca-peel) or [glycolic peel](https://aedit.com/procedure/glycolic-peel), can be specially designed for the eye area. “While you can see benefits from just one peel, the more you do, often the better the result,” the pro says, noting that you’ll want to wait “three to six weeks in between treatments.” She emphasizes that it is “especially important to go to someone you trust to minimize any potential side effects and ensure a proper concentration is used.”
- **Platelet-Rich Plasma (PRP)**: Like dermal fillers, injections of blood-derived PRP can increase volume under the eye area, and it's also [been shown](https://pubmed.ncbi.nlm.nih.gov/24641609/) to improve the appearance of dark circles. Alternatively, the combination of [microneedling with PRP](https://aedit.com/procedure/microneedling-with-prp) in the under eye area can help with both “skin quality as well as hyperpigmentation,” Dr. Garshick says. It's a good choice for those experiencing texture conditions like crepiness, she adds.
- **Laser Treatments**: Lasers reduce hyperpigmentation by “targeting a specific pigment in the skin and destroying it,” Dr. Zeichner says. Depending on your needs, your provider may recommend anything from [intense pulse light (IPL)](https://aedit.com/procedure/ipl) to [fractional lasers](https://aedit.com/procedure/nonablative-fractional-lasers). Know that, “after a laser, [the hyperpigmentation] may look worse before it looks better because it needs to heal from the treatment,” he shares. It varies by laser, but the healing process usually takes one to two weeks. “In some cases, multiple laser treatments may be necessary to achieve optimal results – especially in more severe cases,” Dr. Zeichner notes.

Keep in mind that many patients require more than one treatment modality to see results, Dr. Hartman says. For example, “if you have volume loss and hyperpigmentation in the skin, I could give you fade cream or do laser,” he shares. “But, until you correct the volume, you're still going to have a shadow.” 

## **The Takeaway**
Several factors can contribute to under eye hyperpigmentation, so the best course of action is to consult your dermatologist or plastic surgeon for a personalized treatment plan. We get it: Scooping up a new skincare product is exciting, but consulting with a professional will take all of the guesswork — and stress — out of the process.

*All products featured are independently selected by our editors, however, AEDIT may receive a commission on items purchased through our links.*

Eye cream isn't cutting it? Your dark circles could be hyperpigmentation, which may require professional intervention. Here's what to look for, according to the pros.

How To Treat Hyperpigmentation Under The Eyes

Are Your Dark Circles Actually Hyperpigmentation?

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As the saying goes, the eyes are the windows to the soul. And, sometimes, these windows can be overrun by heavy upper lids, baggy lower eyelids, or even low-hanging brows that impede the appearance of an awake, youthful-looking eye. With so many potential changes affecting the eye area, how is one to know if they need a [blepharoplasty](https://aedit.com/procedure/blepharoplasty-eyelid-surgery) (a.k.a. eyelid lift), a [brow lift](https://aedit.com/procedure/brow-lift-forehead-lift-browplasty), or [both](https://aedit.com/aedition/combining-blepharoplasty-and-brow-lift)? We tapped into four plastic surgeons for their insight on choosing the right surgery.

## **Age-Related Eye Changes**
The [aging eye](https://aedit.com/concern/aging-and-tired-eyes) can be difficult to navigate since there are various changes the area experiences. Like no two bodies are the same, neither are any two sets of eyes. But, for the most part, the relative transformation that most of us tend to notice to the eyes and the surrounding area include:

- **Saggy Skin**: The eyes boast perhaps the [thinnest skin](https://aedit.com/aedition/how-to-treat-the-skin-around-the-eyes-with-skincare-and-non-surgical-cosmetic-procedures) on the entire face, which is why they are often one of the first areas — if not the first — to show their age. Both the upper and lower eyelid skin can transform from firm and elastic to crepey, stretched out, and sagging.
- **Under-Eye Bags**: Not everyone experiences bulging bags, but, if they surface, it's usually from a weakening of the muscles and tendons coupled with displaced, protruding fat. 
- **Fat**: In some, there are signs of fat loss and a hollowing of the under-eye area; in others, fat becomes displaced and begins to protrude from the lower eyelids causing bags to form.
- **Fine Lines & Wrinkles**: With changes to the quality of the skin come finely etched in lines and wrinkles around the eyes (i.e. crow’s feet), underneath them, and on the upper eyelids. Sun exposure, lifestyle choices, and inherently thin skin are all to blame.

Plastic surgeons don't follow a one-size-fits-all method to correct the eyes. Since the cause of aging in the region is multifactorial, your surgeon must tailor the solutions to address the issues at hand. For instance, if someone has excess skin, the skin has to be dealt with, says [Steven Williams, MD](http://trivalleyplasticsurgery.com/), a board certified plastic and reconstructive surgeon in Dublin, CA, and the vice president of the American Society of Plastic Surgeons ([ASPS](https://www.plasticsurgery.org/)). On the other hand, if there is fat atrophy, it should not be glossed over. “Without addressing each of these issues specifically, you will get incomplete results or unsatisfactory results,” he shares. 

Although a brow lift and blepharoplasty both tackle age-related concerns on the upper third of the face, they address different facial features. As Dr. Williams explains, blepharoplasty helps correct loose lid skin on the upper and/or lower lid and periorbital fat. A [brow lift](https://aedit.com/aedition/guide-to-surgical-and-non-invasive-brow-lift-procedures), meanwhile, repositions the eyebrow and the skin of the forehead. “The brow is influenced by the frontalis muscle, a very thick, strong muscle, while much weaker muscles influence eyelids,” he notes.

## **Blepharoplasty, Brow Lift, or Both?**
Now that you know how age and gravity affect the eye area, it’s time to talk about how to [rejuvenate the region](https://aedit.com/aedition/cosmetic-procedures-for-under-eye-rejuvenation). As we’ve discussed, blepharoplasty can address skin and fat concerns on the upper and lower eyelids, while a brow lift can reposition the brow (which may have an effect on the upper lid) and target forehead skin laxity. These surgeries can be performed alone or in tandem depending on the patient and their aesthetic goals. Here’s what you need to know:

### **CHOOSE A BROW LIFT FOR EYEBROWS THAT APPEAR HEAVY**
Dr. Williams says people often see him for a blepharoplasty consultation only to find out they need a brow lift. “Patients that feel they need an eye lift may have heavy brows as well,” he explains. “Many times, Botox® can contribute to masking brow ptosis issues, which can contribute to the overall undesired look.”

A brow lift is likely redundant skin on the upper eyelids is an issue (unless the brows have fallen considerably). In comparison, a brow lift focuses on raising the brow area strictly when the drooping stems from changes to the brows themselves and the area right above them. A brow lift also corrects any feeling of heaviness, says [Robert Schwarcz, MD](https://www.naturalfacedr.com/contents/about-the-practice), a board certified reconstructive and oculoplastic surgeon in New York City.

<BeforeAfterModule
  title={Before & Afters: Brow Lift}
  procedureId={980}
/>

Like so many other facial features, the brows can also ‘fall’ with time. Whenever a surgeon assesses a patient and checks their brow position, Dr. Schwarcz says the brows should ideally sit at the brow bone – not below it or encroaching on the eyelid space. When the brows sit lower on the face and closer to the upper eyelid than they should, they can block off a decent amount of real estate. 

Excess skin is just one of many reasons why it is crucial to evaluate the brow and upper eyelid together. “If the lateral brow is sagging, it contributes to sagging skin and fullness in the upper eyelid,” explains [Bob Basu, MD](https://aedit.com/provider/bob-basu-34656), a board certified plastic and reconstructive surgeon in Houston, TX. “A brow lift helps correct brow sagging and hooding to open up the entire eye.” If there is little space between the eyelid and the brow, a brow lift can open the eye area back up – likely without the need to remove as much upper eyelid skin.

A brow lift can be personalized for the patient. There are four different types of brow lifts that involve varying degrees of invasiveness (and scarring), and each one corrects a unique situation.

1. **[Coronal Brow Lift](https://aedit.com/procedure/coronal-brow-lift)**: This requires an incision from ear to ear (within the hairline) over the crown to remove excess skin and create more rejuvenated and lifted brows.
2. **[Endoscopic Brow Lift](https://aedit.com/procedure/endoscopic-brow-lift)**: Perhaps the most favored technique, this version is the least invasive surgical option and requires only a few small incisions.
3. **[Pretrichial Brow Lift](https://aedit.com/procedure/pretrichial-brow-lift)**: The hairline or trichophytic incision removes a small amount of skin as a way of elevating the eyebrows and is best suited for those with extremely high hairlines.
4. **[Direct Brow Lift](https://aedit.com/procedure/direct-brow-lift)**: Making an incision directly over the eyebrows can lower a high hairline, however, this technique does not always address the entire brow but rather only a portion of it.

To artfully perform a good brow lift, incisions are made so that the surgeon can go in either endoscopically or more traditionally to lift the muscles and raise the outer third of the brows. As a result, the eyebrows appear better positioned and regain a more natural shape, plus the forehead will appear smoother. By improving the positioning, the brows look less heavy and the eyes look more awake. 

But there is still a balancing act at play to achieve a natural result. “I always look at old photos to see if a patient always had low brows or did it change with aging,” Dr. Schwarcz says. “Not to complicate things, but in a small subset of the population – usually seen in very thin face patients – the brows can go up with age.” Furthermore, it's imperative not to overcorrect the brows when lifting them because that can make a person appear surprised. “Also, it’s important to be aware if someone has a hollow upper eyelid region, as this can be more exposed with a brow lift,” Dr. Schwarcz adds.

Preventatively, neuromodulators (i.e. the so-called [Botox brow lift](https://aedit.com/procedure/chemical-brow-lift)) can help maintain the arches. “[Recent data](https://www.ncbi.nlm.nih.gov/books/NBK574523/) proves that the frontalis muscle has a bi-directional pull on the skin of the face – both up and down,” Dr. Williams shares. “Botox may delay the need for a brow lift when used to treat that downward pull.” Even post-brow lift surgery, surgeons still may recommend neurotoxin injections to correct any wrinkles that crop up around the eyebrows, like between them (known as the glabellar lines or elevens) or right above them.

### **OPT FOR AN UPPER BLEPHAROPLASTY IF THE LIDS ARE HOODED**
A tired-looking eye can result from upper [eyelid hooding and loose skin](https://aedit.com/concern/sagging-and-hooded-eyelids) (independent of the brow). In some cases, a low-hanging lid can impede the eyes' ability to function correctly. The excess skin makes it hard to apply makeup and eye products and can even affect one's vision. In the case of the latter, insurance may [cover the cost](https://aedit.com/procedure/blepharoplasty-eyelid-surgery/cost) of treatment. 

<BeforeAfterModule
  title={Before & Afters: Upper Eyelid Blepharoplasty}
  procedureId={897}
/>

Regardless of the cause, most plastic surgeons perform an [upper eyelid blepharoplasty](https://aedit.com/procedure/upper-eyelid-blepharoplasty) in one of two ways: either as a skin pinch or as a fat and skin removal procedure. Dr. Williams says that the techniques used for blepharoplasty depend on what needs to be corrected. “For example, if excess fat is contributing to the tired or heavy look, then ignoring the fat will lead to an incomplete result,” he says. Most patients need to address a combination of thick muscle, skin excess, and fat.

A small incision is made in the crease of the upper eyelid or in the lash line (we promise it sounds scarier than it is), which provides access to excise the skin and remove or reposition fat. Depending on the patient, the fat can be adjusted instead of removed to allow it to lay better without losing volume.

### **GO WITH A LOWER BLEPHAROPLASTY WHEN STUBBORN BAGS PERSIST**
Is concealer not enough to send those under-eye bags packing? Puffy and protruding bags, which usually come with crepey skin, often require surgical intervention in the form of a [lower eyelid blepharoplasty](https://aedit.com/procedure/lower-eyelid-blepharoplasty-subciliary-approach). “In the earlier days of the blepharoplasty operation, over obsession with the excess fat was a concern,” Dr. Williams recalls. “Modern-day techniques include a combination of fat removal and also fat repositioning to avoid the hollow look that most patients want to avoid.” Although plastic surgeons can remove fat in several ways, most practice is through an [incision in the eyelid](https://aedit.com/procedure/lower-eyelid-blepharoplasty-transconjunctival-approach) to avoid an external scar.

<BeforeAfterModule
  title={Before & Afters: Blepharoplasty}
  procedureId={981}
/>

Dr. Basu explains that a lower blepharoplasty can remove loose skin and fat bags and improve the overall appearance of the lower eyelids. “Often, fat repositioning or fat micrografting also improves a tear-trough deformity – the hollowing in the lower eye area that contributes to an aged or tired look,” he says. “I frequently complement my surgical results with [fat micrografting](https://aedit.com/procedure/facial-fat-grafting) to achieve a more refreshed, natural-looking, rejuvenated result.” This way, there's a smooth transition between the lower eyelids and where they meet the upper cheeks.
 
It should be noted that a lower eye lift cannot fully eradicate every minor imperfection. When skin texture concerns, such as lines and wrinkles, are a patient's priority to get rid of, a resurfacing laser is often used instead.

### **DO A COMBINATION FOR HOLISTIC REJUVENATION**
For some, both the upper and lower lids and the eyebrows require a refresh to create a holistic and harmonious result. “In moderate to severe cases, we can achieve the best results with both a brow lift and an upper eyelid lift,” Dr. Basu shares. It's essential to visit a board certified plastic surgeon to learn about your options and determine your needs.

Of course, when pairing procedures, your surgeon can do any combination. Still, the most popular combos are usually a brow lift and upper blepharoplasty and, perhaps, correcting the lower lids as necessary. The reason is that loose skin often accompanies upper lid hooding and a saggy brow, so addressing all the changes yields the most positive results. 

When faced with more than one eye-related issue, most patients opt to go in for [everything at once](https://aedit.com/aedition/when-is-it-safe-to-combine-plastic-surgery-procedures) because it means a reduced cost (compared to two separate appointments), one recovery period, and maximized results. When done individually, Dr. Schwarcz says it’s usually because the patient doesn't want too much surgery at once or because “they want more accurate results to see how much skin is left after the brow lift heals.” In this staggered approach, the brow surgery comes first with the blepharoplasty performed later. “This is less common because there are two healing times and extra operating room expenses,” he notes.

## **The Takeaway**
As Dr. Basu explains, the best ways to maintain the results of an eyelid lift, brow lift, or both include following a healthy lifestyle (think: hydration, good nutrition, and [getting proper sleep](https://aedit.com/aedition/impact-of-beauty-sleep-on-skin-health-nighttime-skincare-products)), adopting a medically supervised skincare regimen, and introducing modalities to minimize collagen loss. If [aging and tired eyes](https://aedit.com/procedure/eye-rejuvenation-solutions) are the bane of your existence, consider a consultation with a board certified plastic surgeon, facial plastic surgeon, or oculoplastic surgeon for a full assessment of what changes you are experiencing in the upper third of the face and the best ways to address them.

The rejuvenating procedures are not the same, nor are they interchangeable.

How To Tell If You Need A Blepharoplasty, Brow Lift, Or Both For Eye Rejuvenation

How To Tell If You Need A Brow Lift, An Eyelid Lift, Or Both

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Given how much we all talk about the [under eye filler](https://aedit.com/procedure/under-eye-filler), it’s easy to assume that the treatment was already an indication approved by the United States Food and Drug Administration (FDA). But injecting the tear troughs to rejuvenate hollows and minimize the appearance of bags and dark circles has actually been an ‘off label’ use of hyaluronic acid (HA)-based filler. Not any more. 

On Tuesday, Allergan Aesthetics [announced](https://www.prnewswire.com/news-releases/fda-approves-juvederm-volbella-xc-for-undereye-hollows-301477144.html) the FDA approval of [Juvéderm® Volbella XC](https://aedit.com/procedure/juvederm) for improvement of infraorbital hollows in adults over the age of 21. “This additional indication… demonstrates Allergan Aesthetics' continued commitment to innovation,” Carrie Strom, president of Global Allergan Aesthetics and senior vice president of AbbVie, said in a press release. So, what does the news mean for your next filler appointment? Here’s what you need to know.

## **The Popularity of Under Eye Filler**
Under eye filler has risen in popularity over the last couple of years, especially as pandemic-related face coverings put more [emphasis on the eyes](https://aedit.com/aedition/popularity-of-eyelid-surgery-cosmetic-eye-procedures-during-covid-19) and the stress of everyday life made dark circles, well, darker. “The under eye area is one of the most frequently requested treatment sites among patients, regardless of race and ethnicity, but it is undertreated,” says [Julie Woodward, MD](https://www.dukehealth.org/find-doctors-physicians/julie-ann-woodward-md), a board certified oculofacial plastic surgeon and ophthalmologist and Allergan Medical Institute (AMI) trainer. “This is in part because it is a sensitive area to inject as it takes great skill and precision.”

The tear troughs are a very delicate area to treat and require [unique technique](https://aedit.com/aedition/guide-to-injectable-techniques-needles-for-botox-filler) from a highly skilled provider. This approval should help improve the safety and efficacy of the procedure.  Per an FDA requirement for this new indication, Allergan Aesthetics will provide training programs, including how to assess facial anatomy holistically and the identification and management of [potential complications](https://aedit.com/aedition/risk-of-vascular-occlusion-after-dermal-filler). Providers will need to complete this training before being allowed to inject Juvéderm® Volbella XC under the eyes. 

## **The Benefits of Under Eye Filler with Juvéderm Volbella XC**
Juvéderm® Volbella XC was first approved by the FDA in 2016 for use in the lips and perioral rhytids (a.k.a. the vertical lines that extend from the upper lip). What gives the product a natural look and feel for the lip area extends to the tear troughs. “The characteristics of Juvéderm® Volbella XC with lower amounts of hyaluronic acid molecules and low water affinity provides a soft, smooth formulation appropriate for treating under eye hollows,” Dr. Woodward explains.

Allergan Aesthetics reports that, according to clinical trial data, 90 percent of patients reported satisfaction through one year after treatment with Juvéderm® Volbella XC and said they would recommend the treatment to a friend. “The results of the clinical trial demonstrate significant improvements in the appearance of under eye hollows and overall appearance,” Dr. Woodward shares. “In addition, 80 percent of subjects reported they were a little or not at all bothered by how tired and old the under eye area looked at three months compared to 15 percent and 30 percent before treatment, respectively.”

## **Under Eye Filler Recovery & Results**
The majority of patients in the clinical trials experienced side effects such as injection site tenderness, [bruising](https://aedit.com/aedition/how-to-treat-prevent-bruising-after-lasers-filler-botox), swelling, lumps and bumps, redness, pain after injection, firmness, discoloration (other than redness or swelling), and/or itching. This data is based on patient reporting in their 30-day daily diaries. Allergan Aesthetics notes that a majority of these side effects were “mild in severity” and “easily tolerated” – though some subjects experienced mild swelling that lingered for more than 30 days post-treatment. One patient in that group required treatment with antibiotics (the rest did not require intervention), and all of these effects resolved by day 45.

The results of all hyaluronic acid-based fillers are [temporary](https://aedit.com/aedition/how-frequently-to-get-non-surgical-cosmetic-procedures-like-dermal-filler-botox-chemical-peel), and under eye filler is no exception. Based on the clinical studies, patients reported being satisfied with their results from Juvéderm® Volbella XC for at least 12 months.

Here’s what it means for your next injectable appointment.

FDA Approves Juvéderm Volbella XC For Under Eye Filler

The FDA Just Approved Under Eye Filler For The First Time

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If the condition of your eye area has you crying your eyes out, you are not alone. Eye-related procedures are consistently among the most popular in aesthetic medicine. In 2020 alone, the American Society of Plastic Surgeons (ASPS) [reports](https://www.plasticsurgery.org/documents/News/Statistics/2020/plastic-surgery-statistics-full-report-2020.pdf) that there were some 325,000 eyelid surgeries performed, putting it behind only rhinoplasty on the list of the top five cosmetic surgical procedures. 

As we've adapted to wearing face coverings during the COVID-19 pandemic, [eyes took centerstage](https://aedit.com/aedition/popularity-of-eyelid-surgery-cosmetic-eye-procedures-during-covid-19) in a new way, and then there is the so-called '[Zoom effect](https://aedit.com/aedition/aedit-survey-reveals-how-2020-altered-aesthetic-landscape)' that has had people scrutinizing their faces in front of a camera. All of this is to say that eye rejuvenation procedures (surgical or otherwise) have always been popular, but perhaps they have never enjoyed such universal appeal as they do now. “More and more men want to have their eyes done,” says [Andrew T. Cohen, MD](https://www.drandrewcohen.com/), a board certified plastic and reconstructive surgeon in Encino, CA. “They want the bags removed and skin removed.”

We’ve previously covered the [top eye rejuvenation procedures for women](https://aedit.com/aedition/cosmetic-procedures-for-under-eye-rejuvenation), and, while the concerns are generally the same, there is nuance to how they manifest and the best way to treat them. Here, we’re breaking down the best surgical and non-surgical eye rejuvenation procedures for men.

## **Why Men Seek Eye Rejuvenation**
When you think of the eye area, what comes to mind? Under eye darkness and/or volume loss is probably up there. Maybe a sagging brow is, too. Fine lines at the corners of the eyes (a.k.a. crow's feet) are a bother to some. Or perhaps its excess skin in the upper or lower eyelid region that gives you pause. According to [Stafford Broumand, MD](https://plasticsurgeonsnyc.com/), a board certified plastic and reconstructive surgeon in New York City, men often seek treatment for upper eyelid hooding and bags under the lower lid. “Some men will complain about crow’s feet around the lateral part of the eye,” he adds. 

Sometimes these eye concerns have functional implications. For instance, if excess eyelid skin interferes with someone’s vision, there is a medical reason to correct it and it may be [covered by insurance](https://aedit.com/aedition/insurance-coverage-for-plastic-surgery-cosmetic-procedures). But, more often than not, these issues are cosmetic in nature. Heavy brows, drooping eyelids, dark circles, and crepey skin can all lead to [looking aged, tired, or even stern](https://aedit.com/concern/aging-and-tired-eyes).

Because we rely so much on our eyes to express emotion, you likely want your peepers to better reflect how you’re feeling. In fact, you’d ideally like them to reflect the most well-rested and youthful version of you. Fortunately, that’s a reasonable request.

## **Best Eye Rejuvenation Procedures for Men**
Now that you understand the cause of many aesthetic eye concerns, it’s time to learn how to treat them. [Eye rejuvenation procedures](https://aedit.com/procedure/eye-rejuvenation-solutions) can address the entire eye area, which includes:

- Upper eyelid
- Eyebrow
- Lower eyelid
- Under eye
- Periorbital skin

To treat eye concerns, both surgical and non-surgical options are available. “Non-surgical is done with lasers or with fillers,” Dr. Cohen explains. “[Dysport®](https://aedit.com/procedure/dysportr) or [Botox®](https://aedit.com/procedure/botox) can be used around the eyes in the crow’s feet area.” Surgical treatment, meanwhile, can include blepharoplasty (a.k.a. eyelid surgery) and browplasty (a.k.a. brow lift). Below is what eye rejuvenation entails for each part of the eye:

### **For Upper Eyelids**
Upper eyelids experience wear and tear. For starters, think about how many times a day you blink and note that the action contributes to your upper lids showing signs of aging. The natural aging process can also lead to excess skin in the region that causes them to look like they are sagging or spilling over into the rest of your eye area. 

<BeforeAfterModule
  title={Before & Afters: Upper Eyelid Blepharoplasty}
  procedureId={897}
/>

Most of the time, surgery is the best option. “We can address the upper eyelid heaviness by removing the excess skin and creating a more youthful eyelid,” Dr. Broumand says. “This is called an upper blepharoplasty.” The results of an [upper eyelid blepharoplasty](https://aedit.com/procedure/upper-eyelid-blepharoplasty) are immediate (save for temporary swelling and bruising) and permanent (save for the natural aging process). The upper eyelids will be rejuvenated, with the eyelid skin toned and tightened.

### **For Lower Eyelids**
Skin sagging isn’t the only concern that impacts the lower eyelid. “A lot of men complain about bags under their eyes,” Dr. Broumand notes. For many, this is the result of the movement of the nasojugal fat pads, which appear when the the skin under the eyes loses elasticity and creates a groove between the lower eyelid and cheek bone. “Surgically, we can remove the fat pads that accumulate with age through an incision on the inside of the eyelid where the lashes meet the lid and remove the fat pads,” he explains. This is known as a [lower eyelid blepharoplasty](https://aedit.com/procedure/lower-eyelid-blepharoplasty-transconjunctival-approach). Depending on your concerns, there are techniques that can reposition fat, remove excess skin, or some combination of the two.

<BeforeAfterModule
  title={Before & Afters: Blepharoplasty}
  procedureId={981}
/>

When it comes to sagging lower eyelid skin, however, going under the knife isn’t necessarily the only solution. “If patients present with laxity in the lower lid skin, we can use AccuTite, a minimally invasive radiofrequency treatment, to [firm] the skin around the eye or perform [Morpheus8](https://aedit.com/procedure/microneedling-with-radiofrequency) to tighten around the eye,” Dr. Broumand adds.

### **For Eyebrows**
The same gravity that is pulling down your eyelids can also be responsible for creating the appearance of a heavy brow. For men, this often leads to looking perpetually angry or tired. It can also lead to the eyes looking smaller than they actually are. 

Depending on the severity of the sagging, there are surgical and non-surgical brow lift techniques. Dr. Broumand usually recommends [neuromodulators](https://aedit.com/procedure/chemical-brow-lift), like Botox®, and/or ultrasound-based skin tightening as a first line of defense. “We can put a little Botox® in to lift the brow slightly,” he shares. “We can also address brow placement with [Ultherapy®](https://aedit.com/procedure/ultrasound-skin-tighteningultherapy), a non-surgical ultrasound treatment.” Both require ongoing maintenance.

<BeforeAfterModule
  title={Before & Afters: Botox Brow Lift}
  procedureId={721}
/>

While Dr. Broumand says men do not generally require a [surgical brow lift](https://aedit.com/aedition/theres-more-to-a-brow-lift-than-meets-the-eye), “it can be done if requested.” It’s also worth noting that, for some patients, pairing a [blepharoplasty with a brow lift](https://aedit.com/aedition/combining-blepharoplasty-and-brow-lift) may achieve the most natural and long-lasting result. Consulting with a board certified plastic surgeon will help determine the best treatment for your needs.

### **For Under Eyes**
[Dark circles](https://aedit.com/aedition/best-aesthetic-procedures-to-minimize-dark-circles) do not discriminate. Everyone deals with them, yet the reason why is a bit more specific to the individual. For some, it’s simply exhaustion. For others, it’s genetic predisposition. Alcohol, [smoking](https://aedit.com/aedition/impact-of-cigarette-smoking-vaping-on-skin-hair-teeth-health), and caffeine can exacerbate darkness, too. Hyperpigmentation brought on by sun exposure, hormones, or medication is another potential culprit, as is the lower eyelid volume loss we discussed above. Depending on how those fat pads move, you may experience a hollowing effect that causes shadowing.

<BeforeAfterModule
  title={Before & Afters: Under Eye Filler}
  procedureId={1018}
/>

While surgery may be your best bet to redistribute the fat, there are non-surgical treatment options for dark circles. Hyaluronic acid (HA)-based fillers, like [Juvéderm®](https://aedit.com/procedure/juvederm) and [Restylane®](https://aedit.com/procedure/restylane), can be injected into the [tear trough region](https://aedit.com/procedure/under-eye-filler) to add or restore volume. Natural alternatives to HA filler include platelet-rich plasma (PRP) and [autologous fat](https://aedit.com/procedure/facial-fat-grafting). For those experiencing dark circles as a result of unwanted pigmentation, gentle [chemical peels and laser treatments](https://aedit.com/aedition/chemical-peel-vs-laser-treatment-what-is-best-for-your-skin) can improve skin tone and texture.  

### **For Periorbital Skin**
Not all skin concerns in the periorbital area require surgical intervention. If you are concerned about [crow’s feet](https://aedit.com/procedure/periorbital-botox), neurotoxin injections can temporarily smooth the skin.

You've likely noticed that the [skin around your eyes](https://aedit.com/aedition/how-to-treat-the-skin-around-the-eyes-with-skincare-and-non-surgical-cosmetic-procedures) is different from the skin on the rest of your face. It’s quite thin and lacks oil glands, which makes it drier and more prone to irritation and textural concerns. With age, these issues are only exacerbated. Caring for it with a regimen of its own is essential. [Eye creams](https://aedit.com/aedition/eye-creams-serums-to-treat-crows-feet-dark-circles-puffiness) and [under eye patches](https://aedit.com/aedition/best-under-eye-patches-masks) have the ability to tighten, brighten, and depuff for a rejuvenating effect. Look for products with moisturizing [ceramides](https://aedit.com/aedition/guide-to-topical-ceramides-in-skincare) and [hyaluronic acid](https://aedit.com/aedition/guide-to-hyaluronic-acid-in-skincare-dermal-filler), firming [peptides](https://aedit.com/aedition/guide-to-topical-peptides-in-skincare) and [retinol](https://aedit.com/aedition/guide-to-vitamin-a-retinol-retinoids-in-skincare), radiance-boosting [caffeine](https://aedit.com/aedition/caffeine-in-skincare-products-for-eyes-body-cellulite) and [vitamin C](https://aedit.com/aedition/guide-to-topical-vitamin-c-in-skincare), and depuffing oat kernel and/or licorice extract.

## **The Takeaway**
There is no one-size-fits-all solution for eye-related aesthetic concerns, but there are an array of surgical and non-surgical treatment options that can refresh and revitalize the entire eye area. Regardless of which procedures are right for you, routine maintenance with a well-formulated eye cream can help to keep the skin around your eyes healthy, hydrated, and youthful.

If the appearance of your eye area has you crying your eyes out, you are not alone. Here’s how to change that.