Subdermal Hyaluronic Acid Filler Injections Can Treat Under-Eye Circles

Lower-Eyelid Blepharoplasty.Asian Eyelid Surgery.Upper blepharoplasty.Correcting the aging process
The researchers’ aim was to describe a novel technique to improve dark circles caused by a diffuse valley-type pre-septal tear trough deformity in patients with thin eyelid skin.

The efficacy and safety of a novel nonsurgical technique for the aesthetic treatment of dark under-eye circles is supported by study data published in the Journal of Cosmetic Dermatology.

In a retrospective cohort study of more than 150 patients, microdroplet subdermal placement of filler in the preseptal tear trough area was associated with long-term aesthetic improvement and patient satisfaction. The technique had low risk for complications, and no significant adverse events were reported.

Practitioners at a cosmetic surgery practice in the United Kingdom performed a retrospective review of patients who sought under-eye rejuvenation in 2010. The surgeons hypothesized that hyaluronic acid filler could be used to improve under-eye appearance.

Patients interested in this novel technique were provided a detailed discussion of risks and benefits. Patients who consented were treated by a 1 surgeon, who first applied topical anesthesia to the treatment area.

Treatment was performed using a “smart click” syringe with a serial puncture injection technique. Treatment was continued until the under-eye area was saturated with subdermal “bubbles” of hyaluronic acid spaced 3 to 5 mm apart.

Clinicians revisited patients 2 to 12 weeks after treatment for clinical evaluation. They asked patients to evaluate their satisfaction with treatment results using the Global Aesthetic Improvement Scale (GAIS), which ranged from a score of 1 (“very much improved”) to 5 (“worsened”). Patients were followed up every 6 months thereafter until additional treatment was requested.

A total of 165 patients (330 eyelids) were treated. Median age was 30 years (range, 18-45 years), and the majority (73.3%) were women.

All patients reported some localized bumps in the treated area, which resolved within 2 to 7 days. One patient had filler dissolved due to persistent swelling. No patients experienced infections, necrosis, or blindness.

All patients completed at least 6 months of follow-up, with a range of 6 to 36 months. Treatment was found to last up to 36 months.

Overall, 161 patients (97.6%) felt their under-eye appearance had improved from pretreatment at the 6-month follow-up. The distribution of GAIS scores at the 6-month visit was as follows: 16.9% “very much improved;” 45.5% “much improved;” 35.2% “slightly improved;” 1.2% “no change;” and 1.2% “worsened.” An additional 120 patients (74.5%) reported improvements in the texture and hydration of their under-eye skin.

The treatment of under-eye dark circles and puffy skin can be complex due to the sensitive area and multifactorial reasons for swelling. In this retrospective study, subdermal placement of hyaluronic acid filler was found to aesthetically improve under-eye circles with few side effects.

Further study of hyaluronic acid fillers is necessary to determine the long-term safety and efficacy.


Shah-Desai S, Joganathan V. Novel technique of non-surgical rejuvenation of infraorbital dark circles. Published online September 3, 2020. J Cosmet Dermatol. doi:10.1111/jocd.13705