Under-Eye Light Filler: Technique and Results 2026

Tear Trough Anatomy: Why Does This Area Become Problematic?

Two fundamental anatomical structures affect the aesthetic appearance of the under-eye area: the orbicularis retaining ligament (ORL) and the suborbicularis oculi fat pad (SOOF). The ORL is a fibrous structure that anchors the orbicularis oculi muscle to the skeletal tissue over the inferior orbital rim. With ageing, this ligament elongates, the SOOF deflates and descends; the resulting gap casts a shadow onto the skin surface, creating a "tired" appearance.

Simultaneously, the under-eye skin — the thinnest skin on the body — thins further, and the purple pigment (deoxyHb) of the underlying orbicularis muscle becomes visible from the surface. The combination of these two mechanisms creates both the structural and vascular components of dark circles.

At Virtuana Clinic, a photographic analysis protocol is applied before light filler for every patient: standardised photography in both sitting and lying positions, under neutral light, is used to assess shadow depth and skin thickness. This analysis determines both the correct product selection and the filler volume.

Which Type of Dark Circle Is It Suitable For? Suitability Table

Under-eye dark circles are not all the same type; the filler decision must be made according to the type:

For the pigment type, light filler alone is insufficient; a combination with pigmentation treatment (chemical peel, laser or topical agents) is always required. In patients where fat herniation is predominant, filler can optically reduce the shadow but does not resolve the underlying problem.

Product Selection: Why Low-Viscosity HA?

In product selection for the under-eye area, viscosity and cohesivity are the most critical parameters. High G' (elasticity modulus) products used for cheek or chin filler are contraindicated in this area, because:

• They create lumping and a feeling of firmness under thin skin
• They have a high osmotic swelling capacity
• The risk of Tyndall effect increases dramatically with superficial placement

Preferred products for the under-eye area are low-viscosity, high-cohesivity formulations:

Cannula vs. Needle: Safety Comparison

The under-eye area has high vascularisation; the angular artery, infraorbital artery and their branches run through the injection zone. For this reason, technique selection directly affects the risk of complications.

At Virtuana Clinic, the standard for under-eye filler procedures is the single-entry-point 25G cannula technique. The product is deposited in the supraperiosteal or deep subcutaneous plane using a retrograde fan technique.

Tyndall Effect: Risk and Prevention

The Tyndall effect is the scattering of light from colloidal particles in transparent or semi-transparent media. When hyaluronic acid is injected too superficially (just below the dermis) in under-eye filler, the thin skin reflects the blue-grey colour of the HA gel; rather than reducing the dark circle, this worsens it.

The definitive way to prevent the Tyndall effect:

• Application to a deep anatomical plane (supraperiosteal or deep subcutaneous)
• Choosing a low-cohesivity product that integrates into the skin (rationale for preferring Belotero Balance)
• Small amounts, applied gradually ("less is more" principle)
• Less product in thin skin; volume can be increased in thicker skin

If Tyndall effect occurs, the solution is: dissolving with hyaluronidase (Hyalase). Hyaluronidase is kept on hand at Virtuana Clinic for all filler procedures.

Volume Planning: How Much Is Needed?

The amount of under-eye filler is determined by the depth of anatomical hollowing, skin thickness, and the desired aesthetic result:

• Mild hollowing: 0.3–0.4 mL/side
• Moderate depth: 0.5–0.6 mL/side
• Deep tear trough: 0.6–0.7 mL/side

A total of 0.6–1.4 mL is standard. Starting with a smaller amount at the first session and performing a touch-up 2–4 weeks later is a core principle of the Virtuana Clinic protocol. This approach both eliminates the risk of overfilling and allows the result to be shaped according to the patient's preferences.

Recovery Process and Possible Side Effects

Expected temporary findings after under-eye filler:

• Oedema: Lasts 3–7 days post-procedure; more pronounced in the mornings, reduced in the evenings. Stabilises by day 10.
• Ecchymosis (bruising): Seen in 20–30% of patients; resolves in 7–14 days. Cold compresses and arnica gel are recommended.
• Tenderness: Lasts 2–3 days.
• Feeling of firmness: Normal in the first 1–2 weeks; softens as the product integrates with the tissue.

The true result cannot be assessed during the swelling period; patients should allow 3–4 weeks. At Virtuana Clinic, follow-up consultations are scheduled at week 2 and month 1 post-procedure.

Longevity: Why 12–18 Months in This Area?

The under-eye area is among the areas where filler is most long-lasting. The anatomical explanation: muscle movement in this area is minimal, meaning the product is exposed to less mechanical stress. Nevertheless, it is gradually resorbed over time due to the effects of hydration-related swelling and metabolism.

In clinical studies, the average duration of effect for under-eye filler with Belotero Balance has been reported as 12–18 months, and with Juvederm Volbella as 14–18 months. The renewal process is planned before the filler has completely disappeared, when noticeable regression begins (typically at months 10–14).

Outcome Assessment with Photographic Analysis

At Virtuana Clinic, a standardised photographic protocol is applied both before and after under-eye filler:

• Neutral background, fixed light source (1:1 ratio softbox)
• Frontal + lateral (45°) + three-quarter angle shots
• Same position and facial expression
• No make-up, no moisturiser applied

This protocol allows the physician to optimise the treatment plan and enables the patient to observe the change objectively. Photographs are also stored in the patient file, enabling long-term follow-up.

Who Is This Procedure Not Suitable For?

• Marked orbital fat herniation (blepharoplasty first)
• Very thin skin + Type 2 pigment-dominant dark circles (filler insufficient; combination treatment required)
• Pregnancy and breastfeeding
• Active skin infection or herpes
• Those taking blood thinners (discontinuation before the procedure should be planned)
• Unrealistic expectations (dark circles will not disappear entirely; significant reduction is the expected outcome)

Under-Eye Light Filler: Virtuana Clinic Protocol Summary

This article is for informational purposes only. Please consult a qualified physician for treatment decisions.