The Case for Undereye Filler

Tear trough filler has come under fire on social media, but one leading surgeon is defending the treatment.

Hello, hello!

I thought it might be time for a pro-filler post, since some of my recent nonsurgical coverage has been a bit critical — not because I, personally, have an issue with injectables, but because the aesthetics community, at large, seems to have entered an era of heightened scrutiny. After years of constant and unquestioning loyalty, healthcare professionals and savvy consumers are taking a hard look at these products and their potential for causing complications, especially when abused, misused, or carelessly prescribed. Many are rethinking the consequences and value of certain procedures. And this shift, in my opinion, is worth talking about.

Recently, tear trough filler has come under fire online, with experts emphasizing its risks and contraindications and even predicting its obsolescence. Why? Undereye concerns are commonly misdiagnosed and mistreated with filler, often to ill effect. And in this finicky area, with its complex anatomy, hyaluronic acid injections, even when indicated, can easily backfire, leading to chronic puffiness (malar edema), visible lumps, and a bluish discoloration. Since HA can hang around for years under the eyes, these symptoms can become chronic, resolving only with dissolver. (Non-HA fillers, like Sculptra, should never be used around the eyes.)

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But wait… didn’t I promise a pro-filler post?

Yes! So, a few weeks ago, Flora Levin, MD, a board-certified oculoplastic surgeon in Westport, Connecticut, tagged me in a series of Instagram stories defending tear trough filler for dark circles. Addressing the ongoing controversy, she remarked that this treatment, while highly nuanced and not ideal for the vast majority of humans, still has a place and can make a tremendous difference in select faces, including her own. For 10-plus years, tear trough filler has camouflaged her genetic hollows, without issue.

Dr. Levin was gracious enough to chat with me after a long day in the operating room, sharing everything from her philosophy on patient selection to her favorite undereye fillers and her thoughts on alternative treatments, like PRP, fat grafting, and radiofrequency (RF) microneedling.