Injectable Treatment for Under-Eye Hollows
You look in the mirror and a groove under your eye makes you look tired, even after a good night's sleep. What are known as under-eye hollows are primarily related to contour, and you are wondering whether under-eye filler could make the hollow less noticeable. A gel can reduce the shadow of the hollow, but not dark colouring or a bag. Before deciding, the cause of this appearance needs to be examined, and you need to understand the risks of an injection in this area.
- Examination before any decision
- Global Aesthetic consultation
- Sainte-Thérèse
In Brief
Five things to know before deciding- The hollow: an under-eye hollow is related to contour — the groove, where the skin is thin, casts a shadow that makes you look tired; colour (pigment, visible blood vessels) and bags (fat) are other causes, which often occur together with the hollow.
- What a gel targets: the shadow caused by the contour; a hyaluronic acid gel does not improve dark pigment and is not intended to treat either visible blood vessels or a bag caused by fat.
- Risks: bruising, swelling, pain, nodules, asymmetry; more serious, though unlikely, is a blood vessel blocked by the gel, which requires immediate care.
- Duration: temporary; it varies depending on the product and the person, and a touch-up is not automatic.
- Assessment: a doctor examines your hollow before any decision, specifies which gel would be used and for what purpose, and may conclude that it is better not to inject.
What Causes an Under-Eye Hollow, and How Is It Different From Discolouration or a Bag?
At the bottom of the groove, the skin is thin and there is very little fat beneath it, which makes the indentation deeper. With age, the soft tissues become thinner and the underlying bone provides less support: the groove becomes more noticeable. Not all dark circles are caused by aging, however. This shadow comes from the contour, not necessarily from a lack of sleep; it cannot be used to judge your health.
- What you see
-
A groove under the eye that makes you look tired
- What only the doctor can tell on examination
-
- A hollow
- Discolouration
- A bag
A hollow, discolouration and a bag can occur together under the same eye.
The hollow
The hollow is related to contour.
The colour
Colour comes from pigment, which causes a brown under-eye circle, or from blood vessels seen through the skin, which give it a bluish to purple tint.
The bag
A bag caused by fat protrudes instead of forming a hollow.
However, not all swelling is a bag of fat: its cause is confirmed through an examination.
You can have all three at once, which is why a dark under-eye circle is not necessarily caused by a hollow. Distinguishing a bag from a dark circle comes before choosing what to treat: it is the starting point of dark circle treatment.
This page is about the hollow under the eye, from a cosmetic standpoint.
What Can a Hyaluronic Acid Gel Target, and What Does It Not Correct?
Hyaluronic acid is a gel that attracts and retains water. A hyaluronic acid gel fills out the skin and adds volume to it; this is the principle behind any hyaluronic acid injection, and with most gels the effect is visible immediately or almost immediately. Under the eye, this volume can make the contour less pronounced and reduce the shadow it casts. What this looks like on your face depends on your hollow, your skin and the product.
Does hyaluronic acid get rid of dark circles? Not all of them. It can reduce the shadow of a hollow, depending on the situation; it does not improve dark pigmentation, and it is not intended to treat either visible blood vessels or a bag caused by fat. Adding volume does not remove a bag. When a dark circle is both hollow and very dark, the gel can act on the part caused by shadow: the colour remains. The aim is to reduce the shadow, not to make all dark circles disappear. Ask the doctor how much of what you see is shadow, and how much would remain after the injection.
Who Is an Under-Eye Injection Appropriate For?
A well-defined hollow is better suited to filler. Skin thickness also matters: results are better on fairly thick, smooth skin than on very thin, very wrinkled skin.
An examination is an opportunity to see how these factors combine in your case and whether another approach would suit you better.
Conversely, three situations make an injection less appropriate:
- a prominent bag, because the gel can create a puffy appearance that is harder to correct;
- very thin, very wrinkled skin;
- and expectations focused solely on colour, which the gel does not change.
Why Do the Product and Technique Matter Under the Eye?
Hyaluronic acid gels are not interchangeable: they differ in how they are made (cross-linking), their concentration and the size of their particles.
Words such as “soft” or “dense” are therefore not enough to choose one: your anatomy and the intended use must be taken into account. Before injecting, the doctor specifies which gel is appropriate for your hollow and what use it is licensed for; ask the doctor about this.
The gel is placed with a needle or a cannula, at depths that vary according to anatomy.
Neither the needle nor the cannula eliminates all risks. The choice is made based on your anatomy; no technique is better for everyone. Whether to support the cheekbones is discussed case by case: there is no set order in advance.
- Groove under the eye
- Cheekbones
What Are the Risks of an Under-Eye Injection?
Most common effects
- Bruising
- Redness
- Swelling
- Pain
- Tenderness
The most common effects after the injection are bruising, redness, swelling, pain and tenderness.
They generally appear shortly afterwards, and many fade within a few days to a few weeks. The gel retains water and can contribute to swelling. If the area is already puffy, have the cause examined before any decision: some forms of swelling can get worse after filler.
Weeks, months or even years after
- Asymmetry
- Nodules
- Infection
Asymmetry, nodules (small lumps under the skin) or an infection sometimes occur as well.
Some effects only appear weeks, months or even years after the injection: even if the gel is gradually absorbed, a complication is not necessarily short-lived.
Bluish tint
- Tyndall effect
Can the injection make the area look bluer? Yes, in some cases: a bluish tint can appear over a gel placed under the skin.
This is called the Tyndall effect, but a bluish tint is not enough to determine its mechanism or cause. Have it examined after an injection. It is not the same as skin that turns white, grey or blue near the injection site during or just after the procedure: that can signal a blocked blood vessel and requires immediate care.
Accidental injection into a blood vessel
- Necrosis
- Vision problems that can lead to blindness
- Stroke
The risk of greatest concern is accidental injection of the gel into a blood vessel.
It is unlikely, but it can block the vessel and deprive the tissues of blood, with serious and sometimes permanent consequences: necrosis (the death of an area of tissue), vision problems that can lead to blindness, or a stroke. No technique eliminates this risk.
Seek Care Right Away
Seek care right away
During or after an injection near the eye, these signs require immediate medical attention:
- unusual pain;
- a change in vision;
- white, grey or blue skin near the injection site, even without pain;
- signs of stroke: sudden difficulty speaking or walking, numbness or weakness in the face, an arm or a leg, facial drooping, a severe headache, dizziness or confusion;
- signs of infection near the injection site.
Call the person who performed the injection or go to the emergency department, without waiting for a reply to a message submitted through a form.
How Long Does the Effect Last, and What Should You Expect After the Injection?
Filler is not permanent: the hyaluronic acid gel is gradually absorbed.
- Duration
-
How long the effect lasts depends on the product and varies from person to person.
- Touch-up
-
It is not automatic.
A follow-up visit is used to assess the result, and a touch-up is done only if it is needed. There is limited long-term evidence on the safety of injections repeated over many years. Before each new injection, reassess its suitability and risks with the doctor.
- The procedure
-
How long the injection takes and the comfort measures used vary depending on the product, the area and your medical history.
A stinging or burning sensation is possible; ice or a topical anesthetic can be applied to the skin. Before the injection, ask how long it will take and what comfort measures are planned.
- Returning to your activities
-
With most fillers, no downtime is needed, but this is not guaranteed; ask what is planned for your situation.
- Follow-up
-
Ask in advance who will follow up with you after the injection and whom to call if a problem occurs; the gradual absorption of the gel does not resolve a complication.
- Medications
-
Mention all the medications you take, with or without a prescription, as well as your supplements, but do not stop any of them without your doctor's instructions.
- Who performs the injection
-
A physician, or a nurse injector supervised by a physician.
Can a Result Be Corrected, and What Other Approaches Are There?
A prescribed treatment can dissolve a hyaluronic acid gel.
It does not correct all complications: the doctor examines the problem before deciding whether it is appropriate. The injection is performed by a physician, or a nurse injector supervised by a physician. Dissolving the gel also means losing the volume it provided; the hollow can become visible again.
What Does the Doctor Check During the Assessment at CARE MD?
You can discuss this during a Global Aesthetic consultation at CARE MD, in Sainte-Thérèse, on Montreal's North Shore.
The doctor then specifies whether a gel is appropriate for your hollow, which one and for what use, or concludes that it is better not to inject or that another approach would suit you better.
If you have a prominent bag or very thin, very wrinkled skin, the injection is less suitable for you; the doctor may advise against injecting.
- Also mention
-
- whether you are pregnant or breastfeeding (the safety of these products has not been established in these situations),
- your allergies,
- any bleeding disorder
- and any skin infection near the area.
Contraindications depend on the product chosen and the area. The doctor checks these precautions before deciding.
Ask Us About Under-Eye Hollows
Have a question about an under-eye hollow or about what to know before an injection? Write to us. Your message is no substitute for medical care: unusual pain, a change in vision, white, grey or blue skin near the injection site or signs of infection require immediate medical care.
Frequently Asked Questions
What are the dangers of under-eye filler?
Common effects after the injection are bruising, redness, swelling, pain and tenderness. Nodules, asymmetry or an infection can also occur. The most serious danger is accidental injection of the gel into a blood vessel: although unlikely, it can cause necrosis, vision problems that can lead to blindness, or a stroke. No technique eliminates this risk; unusual pain, a change in vision or white, grey or blue skin near the injection site requires immediate care.
Sources2 references
How long does filler for under-eye hollows last?
Hyaluronic acid filler is temporary: the gel is gradually absorbed. How long it lasts varies depending on the product and the person. A touch-up is not automatic: the doctor assesses the result at the follow-up visit and suggests a touch-up only if it is needed, after reassessing its suitability and risks.
Sources3 references
Does hyaluronic acid get rid of dark circles?
Not all of them. A filler gel can reduce the shadow cast by a hollow; it does not improve dark pigmentation and is not intended to treat either visible blood vessels or a bag caused by fat. If your dark circle is hollow but colour is the main factor, the injection can act only on the shadow: the colour remains. It does not eliminate all the causes of the dark circle.
Sources3 references
Can the injection make the area look bluer?
Yes, in some cases. A bluish tint can appear over a gel placed under the skin; this is called the Tyndall effect, but the name does not confirm the cause. Have this tint examined after an injection. Skin that turns white, grey or blue near the injection site during or just after the procedure is something else: it can signal a blocked blood vessel and requires immediate care.
Sources2 references
What can be done about dark circles that are both hollow and very dark?
When a dark circle is hollow and very dark, two things occur together: a shadow caused by the contour and colour caused by pigment or blood vessels. A gel can reduce the shadow, but not the colour. The doctor therefore first examines how much each one contributes; depending on the cause, other approaches can be discussed, such as laser treatment for dark circles or skin care, which target the skin rather than volume.
Sources3 references
Is under-eye filler painful?
A stinging or burning sensation is possible during the injection. Ice or a topical anesthetic can be applied to the skin, depending on the product and the area; ask what comfort measures are planned before the injection starts. Unusual pain during or after the injection is different: it can signal a complication and requires immediate care.
Sources2 references
How do I know whether an injection is appropriate for my under-eye hollow?
A well-defined hollow and fairly thick skin are better suited to filler; a prominent bag, very thin and very wrinkled skin or expectations focused on colour make it less appropriate. The doctor also reviews your medical history, allergies and medications, specifies which gel would be used and for what purpose, and may conclude that it is better not to inject.
Sources2 references
Can filler for under-eye hollows be corrected?
A prescribed treatment can dissolve a hyaluronic acid gel, but it does not correct all complications. The doctor first examines what bothers you to decide whether it is appropriate. Dissolving the gel also means losing the volume it provided: the hollow can become visible again. Unusual pain, a change in vision or white, grey or blue skin near the injection site requires immediate care, not a correction request through a form.
Sources2 references
Sources9 references+
- Dermal Fillers for the Treatment of Tear Trough Deformity: A Review of Anatomy, Treatment Techniques, and their Outcomes — Jaishree Sharad — Journal of Cutaneous and Aesthetic Surgery, 2012 (opens in a new tab)
- Clinical analysis and classification of dark eye circle — Huang et al., International Journal of Dermatology (opens in a new tab)
- Periorbital Discolouration Diagnosis and Treatment: Evidence-Based Review — Pissaridou et al., Journal of Cosmetic and Laser Therapy (opens in a new tab)
- Dermal Fillers (Soft Tissue Fillers) — U.S. Food and Drug Administration (opens in a new tab)
- Fillers: FAQs — American Academy of Dermatology (opens in a new tab)
- Fillers: Preparation — American Academy of Dermatology (opens in a new tab)
- Does the Tyndall Effect Describe the Blue Hue Periodically Observed in Subdermal Hyaluronic Acid Gel Placement? — Rootman et al., Ophthalmic Plastic and Reconstructive Surgery (opens in a new tab)
- Guideline for the Prevention, Diagnosis, and Management of Acute Bacterial Soft Tissue Infections Following Nonsurgical Cosmetic Procedures — Complications in Medical Aesthetics Collaborative — Journal of Clinical and Aesthetic Dermatology (opens in a new tab)
- Management of dermal filler complications, a narrative review — JMIR Dermatology, 2024 (opens in a new tab)
Under-Eye Filler: Limitations and Precautions
Have your under-eye hollow examined at CARE MD before considering filler: there are specific risks under the eye.
Limitations and precautions
During or after the injection near the eye, get immediate medical care if you have unusual pain, a change in vision, white, grey or blue skin near the injection site, or signs of a stroke or infection. Do not wait for a reply to a message submitted through a form.
Tell the doctor whether you are pregnant or breastfeeding, and about any allergy, bleeding disorder or skin infection near the area. Mention any previous cosmetic injections or implants, your medications and your supplements.
Keep taking your medications unless your doctor has asked you to stop them.
The shadow caused by the hollow can become less noticeable, but dark pigmentation cannot; hyaluronic acid gel treats neither visible blood vessels nor bags caused by fat.
Your result is temporary, and how long it lasts varies. The safety of injections repeated over many years is not well known: weigh the benefits and risks again with the doctor before each injection.
Whatever the technique, you face a rare risk of gel being injected into a blood vessel, which can cause necrosis, damage to vision severe enough to cause blindness, or a stroke.
Do not count on dissolving the gel with a prescribed treatment to resolve all complications.
Have an Under-Eye Hollow Examined
To have your under-eye hollow examined and ask your questions before deciding, you can book a Global Aesthetic consultation at CARE MD, in Sainte-Thérèse.