Under-Eye and Eyelid Fillers: What You Must Know Before Getting Them

Eyelid filler is a treatment that naturally restores volume and impression by filling a small amount of hyaluronic acid around sunken and shadowed eyes. The standard material used is the hyaluronic acid (HA) series, and the reason is simple. This is because if a problem occurs, it can be dissolved with an enzyme called hyaluronidase. Being able to "reverse" it in thin and sensitive areas such as around the eyes is a great safety device.

However, the eyelid skin is only about 0.5 mm thick, making it one of the thinnest parts of our body. As such, blood vessels and nerves pass through densely, and it is an area with a high level of treatment difficulty. Therefore, the result is determined by 'how precisely and how little' rather than 'how much' is injected. In this article, we will calmly explain what eyelid filler is, where it is effective, and where its limitations lie.

🔍 What is eyelid filler?

Eyelid filler is a volume treatment that softens the impression by filling in depressions and shadows around the eyes. It is convenient to understand it by dividing it into three general types.

• Upper eyelid filler: Fills sunken eyelids and hollow eyes caused by aging to relieve a tired look.

• Lower eyelid/Tear Trough filler: Alleviates under-eye hollows and shadow-like dark circles.

• Aegyo-sal filler: Injects a small amount directly under the lower eyelashes to create plump aegyo-sal.

What is important is the principle of materials. Semi-permanent (non-HA) fillers such as calcium or PLLA are rarely used around the eyes. Since they cannot be dissolved, correction is difficult, and if a problem occurs in thin skin, it is hard to manage. For the area around the eyes, hyaluronic acid is practically the standard.

📌 Key Summary: Eyelid filler is divided into upper eyelid, lower eyelid, and aegyo-sal, and dissolvable hyaluronic acid is the standard material.

💡 What concerns is it effective for, and what are its limitations?

Eyelid filler is highly effective for 'shadows created by hollows'. Conversely, if the cause is pigmentation or visible blood vessels, the effect will not be as expected.

Taking dark circles as an example, filler works well for the shadow type caused by sunken under-eyes, but has limited effectiveness for the pigmented type or dark circles caused by visible blood vessels. Therefore, the process of distinguishing the 'type' of dark circles during consultation comes first.

Another thing to consider: if under-eye fat is protruding significantly, filler may actually make it look swollen. In this case, a different approach rather than filling is required, and ptosis (a state where the eyelid functionally droops, preventing the eye from opening fully) cannot be resolved with filler, so it must be identified before the treatment.

If there are expression wrinkles as well, it may be combined with botulinum toxin (Botox), but Botox is not a volume-filling treatment, so it cannot fill the eyelid hollow itself. Their purposes are different.

📌 Key Summary: It is effective for hollows (shadows), but has limitations for pigmentation, visible blood vessels, severe fat protrusion, and ptosis.

📏 How much is injected, and how long does it last?

The number one rule of filler around the eyes is 'small amount, conservatively'. Over-injection is the most common cause of failure in eyelid fillers.

The recommended injection amounts for each area are summarized below. This is only a general range and varies depending on individual anatomy.

It is a clinical principle to maintain naturalness by not trying to fill 100% of the hollow, but correcting only about 60 to 70%. Filling it completely can easily make it look swollen and leave a foreign body sensation.

The maintenance period is generally 9 to 18 months. Since there is less movement around the eyes, it tends to last longer than other areas, and cases where it remained for more than two years have also been reported. There are also differences depending on the product, with domestic products known to last about 6 to 12 months and imported products lasting about 12 to 18 months, which also depends on individual metabolism.

📌 Key Summary: Small, conservative injection is the rule, filling only 60-70%, and the maintenance period is usually 9-18 months.

⚠️ Side effects and safety, make sure to know this at least

Most are mild reactions like bruising or swelling, but since it is around the eyes, there are things you should be aware of.

Tyndall effect and common reactions

The Tyndall Effect is a representative side effect where the filler appears bluish when injected too shallowly into the thin under-eye skin. In addition to this, unevenness, asymmetry, long-term edema, and filler migration are mentioned. Fortunately, hyaluronic acid fillers can be largely corrected by dissolving them with hyaluronidase injections.

If there is severe under-eye lymphedema or sagging, such as malar bags or festoons, filler can worsen the swelling, so careful judgment is required.

Vascular occlusion, a rare but most cautious situation

If the filler is incorrectly injected into the ophthalmic artery system, vascular occlusion can occur. Although rare, this situation can lead to skin necrosis or vision loss, making the injector's understanding of anatomy critical. Indeed, one global literature review reported 98 cases of filler-related blindness complications.

Blood vessels that require special caution around the eyes are the supraorbital artery, supratrochlear artery, angular artery, dorsal nasal artery, and infraorbital artery. Using a blunt-tipped **cannula** can reduce the risk of vascular damage, but keep in mind that it does not reduce the risk to zero.

If any of the signals below appear, you must immediately notify the clinic where you received the treatment and take action.

• Blurry vision, vision loss, eye pain

• Severe headache

• Pale skin, net-like skin discoloration (Livedo Reticularis)

• Extreme pain, symptoms of skin turning dark red

Therefore, when choosing a clinic, checking the availability of hyaluronidase and the emergency response system for vascular occlusion is the most practical standard.

📌 Key Summary: The Tyndall effect and other issues can be corrected by dissolving, but signs of vascular occlusion (vision, pain, skin discoloration) must be reported immediately.

📅 Before and after treatment, what should you prepare?

Small habits determine the results. Before the treatment, reduce factors that increase bruising and swelling.

• Before treatment: Refrain from anticoagulant ingredients such as aspirin and omega-3, and alcohol from a few days prior

• After treatment: Avoid sauna, strenuous exercise, and alcohol for the time being

If you are receiving it for the first time ahead of an important schedule like a wedding, it is safe to do so at least 4 weeks prior, with 1 to 2 months recommended. This is because time is needed for the swelling to subside and for the filler to settle. The final result is usually evaluated after 2 to 4 weeks.

Whether the filler still remains can be checked through examination, palpation, and ultrasound, and can also be observed on MRI if necessary.

📌 Key Summary: Refrain from anticoagulant ingredients and alcohol in advance, and receive the treatment at least 4 weeks (1-2 months recommended) before important schedules.

🌿 How Onlif views eye area concerns

Onlif Clinic aims to clear away skin concerns that mask your natural impression, rather than performing plastic surgery that alters shapes. For the eye area, it is about refining the 'tired-looking signals' created by hollows, shadows, and loss of elasticity.

Therefore, the approach is centered on non-surgical skin treatments. We fill volume with filler, complement the texture and moisture of the thinned skin around the eyes with skin boosters if necessary, and combine ultrasound/high-frequency lifting when elasticity is key. If a surgical incision for fat repositioning is more appropriate, we will guide you in a balanced manner, but the path Onlif recommends is non-excessive, non-surgical improvement.

"Because you are precious, we do not change who you are." It's about naturally regaining your original impression, not creating new eyes. The Doctor Specialty System, where a doctor who deeply studies a specific field performs the treatment they do best, is an extension of this direction.

📌 Key Summary: Onlif does not alter shapes but naturally refines hollows, texture, and elasticity around the eyes through non-surgical treatments.

❓ Frequently Asked Questions (FAQ)

Are eyelid filler and under-eye filler the same treatment?

They are both fillers around the eyes in a broad sense, but the areas are different. Eyelid filler addresses upper eyelid hollows, while under-eye filler (tear trough) deals with shadows and dark circles underneath. The injection depth and volume also vary according to the area.

I have severe dark circles, can eyelid filler solve this?

It is effective for shadow-type dark circles caused by hollows. However, if the cause is pigmentation or visible blood vessels, the effect of the filler is limited, so a consultation to first distinguish the type is necessary.

Can eyelid filler cause blindness?

If vascular occlusion occurs, vision damage is theoretically possible. Although extremely rare, 98 cases of blindness have been reported in a global literature review, so it is important to choose a place with an experienced clinician well-versed in anatomy and equipped with an emergency response system.

Can hyaluronic acid filler be completely dissolved?

It can be largely dissolved with an enzyme called hyaluronidase. This is the key reason why hyaluronic acid is used as the standard around the eyes. However, since the dissolving process is also a procedure, it is conducted under professional judgment.

I have a lot of fat under my eyes, can I still get filler?

If fat protrusion is severe, filler can actually make it look swollen, so you must be cautious. In this case, other methods might be more suitable than filling, so it is best to make a judgment after assessing the condition accurately.

What should I do if my vision becomes blurry or my eyes hurt after the treatment?

Blurry vision, eye pain, pale skin, or net-like discoloration are signals that must be reported immediately. It is safest to contact the clinic where you received the treatment without delay to take action.

How early should I get the treatment before an important event?

If you are receiving it for the first time, we recommend at least 4 weeks, or 1 to 2 months for peace of mind. Time is needed for the swelling to subside and for the filler to settle, and the final result is usually evaluated after 2 to 4 weeks.

Since the eye area is thin and delicate, the results can vary significantly depending on how even the same filler is handled. The right method and amount for your eyes can only be determined by directly assessing the condition, so we recommend confirming through a specialist consultation for an accurate judgment.

Eyelid filler, things to check before choosing a clinic

Even for the same treatment, the results and recovery process vary depending on where, by whom, and how it is performed.

Asking these questions directly during the consultation will help you make a decision.

• Is it a clinic that performs the treatment frequently? — Every clinic has different treatments they focus on. Check if it is a place that regularly performs eyelid fillers.

• Can I verify the products and equipment used? — Ask during the consultation if you can confirm the product name and authenticity (whether it is an officially imported product and if there is a process to confirm unboxing).

• Do they explain the cost breakdown? — Rather than just hearing the total amount, you need to hear an explanation of what product is used, how much, and on which areas to make a proper judgment.

• Do they design with the entire face in mind? — Even for the same treatment, the injection location and amount vary depending on face shape, skin condition, and left-right asymmetry.

• Do they explain adverse reactions and the recovery process first? — A consultation that informs you of potential adverse reactions and how to cope with them is better for making a decision than one that only talks about expected positive changes.

• Is there a way to follow up after the treatment? — Check if the timing for checking progress, how to contact them if there is an issue, and the criteria for a return visit are established.

This is how Onlif Clinic performs eyelid fillers

• We divide responsibilities — Believing that a single doctor cannot handle all treatments, Onlif divides medical care among doctors in charge of each field.

• We verify products and equipment together during the consultation — We guide you through the products used and the unboxing verification process during the consultation.

• Costs are guided along with the plan after diagnosis — Since the area, volume, and scope differ for each person, we explain what costs what and why.

• We design looking at the overall facial balance — We view the face through three axes: texture, balance, and signals of youth, planning to clean up the parts masking the natural impression rather than changing shapes.

• We discuss adverse reactions and the recovery process first — Along with the expected changes, we guide you on individual differences, potential adverse reactions, and countermeasures before the treatment.

• We monitor progress after the treatment together — If verification is needed during the recovery period, we guide you on return visits and communication channels.

If you are considering eyelid fillers, it is best to first check what is possible and what is difficult in your current state.

An accurate diagnosis and treatment plan can only be determined through an in-person medical examination. Please check through a consultation at Gangnam Onlif Clinic.