Dr Otgen Clinic guide

Under-eye (tear trough) filler aims to soften the hollow between the lower eyelid and the cheek, reducing the dark, tired look caused by shadow. But not every dark circle comes from this hollow. If pigmentation, blood vessels showing through thin skin or under-eye bags are the cause, filler may not improve the appearance and can sometimes make it more noticeable. So the real question is not "should I have filler?" but "what is causing the darkness under my eyes?"

Four causes of dark circles

Dark circles are usually the result of several factors rather than a single cause. At the consultation these factors are told apart:

  • Shadow from volume loss (tear trough): the groove between the lower eyelid and the cheek deepens, and because light does not reach it, a dark shadow forms
  • Brown discolouration (pigmentation): a true darkening of the skin; genetic tendency, sun exposure and rubbing from allergies can play a role
  • Thin skin and visible blood vessels: when the skin under the eyes is very thin, the vessels beneath give a blue-purple tint
  • Under-eye bags: a bulge caused by the fat around the eye pushing forward, which casts a shadow below it

When filler helps most

Filler helps most with shadow caused by volume loss. In people with a visible tear trough, relatively thick skin and no bags, filler can fill the groove so that light spreads more evenly, reducing the tired look.

In these people the darkness often changes with the angle of the light: it is more visible with overhead light and less so when light falls on the face from the front. This simple observation is one of the clues used at the consultation.

When filler is unsuitable or not enough on its own

  • Prominent under-eye bags: filler does not hide bags and can sometimes make them more noticeable; lower eyelid surgery is considered
  • Marked skin laxity and wrinkles: filler does not tighten skin; treatments for skin quality or surgical options are discussed
  • Brown pigmentation: filler does not remove colour; skincare, sun protection and pigmentation treatments are considered
  • Very thin skin with visible vessels: the effect of filler may be limited and the risk of a bluish tint increases
  • Frequent swelling around the eyes or allergic puffiness: filler can increase the swelling; the cause needs to be controlled first
  • Active infection at the treatment site, pregnancy and breastfeeding: treatment is postponed

What is assessed at the consultation?

An under-eye assessment is not made by looking in a mirror alone. The doctor examines your face under different light angles, assesses the thickness and elasticity of the skin under your eyes, and checks whether bags become more visible when you smile and look up.

Volume loss in the cheek is assessed too. In some people, supporting the cheek gives a more natural result than filling the tear trough directly. If you have had filler or another treatment around the eyes before, bring the details to the consultation.

Options to consider instead of, or alongside, filler

  • Lower eyelid surgery: for prominent bags and laxity
  • PRP and treatments for skin quality: supportive options for thin, tired-looking skin
  • Pigmentation treatments and regular sun protection: for brown discolouration
  • Cheek support: if volume loss in the mid-face contributes to the under-eye shadow

Which option is suitable is decided at the consultation; often a combination of approaches gives a more balanced result.

The treatment and aftercare

A numbing cream is applied; the filler is mostly placed with a cannula, in small amounts and in a deep plane. The appointment usually takes 20–60 minutes and most people return to daily life the same day.

You are advised to sleep with your head slightly raised on the first night, not to press on the area and to avoid strenuous exercise, saunas and Turkish baths for the first 24–48 hours. Swelling under the eyes can take longer to settle than in other areas; the result is assessed at a follow-up about two weeks later.

Possible side effects and urgent warning signs

Swelling and bruising are the most common side effects and usually ease within a few days. If filler is placed too close to the surface, a bluish tint can appear in thin skin (the Tyndall effect); with hyaluronic acid fillers this can be corrected by dissolving the filler if needed.

A rare but serious complication is filler blocking a blood vessel. If you notice blurred vision or loss of vision, severe pain around the eye or blanching of the skin, contact the clinic that performed the treatment or the nearest emergency department without waiting.

Frequently asked questions

How long does under-eye filler last?

Because the under-eye area moves little, the effect often lasts longer than in mobile areas such as the lips. How long depends on the product, the amount and the individual; you will be given personal information at the consultation.

I have under-eye bags — can I have filler?

If the bags are caused by fat pushing forward, filler may not correct them and can even make them more noticeable. In that case options such as lower eyelid surgery are considered.

Can under-eye filler be dissolved if I do not like it?

Hyaluronic acid fillers can be dissolved by a doctor with the enzyme hyaluronidase if needed. This is an important safety difference compared with permanent materials that cannot be reversed.

What can be done for dark circles other than filler?

Depending on the cause, pigmentation treatments, procedures that support skin quality, sun protection or eyelid surgery may be considered. Sleep patterns and controlling allergies can also affect the appearance.

Dr Otgen Clinic Medical Editors · Last updated: October 6, 2026