Under-eye filler: does it work, how long does it last, and what can go wrong?

This guide is not medical advice: only a doctor who examines you can say what is behind a shadow under the eye.

Is under-eye filler harmful?

Usually the harm is short-lived: bruising, swelling, tenderness and small lumps, which in most people go away on their own.¹² In diaries from the four FDA trials, 40% to 71% of people reported bruising, 42% to 85% swelling and 39% to 65% lumps.³⁴⁵⁶ Most cleared within one to two weeks, but in the newest trial 12.1% of people still had one on day 30.⁴⁵⁶

The serious risk is filler entering a blood vessel, which can cause tissue death, stroke or blindness. The FDA calls the chance low but the harm possibly permanent,⁷ and lists the area around the eyes among the places it has been reported.⁴ We found no published rate for the under-eye area alone. Across the whole face, an unaudited survey of 370 US dermatologists covering 1.7 million syringes found a blocked vessel no more often than once in 5,000 syringes.⁸

Among published cases of vision loss, injections around and under the eye are a small share: the area around the eye was 2 of 226 injection sites in an American Academy of Ophthalmology report, and the tear trough 1 of 60 cases in a review of cases from 2015 to 2018.⁹¹⁰ These are reported cases, not a rate. Vision loss nearly always starts at once, and in a review of 365 cases, 68.2% of those with a recorded outcome did not recover their sight.¹¹¹²

Get help immediately for any change in your vision, signs of a stroke, skin turning white, or unusual pain during or shortly after the treatment.¹² Sudden or growing pain, or pale or dusky skin, can mean a blocked vessel and needs an urgent in-person review.¹³ The emergency numbers for each country are in our lip filler guide.

What kind of shadow can filler change?

Mainly one kind: the shadow of a hollow, where volume is missing along the groove between the lower lid and the cheek.³¹¹⁴¹⁵ Dark circles can also come from pigment, from thin skin that shows the vessels and muscle beneath, from fluid, or from fat bulging forward, and most people have more than one cause.¹⁶¹⁴¹⁷ Bulging fat deepens the groove below it,¹⁷ and when the problem is fat rather than a hollow, filler can make the puffiness worse.¹⁸

How long does it last?

In the FDA trials, most people were still improved about a year after treatment, and the effect faded slowly.¹⁶ Two to three months after treatment, 79% to 87% of treated people were at least one grade better on a photo scale of the hollow, against 2% to 18% of people left untreated; at 48 to 52 weeks, 60.5% to 81.4% still were.³⁴⁵⁶ Touch-ups were common: 61% and 78% of people in two trials had one, usually two weeks to a month after the first injection.¹⁴ The gel can outlast what you see: in a small MRI series of 33 people treated in the midface, it was still detectable in all of them at least two years later.¹⁹

What can go wrong under the eye in particular?

The problems particular to this area include a bluish tint, swelling that lingers, uneven contours and filler that moves.²⁰¹⁰ The bluish tint, called the Tyndall effect, is usually put down to light scattering through gel that sits too near the surface of the thin eyelid skin.⁶¹⁰ It was seen in 3.3% of one surgeon's 583 patients, 7 of 233 people in the newest FDA trial, and 0% to 31% across studies, more often where follow-up was longer.²¹⁶¹⁰

Across studies of filler around the eyes, 0% to 15% of people, depending on the study, had swelling lasting more than four weeks; when it spreads over the cheekbone it is called malar oedema.¹⁰ Among the 583 patients, 10% had swelling, it lasted a median of four weeks, and injecting more than 0.3 mL was linked with more of it.²¹ In one eye unit's long-term review of 147 people, 31.3% had a blue-grey tint, 30.5% uneven contours and 11% malar oedema, and 90% of these problems were mild and needed no treatment.²⁰ Filler can also move, sometimes into the eye socket, and show up as swelling or a lump months or years later.¹⁰²²

Hyaluronic acid filler can be dissolved with an enzyme, hyaluronidase, which often clears a bluish tint within a day.¹²³ The enzyme has its own risks: immediate allergic reactions are rare at the doses used, with a reported incidence of about 0.1%, and at high doses it can remove the result along with the problem.²³ Other fillers can be difficult or impossible to remove.²⁴

Who may inject it, and how can you check?

In Turkey and Azerbaijan it is a doctor's procedure in a licensed facility; in England there is still no licence to inject.^25262728

In Turkey, treating patients requires a medical degree,²⁵ aesthetic procedures are for doctors working in licensed health facilities,²⁶ and beauty salons may not perform them even with a doctor on staff.²⁹ A facility treating patients from abroad needs Ministry of Health authorisation; check it on the Ministry's list of authorised facilities.³⁰³¹ To check the doctor, see how to check a doctor in Turkey.

In Azerbaijan, the Ministry of Health's Analytical Expertise Centre says such procedures belong only in licensed medical institutions, with doctors of the relevant specialty.²⁷ You can check a doctor's certificate by its number, after registering, on the Ministry's website.³²

In England, the law lets the government create a licence to inject,³³ and the government says it will,³⁴³⁵ but for now practitioners without approved qualifications or enough training can legally do these procedures.²⁸ Injecting cosmetic filler into anyone under 18 is an offence.³⁶ The NHS suggests checking whether a practitioner is on a register accredited by the Professional Standards Authority; two such registers cover non-surgical cosmetic practitioners.³⁷²⁸

What if you have it done abroad?

Plan for the weeks after you fly home: a clinic abroad may not offer follow-up, and there may be no one at home who can treat a problem.³⁸ A touch-up can come a month after the first injection,¹ and in one series of 583 patients, swelling that lingered lasted a median of four weeks and up to a year.²¹ Ask for the name of the product used,²⁷ and ask the question UK government advice calls vital: "if it goes wrong, who will fix it?"³⁹ The rest of the planning is in filler on a trip.