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

Eyelid filler is a procedure that restores volume and impression naturally by filling a small amount of hyaluronic acid around the sunken and shadowed eyes. The standard material used is members of the Hyaluronic Acid family, for a simple reason. This is because if a problem arises, it can be dissolved with an enzyme called hyaluronidase. Being able to 'reverse' it on thin and sensitive areas like around the eyes is a huge safety net.

However, the eyelid skin is only about 0.5mm thick, which is among the thinnest in our body. As such, blood vessels and nerves pass through heavily, making it a highly difficult area to perform procedures. Therefore, the result depends on 'how precisely and how little' is injected rather than 'how much' is injected. In this article, we will calmly explain what eyelid filler is, where it is effective, and what its limitations are.

🔍 What is Eyelid Filler?

Eyelid filler is a volumizing procedure that makes the impression softer by filling depressions and shadows around the eyes. It is usually easier to understand by dividing it into three areas.

• Upper Eyelid Filler: Fills sunken upper eyelids and eyes that have become hollow as you age to reduce look of puffiness or tiredness.

• Lower Eyelid and Tear Trough Filler: Alleviates sunken under-eyes and shadowed dark circles.

• Aegyo-sal Filler: Plumps up the area right below the lower lashes by injecting a small amount to create youthful-looking under-eye rolls.

The important thing 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 on thin skin, it is hard to deal with. Hyaluronic acid is virtually the standard around the eyes.

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

💡 For which concerns is it effective, and what are its limitations?

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

Taking dark circles as an example, filler works well for the shadowed type caused by sunken under-eyes, but its effect is limited when it is dark due to pigmentation or visible blood vessels. Therefore, the process of distinguishing the 'type' of dark circle comes first during the consultation.

Another thing. If the under-eye fat is protruding significantly, fillers can make it look more swollen instead. In this case, a different approach is needed rather than filling, and ptosis (a condition where the eyelids droop functionally, making the eyes open less) cannot be resolved with fillers, so it must be identified before the procedure.

If expression wrinkles are also present, it may be combined with botulinum toxin (Botox), but Botox is not a volumizing procedure, so it cannot fill the eyelid hollow itself. The purposes are different.

📌 Key Summary: 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 principle of filler around the eyes is 'small amount, conservatively.' Over-injection is the most common cause of failure in eyelid fillers.

The recommended injection amount by area is summarized as follows. This is only a general range and varies according to individual anatomy.

27">It is a clinical principle to maintain naturalness by not trying to fill the hollows 100% but correcting only about 60-70%. If you pack it full, it is easy to look puffy and leave a foreign sensation.

The maintenance period is generally 9 to 18 months. Because there is little movement around the eyes, it tends to last longer than other areas, and cases remaining for more than 2 years have been reported. There are also differences depending on the product, with domestic brands known to last about 6 to 12 months and imported ones 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, Keep This in Mind

Most are mild reactions like bruising or swelling, but since it is around the eyes, there are things you must know.

Tyndall Effect and Common Reactions

The Tyndall Effect is a representative side effect where the filler looks bluish when injected too shallowly into the thin under-eye skin. Other than this, bumpiness, asymmetry, long-term swelling, and filler migration have been mentioned. Fortunately, hyaluronic acid filler can be corrected to a large extent by dissolving it with a hyaluronidase injection.

If under-eye lymphedema or sagging is severe, such as malar bags or festoons, filler can worsen the swelling, so we judge cautiously.

Vascular Occlusion, Rare but Most Crucial Situation

If filler mistakenly enters the ophthalmic artery system vessels, vascular occlusion can occur. Although rare, this situation can lead to skin necrosis or vision loss, so the injector's understanding of anatomy is critical. In fact, a global literature review reported 98 cases of filler-related blindness complications.

Vessels of particular 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 blood vessel damage, but bear in mind that it does not make the risk zero.

If any of the signals below appear, you must immediately report to the clinic where you received the procedure and respond.

• Blurry vision, vision loss, eye pain

• Severe headache

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

• Extreme pain, symptoms where the skin turns dark red

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

📌 Key Summary: Tyndall effect can be dissolved and corrected, but vascular occlusion signals (vision, pain, skin discoloration) must be reported immediately.

🗓️ Before and After the Procedure, What Should You Prepare?

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

• Before: Avoid anticoagulants like aspirin and omega-3, and alcohol a few days prior

• After: Avoid saunas, intense exercise, and alcohol for the time being

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

Whether filler still remains can be checked through medical examination, palpation, ultrasound examination, and if necessary, it can also be observed in MRI.

📌 Key Summary: Abstain from anticoagulants and alcohol in advance, and perform the procedure at least 4 weeks (recommended 1-2 months) before important schedules.

🌿 How Onlif Views Eye Area Concerns

Onlif Clinic aims to remove skin concerns that mask one's natural impression, rather than plastic surgery that alters shapes. For the eye area, it's about refining 'tired-looking signals' created by hollowing, shadows, and loss of elasticity.

Therefore, the approach centers on non-surgical skin treatments. We fill volume with fillers, complement the texture and hydration of the thinned eye area with skin boosters if necessary, and combine ultrasound and radiofrequency lifting when elasticity is the key. If incision surgery for fat repositioning is a more suitable situation, we guide you to that in a balanced way, but the path Onlif recommends is non-excessive, non-surgical improvement.

"Because you are precious, we do not change you." Restoring the original impression naturally, rather than creating new eyes. The doctor specialty system, where a doctor dealing deeply with one field takes charge of the procedure they do best, is also an extension of this direction.

📌 Key Summary: Onlif does not change shapes, but naturally refines the hollows, texture, and elasticity of the eye area with non-surgical treatments.

❓ Frequently Asked Questions (FAQ)

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

In a broad sense, they are both fillers around the eyes, but the areas are different. Eyelid filler deals with hollow upper eyelids, while under-eye filler (tear trough) deals with lower shadows and dark circles. The depth and amount of injection also vary according to the area.

I have severe dark circles. Can they be resolved with eyelid fillers?

It is effective for shadowed dark circles caused by hollows. However, if the cause is pigmentation or visible blood vessels, the filler effect is limited, so a consultation to distinguish what type it is is required first.

Can you go blind from eyelid fillers?

If vascular occlusion occurs, vision damage is theoretically possible. Although very rare, 98 cases of blindness have been reported in one global literature review, so it is important to choose a clinic with skilled procedures and an emergency response system well-acquainted with anatomy.

Can hyaluronic acid fillers be completely dissolved?

They can be dissolved to a large extent with an enzyme called hyaluronidase. This point is the key reason why hyaluronic acid is used as a standard around the eyes. However, since the dissolving process is also a procedure, it is carried out under professional judgment.

I have a lot of under-eye fat. Can I get fillers?

If the fat protrusion is severe, fillers can make it look more puffy instead, so you must be careful. In this case, other methods might be more suitable than filling, so it is recommended to examine the condition accurately for making decisions.

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

Blurry vision, eye pain, pale skin, or net-like discoloration are signals that must be reported immediately. Contacting the clinic where you received the procedure without delay is the safest way to respond.

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

If you are receiving it for the first time, at least 4 weeks prior yields safe margins, with 1 to 2 months prior recommended. Time is needed for the swelling to subside and for the filler to settle, and the final result is usually evaluated 2 to 4 weeks later.

Since the eye area is thin and delicate, even with the same filler, the results vary greatly depending on how it is handled. The method and amount that fit your eyes can only be known by looking at the condition directly, so we recommend confirming accurate judgments through consultations with a specialist.