Aesthetics & Wellness
Tear Trough Filler: Risks and Who's a Candidate
Published · Haute MD Editorial Team
Tear trough filler is an injection of hyaluronic acid (HA) gel along the hollow where the lower eyelid meets the cheek, to soften a shadowed, tired look. Four HA fillers are FDA-approved for under-eye (infraorbital) hollows: Juvéderm Volbella XC, Restylane Eyelight, Belotero Balance (+) and RHA Redensity Eye. In their FDA trials, results were still present for most patients a year later. Good candidates have a true hollow, good skin quality, little puffiness and no tendency to swelling. Filler won't fix bulging fat pads, loose skin or pigmented dark circles, which may need surgery or other treatments. Bruising and swelling are common. Rare but serious risks include filler blocking a blood vessel, which can cause skin damage or blindness, so the injector matters as much as the product.
At a glance
What it treats: A volume deficit (hollow) at the junction of the lower eyelid and cheek. What it doesn't treat: Bulging lower-lid fat ("bags"), loose or crepey skin, pigmented dark circles, festoons. FDA-approved products for the under-eye hollow: Juvéderm Volbella XC (2021), Restylane Eyelight (2023), Belotero Balance (+) (2023), RHA Redensity Eye (2026); adults 22 and older. Results in FDA trials: 83–87% of treated patients improved at 3 months; 63–73% still met the response threshold at 12 months. Can it be reversed?: HA filler can be dissolved with hyaluronidase, an enzyme. Common side effects: Tenderness, swelling, bruising, lumps, redness, usually lasting days to about two weeks. Under-eye-specific risks: Prolonged under-eye (malar) swelling, a bluish tint (Tyndall effect), contour irregularities. Rare, serious risks: Filler in or pressing on a blood vessel: skin necrosis, vision loss including blindness, stroke. Sources: openFDA PMA database and FDA SSEDs/labeling for P110033/S053, P040024/S135, P090016/S050 and P170002/S050; FDA; Woodward et al. 2023; Liu et al. 2024. Checked Oct. 27, 2026.
What the tear trough is, and what filler can change
The tear trough is the groove that runs from the inner corner of the eye down and out toward the cheek. The FDA labels call the treated area the infraorbital hollow. Restylane Eyelight's FDA summary defines it as "the junction of the lower eyelid and midface where a volume deficit had formed." Hollows can be present from youth and deepen with age. A 2023 review lists the causes as an underdeveloped upper-jaw (maxillary) bone, age-related loss of fat under the skin, descent of fat pads, thinning skin over the orbital rim and bone loss around the eye socket (Woodward et al.). Because the hollow casts a shadow, it often looks like a dark circle. Filler adds volume to fill in the hollow and soften that shadow. It doesn't remove anything: it can't take away bulging fat, tighten loose skin or lighten pigment.
Which fillers are FDA-approved for under the eyes?
Juvéderm Volbella XC: FDA approval for the under-eye hollow: May 28, 2021 (P110033/S053); Approved wording: "improvement of infraorbital hollowing in adults over the age of 21". Restylane Eyelight: FDA approval for the under-eye hollow: May 8, 2023 (P040024/S135); Approved wording: "improvement of infraorbital hollowing in patients over the age of 21". Belotero Balance (+): FDA approval for the under-eye hollow: Sept. 27, 2023 (P090016/S050); Approved wording: "volume augmentation for the improvement of the infraorbital hollow in adults over the age of 21". RHA Redensity Eye / Eye Lido: FDA approval for the under-eye hollow: May 12, 2026 (P170002/S050); Approved wording: "correction of moderate to severe tissue volume deficiencies in the infraorbital region, in adults aged 22 years or older". All four are hyaluronic acid gels. Using any other filler under the eyes is off-label, and the FDA's general consumer page on dermal fillers still lists the "periorbital area (around the eyes)" among places where it "recommends against" injecting filler. Ask your injector which product they plan to use and whether it is approved for this area. FDA also advises asking for the product's patient labeling and never buying filler online, because it may be counterfeit or unapproved.
What the FDA trials showed
Each approval was based on a randomized trial in which most participants were treated and a smaller group got no treatment, with results judged by an evaluator who didn't know who had been treated. Juvéderm Volbella XC (140 randomized adults): 83.1% of treated participants improved by at least one grade on a hollowness scale at 3 months, versus 15.6% of untreated controls. At 12 months, 73.4% still met that threshold, and 75.5% said they were satisfied with the overall result. Restylane Eyelight (333 randomized adults): 87.4% improved at 3 months, versus 17.7% of untreated controls. Response rates were 86.0% at 6 months, 77.6% at 9 months and 63.5% at 12 months. Most patients (78%) had an optional touch-up at one month. A 2022 systematic review of 23 studies of tear-trough filler reported that the effect lasted 8 to 12 months and that patient satisfaction was high (Trinh, Grond and Gupta). Results vary by product, amount and person. See How Long Do Fillers Last?
Who is a good candidate?
Filler works when the problem really is a hollow. A 2023 review of infraorbital rejuvenation describes the ideal filler patient as someone with little fat-pad bulging or skin laxity and mild to moderately deep tear troughs, with a well-defined hollow caused by loss of soft tissue and bone volume (Woodward et al.). Patients of all skin types can be candidates. Likely a good candidate: A visible hollow or groove along the orbital rim. Likely a poor candidate (or needs another approach): Prominent or bulging lower-lid fat pads ("bags"). Likely a good candidate: Smooth, thicker skin; little or no laxity. Likely a poor candidate (or needs another approach): Very thin, translucent skin, or loose, crepey skin. Likely a good candidate: No history of under-eye or cheek swelling or fluid retention. Likely a poor candidate (or needs another approach): Puffiness that comes and goes, or a history of eyelid or malar swelling. Likely a good candidate: Little or no festoons or malar mounds. Likely a poor candidate (or needs another approach): Festoons or malar mounds (swellings on the upper cheek). Likely a good candidate: Dark circles mainly from shadow. Likely a poor candidate (or needs another approach): Dark circles mainly from pigment, which filler won't lighten. Source: Woodward et al., 2023 (Allergan-funded review; see Sources). The FDA labeling adds cautions. Restylane Eyelight's label warns that people with a pre-existing tendency to edema may get "excessive swelling," that injection in people with pigmented dark lower-eyelid circles "may be associated with more prominent discoloration," and that injecting too superficially in thin periorbital skin can cause lumps and a bluish discoloration. Its label lists a history of anaphylaxis or multiple severe allergies, and allergy to lidocaine or to the gram-positive bacterial proteins in the gel, as reasons not to use it. Who was left out of the trials. The pivotal studies excluded people with, among other things, large or herniating lower-lid fat pads, chronic under-eye swelling or rosacea, lower-lid retraction or prominent eyes, pigment-based dark circles, prior lower-face or eyelid surgery (in the Volbella trial), or permanent facial implants. That doesn't mean those patients can never be treated, but the FDA data don't cover them. General filler candidacy. The American Society of Plastic Surgeons lists people who are physically healthy, don't smoke and have realistic goals. FDA says filler safety is unknown during pregnancy or breastfeeding, in people under 22, and in people prone to excess scarring. Tell your doctor about bleeding disorders, blood thinners, allergies, and any past filler or surgery around the eyes.
Filler or lower-eyelid surgery?
The same 2023 review says patients with severe fat-pad bulging and loose skin "are not good candidates because even large amounts of filler would not be able to camouflage the contour irregularity." It notes that these patients may do better with blepharoplasty to remove or reposition the fat, and may have filler after they heal. Filler may fit a true hollow with good skin and little puffiness, if you want no incisions and accept that results are temporary. Lower blepharoplasty may fit if bags, bulging fat or loose skin are the main problem. See What Is Blepharoplasty? and Blepharoplasty Recovery. Pigment may respond better to laser or topical treatment than to filler. An evaluation by a physician who does both filler and eyelid surgery helps keep the recommendation from being limited to one option.
Risks and side effects
Common, usually short-lived. FDA lists bruising, redness, swelling, pain, tenderness, itching and rash as common risks of fillers. In the Volbella trial diaries, about 40% of participants reported bruising, 42% swelling and 39% lumps or bumps, and most were mild. In the Restylane Eyelight trial, most diary-reported events lasted 2 to 7 days. The American Academy of Dermatology says minor side effects "tend to clear within 7 to 14 days." A 2024 meta-analysis of HA tear-trough treatment (31 reports, 2,556 participants) found pooled rates of: swelling: 19.2% bruising: 18.4% redness: 7.1% contour irregularity or lumps: 5.3% bluish discoloration (Tyndall effect): 0.9% The pooled satisfaction rate was 91.0% (Liu et al.). Needle or cannula. A 2023 meta-analysis of prospective trials found more bruising with needles and more swelling with blunt cannulas (Nikolis et al.). In the Eyelight trial, treatment-related adverse events were reported in 4.9% of participants injected by needle and 20.9% by cannula. Risks specific to the under-eye area: Prolonged swelling (malar or eyelid edema). A 2026 expert-panel review calls malar edema "a relatively common complication" of under-eye HA filler. It links the swelling to the area's limited lymphatic drainage and lists older age, previous eye-area surgery, allergies, too much filler and placement that is too shallow as risk factors. Tyndall effect. A bluish tint when HA sits too close to the surface of thin skin. RHA Redensity Eye's FDA summary describes it as a "temporary blue hue of the skin caused by light scattering onto the gel." In the Volbella trial it was seen in 7 eyes of 4 treated participants at day 30. Lumps, migration and late reactions. A 2022 review of 52 published case reports of delayed tear-trough complications found swelling (42.3% of the cases) and lumps or nodules (25.0%) most often. The average onset was 16.8 months after injection. These are reported cases, not a rate for all patients. Rare, serious: filler in a blood vessel. The FDA calls unintentional injection into a blood vessel "the most concerning risk" of fillers. The chances are low, but it can cause tissue death (necrosis), vision problems including blindness, or stroke, and the damage may be permanent. Restylane Eyelight's FDA summary says vascular occlusion and visual disturbances including blindness have been reported after filler in the face, "especially in the nose, glabella, periorbital areas, nasolabial folds, and cheek." Its label warns that "localized superficial necrosis and scarring may occur after injection in or near vessels, such as in the periorbital area." In the most recent review of published filler-blindness cases (365 new cases, 2018–2023), the highest-risk sites were the nose, forehead and glabella. 68.2% of patients with reported outcomes had no recovery of vision (Doyon et al., 2024). Seek care right away for unusual pain, vision changes, skin near the injection turning white, gray or blue, or any sign of a stroke (including sudden difficulty speaking, numbness or weakness in the face, arms or legs, difficulty walking, face drooping, severe headache, dizziness or confusion), says FDA, which also asks injectors to have a plan for treating a blood-vessel complication. Reversibility. Because these are HA fillers, hyaluronidase can dissolve them to correct overfilling, lumps, Tyndall effect or swelling.
What to expect
The consultation: the doctor checks the hollow, skin, fat pads and any swelling or pigment, asks about past filler and eye-area surgery, and may check your vision first. The treatment: small amounts of HA are placed deep along the orbital rim with a fine needle or blunt cannula. In the Restylane Eyelight trial, doctors could use up to 1 mL per side, and a touch-up was offered at one month. Afterward: expect some tenderness, swelling or bruising for several days. Ask your doctor what to avoid while it settles. Maintenance: results fade over time, and repeat treatment keeps them.
Questions to ask at your consultation
1. Is my problem a hollow, puffy fat pads, loose skin or pigment, and is filler the right tool for it? 2. Which product will you use, and is it FDA-approved for the under-eye area? 3. Will you use a needle or a cannula, and why? 4. How many under-eye treatments have you done? 5. What will you do if filler enters a blood vessel? Do you keep hyaluronidase on hand? 6. What's my risk of long-lasting swelling, given my history? More: Questions to Ask Before Botox or Fillers.
Who should inject?
The FDA advises a licensed health care provider experienced in dermatology or plastic surgery and trained in the specific filler. AAD notes that side effects are more common without in-depth skin knowledge and injection training, "especially true when injecting fillers around the eyes." Board-certified dermatologists, facial plastic surgeons, plastic surgeons and oculoplastic surgeons (ophthalmologists who specialize in eyelid surgery) commonly treat this area. AAD advises never getting filler in a non-medical setting, such as a non-medical spa, a salon or someone's home, and FDA says needle-free devices are not approved for injecting fillers.
Find a doctor
Browse Facial Plastic Surgery, Dermatology or Ophthalmology in the Haute MD directory, or start at Find a Doctor. Featured doctors: Dr. Raghu Athre, a double board-certified facial plastic surgeon at Athré Facial Plastics in Houston, Texas, whose practice includes cosmetic injectables and an under-eye filler technique he developed, called OcuRX; and Dr. Nora Siegal, an ophthalmologist and fellowship-trained oculoplastic surgeon at LNC Oculoplastics in Lancaster, Pennsylvania, who performs cosmetic and reconstructive eyelid surgery and pairs it with non-surgical treatments. Haute MD members are featured through paid membership. Membership is not an endorsement or a ranking.
Sources
1. U.S. Food and Drug Administration, "Dermal Fillers (Soft Tissue Fillers)" (content current as of 07/06/2023). https://www.fda.gov/medical-devices/aesthetic-cosmetic-devices/dermal-fillers-soft-tissue-fillers (fetched 2026-10-27). 2. U.S. Food and Drug Administration, "FDA-Approved Dermal Fillers." https://www.fda.gov/medical-devices/aesthetic-cosmetic-devices/dermal-fillers-approved-center-devices-and-radiological-health (fetched 2026-10-27). 3. openFDA Device PMA database, query `ao_statement:infraorbital` (4 results; data last updated 2026-10-19). https://api.fda.gov/device/pma.json?search=ao_statement:infraorbital (queried 2026-10-27). 4. FDA, Summary of Safety and Effectiveness Data, JUVÉDERM VOLBELLA XC, P110033/S053 (approved May 28, 2021). https://www.accessdata.fda.gov/cdrh_docs/pdf11/P110033S053B.pdf (fetched 2026-10-27). 5. FDA, Summary of Safety and Effectiveness Data and labeling, Restylane Eyelight, P040024/S135 (approved May 8, 2023). https://www.accessdata.fda.gov/cdrh_docs/pdf4/P040024S135B.pdf and https://www.accessdata.fda.gov/cdrh_docs/pdf4/P040024S135D.pdf (fetched 2026-10-27). 6. FDA, Summary of Safety and Effectiveness Data, Belotero Balance (+), P090016/S050 (approved Sept. 27, 2023). https://www.accessdata.fda.gov/cdrh_docs/pdf9/P090016S050B.pdf (fetched 2026-10-27). 7. FDA, Summary of Safety and Effectiveness Data, RHA Redensity Eye / Eye Lido, P170002/S050 (approved May 12, 2026). https://www.accessdata.fda.gov/cdrh_docs/pdf17/P170002S050B.pdf (fetched 2026-10-27). 8. American Society of Plastic Surgeons, "Dermal Fillers" (candidates and risks/safety pages). https://www.plasticsurgery.org/cosmetic-procedures/dermal-fillers (fetched 2026-10-27). 9. American Academy of Dermatology, "Fillers giving patients better, longer-lasting results," "Fillers: FAQs" and "Fillers: Preparation." https://www.aad.org/public/cosmetic/wrinkles/fillers-lasting-results ; https://www.aad.org/public/cosmetic/wrinkles/fillers-faqs ; https://www.aad.org/public/cosmetic/wrinkles/fillers-preparation (fetched 2026-10-27). 10. Woodward J, Cox SE, Kato K, et al. "Infraorbital Hollow Rejuvenation: Considerations, Complications, and the Contributions of Midface Volumization." Aesthet Surg J Open Forum. 2023;5:ojad016. doi:10.1093/asjof/ojad016. https://pmc.ncbi.nlm.nih.gov/articles/PMC10045888/ (full text fetched 2026-10-27; funded by Allergan Aesthetics). 11. Liu X, Gao Y, Ma J, Li J. "The Efficacy and Safety of Hyaluronic Acid Injection in Tear Trough Deformity: A Systematic Review and Meta-analysis." Aesthetic Plast Surg. 2024;48(3):478–490. doi:10.1007/s00266-023-03613-7. https://pubmed.ncbi.nlm.nih.gov/37684413/ (abstract fetched 2026-10-27). 12. Trinh LN, Grond SE, Gupta A. "Dermal Fillers for Tear Trough Rejuvenation: A Systematic Review." Facial Plast Surg. 2022;38(3):228–239. doi:10.1055/s-0041-1731348. https://pubmed.ncbi.nlm.nih.gov/34192769/ (abstract fetched 2026-10-27). 13. Trinh LN, McGuigan KC, Gupta A. "Delayed Complications following Dermal Filler for Tear Trough Augmentation: A Systematic Review." Facial Plast Surg. 2022;38(3):250–259. doi:10.1055/s-0041-1736390. https://pubmed.ncbi.nlm.nih.gov/34666405/ (abstract fetched 2026-10-27). 14. Nikolis A, Enright KM, Berros P, Sampalis JS. "Safety of infraorbital hyaluronic acid injections: Outcomes of a meta-analysis on prospective clinical trials." J Cosmet Dermatol. 2023;22(9):2382–2390. doi:10.1111/jocd.15925. https://pubmed.ncbi.nlm.nih.gov/37424173/ (abstract fetched 2026-10-27). 15. Baranska-Rybak W, Lajo-Plaza JV, Walker L, Alizadeh N. "Malar Edema after Hyaluronic Acid Dermal Fillers: Expert Recommendations on Etiology, Prevention, and Management." Dermatol Ther (Heidelb). 2026;16(11):5429–5443. doi:10.1007/s13555-026-01920-w. https://pubmed.ncbi.nlm.nih.gov/42844557/ (abstract fetched 2026-10-27; authors consult for Teoxane). 16. Doyon VC, Liu C, Fitzgerald R, et al. "Update on Blindness From Filler: Review of Prognostic Factors, Management Approaches, and a Century of Published Cases." Aesthet Surg J. 2024;44(10):1091–1104. doi:10.1093/asj/sjae091. https://pubmed.ncbi.nlm.nih.gov/38630871/ (abstract fetched 2026-10-27).
Medical disclaimer
This page is for general education and is not medical advice. Talk with a board-certified dermatologist, facial plastic surgeon, plastic surgeon or oculoplastic surgeon about your eyes.
Frequently Asked Questions
What is tear trough filler?
An injection of hyaluronic acid filler into the hollow between the lower eyelid and the cheek, to soften a shadowed or tired look.
Is tear trough filler FDA-approved?
Four HA fillers are FDA-approved for under-eye (infraorbital) hollows: Juvéderm Volbella XC, Restylane Eyelight, Belotero Balance (+) and RHA Redensity Eye. Other fillers used there are off-label, and FDA's general filler page still cautions against injecting filler around the eyes, so ask which product your injector uses.
Who is a good candidate for under-eye filler?
Someone with a true hollow, reasonably thick skin, little loose skin, small or no fat bags, and no history of under-eye swelling. Filler is less likely to help bulging fat, festoons, crepey skin or pigment-based dark circles.
How long does tear trough filler last?
In the FDA trials, 63.5% (Restylane Eyelight) and 73.4% (Juvéderm Volbella XC) of treated patients still met the improvement threshold at 12 months. A 2022 systematic review reported effects lasting 8 to 12 months.
Can under-eye filler cause blindness?
Rarely, yes. If filler enters or compresses a blood vessel, it can cause vision loss, skin necrosis or stroke. FDA labeling lists the periorbital area among sites where such events have been reported. Get emergency care for any vision change or unusual pain during or after treatment.
Why does my under-eye filler look blue or puffy?
A bluish tint is usually the Tyndall effect, from HA sitting too close to the surface. Puffiness may be malar or eyelid edema. Both can often be corrected by dissolving the filler with hyaluronidase. See the doctor who treated you.
Can tear trough filler be dissolved?
Yes. HA fillers can be broken down with hyaluronidase, an enzyme.
Is filler or lower eyelid surgery better for eye bags?
For bulging fat pads and loose skin, lower blepharoplasty is usually the better tool. Filler suits a true hollow. Some patients have surgery first and filler after healing.
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