What is an under-eye (tear trough) filler?
Beginning near the inner eye corner and running down and outwards towards the cheek is a groove called the tear trough. Lost volume and thinner skin with age can make it deeper, and the shadow it throws can make someone look tired after a full night's sleep.
The treatment lays a little soft hyaluronic acid gel into the groove so that the lower eyelid blends more smoothly into the cheek. Hyaluronic acid is found naturally in the skin, and the body slowly breaks the gel down over the following months.
Is an under-eye filler right for me?
Few areas of the face are as unforgiving as the skin below the eyes, so choosing the right patients matters a great deal. Reviewing the published tear trough studies, a systematic review stressed that a detailed understanding of the anatomy and of injection technique is essential for a safe, natural-looking outcome.
| Generally a good fit | Postpone, or look at alternatives |
|---|---|
| A visible hollow or groove beneath the eye | Lower eyelid fat bags that bulge forward |
| Skin of reasonable thickness and elasticity | Lower lid skin that is very thin, crepey or lax |
| A shadow that gives a tired look | Puffiness that fluctuates, such as fluid retention or festoons |
| Hoping for a subtle improvement | A skin or eye infection, or eye surgery not long ago |
| A healthy adult who is not pregnant or breastfeeding | Earlier filler here that has not been assessed yet |
What can a filler treat, and what can it not?
A dark or tired-looking under-eye area is not always caused by lost volume. Pigment, visible blood vessels, protruding fat pads or loose skin can all be behind it, and each calls for its own approach.
| Concern | Will filler help? | Alternatives that may be discussed |
|---|---|---|
| A hollow tear trough throwing a shadow | Yes – this is what it is mainly for | Cheek support when the midface is flat |
| Fat bags that bulge | No – they can look bigger | Eyelid surgery |
| Brown or bluish discolouration | Hardly any effect | Dark circle mesotherapy |
| Thin, crepey skin | Only a little | Skin booster injections |
| Flat upper cheeks | In part | Cheek fillers |
How is the treatment performed?
- Examination. Dr. Yazır looks at the area under different lighting and with your head in different positions, assesses fat bags, skin quality and any asymmetry, and explains what can realistically change.
- Getting ready. The skin is cleaned carefully and anaesthetic cream is applied.
- Injecting. Hyaluronic acid goes in deep, against the bone, in very small portions, with a fine needle or a blunt microcannula. According to the review of reported techniques, this deep plane, below the orbicularis muscle, was where filler was usually placed.
- Shaping and checking. The area is softly moulded and the two sides are compared. Doing slightly too little is preferred, because swelling can follow and adding a little later is easier than taking excess away.
- Afterwards. Cold compresses are recommended, and a check-up is booked before you leave Izmir.
What does recovery look like?
| After treatment | Typical course |
|---|---|
| Day 1 | Light swelling, soreness and perhaps tiny needle marks; cold compresses help |
| Days 2 to 5 | Any bruise is at its most visible; make-up is usually fine after 24 hours |
| Weeks 1 to 2 | Swelling goes down and the real shape becomes easier to see |
| Weeks 2 to 4 | Result reviewed (with WhatsApp photos once you are home); a small top-up only if needed |
| Months 8 to 12 and later | The filler slowly softens, and many people then think about a maintenance session |
Over the first one to two days, do not rub the area, and avoid hard exercise, saunas and alcohol.
How do I plan my trip to Izmir?
As a short treatment without surgery, it combines easily with a holiday on the Aegean coast or with another treatment. The clinic is in the Egeperla building in Konak, about 25–30 minutes by car from Izmir Adnan Menderes Airport (ADB).
| When | What happens |
|---|---|
| Day 1 | You arrive, have the consultation and, where appropriate, the treatment |
| Day 2 | A quiet day; keep away from sun, heat and strenuous exercise |
| Day 3 | Check-up with Dr. Yazır and advice for the time at home |
| Day 3 or 4 | Flight home |
Photos sent over WhatsApp before your trip allow a first impression. Whether filler is actually the right option is only decided at the face-to-face examination.
What are the risks of under-eye fillers?
In 2024, a meta-analysis combined 31 reports on hyaluronic acid in the tear trough. Satisfaction was high, at roughly nine patients in ten, and complications were uncommon overall; swelling and bruising were the side effects seen most. Risks to be aware of:
- Swelling, bruising and soreness
- Lumps or an uneven contour
- A blue tint showing through the skin (Tyndall effect)
- Swelling that lingers or appears late, even months after treatment
- Infection or an allergic reaction (rare)
- Vascular occlusion, when filler blocks a blood vessel (rare, but serious)
Looking specifically at delayed complications of tear trough filler, a systematic review found late swelling and lumps to be the leading problems, typically arising over a year after treatment. So please let us know about any new swelling, however long ago your treatment was.
What is the Tyndall effect?
Hyaluronic acid lying too superficially under thin skin can scatter light and become visible as a blue-grey shadow. Placing it deep and in small amounts lowers that risk. Should it happen, hyaluronidase can usually dissolve the gel.
Why is the eye area treated with extra caution?
Blood vessels in the face form a dense network, and some of them connect with the vessels that supply the eye. The American Academy of Ophthalmology published a report on cases of vision loss after filler was accidentally injected into a vessel. These cases are uncommon, yet sight was rarely recovered despite treatment. A review of prevention strategies emphasises injecting small volumes slowly and at low pressure, and recognising and treating a problem with hyaluronidase at once. For hollows below the eyes, the US FDA has cleared particular fillers for adults from age 22, and it recommends choosing a licensed injector with experience in filler injection, knowledge of the anatomy and the ability to manage complications.
How long do under-eye fillers last?
Across the tear trough studies in the systematic review, the result usually lasted 8–12 months. This differs between people and between products. A maintenance session normally needs less filler than the first one, and there is no reason to repeat treatment while the earlier effect is still present.
Why does the injector's background matter?
Filling the under-eye area safely depends on a close knowledge of how the eyelid, the cheek and the blood vessels are arranged. Dr. Yazır is an ENT and head & neck surgeon whose practice focuses on facial aesthetic surgery, and he treats the eyelids and midface both surgically and without surgery. So filler is offered where it fits, and eyelid surgery or a different treatment where it does not.