Under eye filler — or tear trough filler — does an excellent job at refreshing the under eye; replacing lost volume due to the natural ageing process. The popularity of the treatment has boomed in recent years, sadly leading to an increase in complications and overfilling.

Overfilled under eyes is something that practitioners are seeing more of in the clinic and correcting the problem. But why does it happen and what can we do about it? We’re diving into how to spot overfilled under eyes, how to fix the issue and the alternative treatments available.

What does overfilled under eyes look like? 

Both experts we spoke to agreed that it doesn’t take much for the under eye area to appear overfilled. Having a degree of hollowness around the under eye area is actually natural to the face, so even the slightest bit of overfilling can give the appearance of a facial imbalance.

“The under eye area is challenging as hyaluronic acid filler (HA) often causes swelling; the skin is more fragile and anatomy prone to oedema [a build-up of fluid],” explains Dr Anna Hemming, Etre Vous Expert, Aesthetic Doctor and Founder of Thames Skin Clinic. In addition to appearing too full, overfilling can present as lumps in the area (described as “sausage-like” in shape), which are more visible when smiling or looking upwards.

There are a few reasons it can happen. The first is filling too close to the surface of the skin where it can be visible, puffy and even appear a little blue in colour. “If you don’t use the right techniques, it’s really easy to overfill it and make it puffy and swollen,” says Dr Ahmed El Muntasar, EV Expert, GP and Aesthetician. The second is using the wrong product, as different types of fillers behave differently. Lastly, the amount of filler is also going to determine the end result. Overfilling can be as simple as it sounds: using more than is needed.

How to avoid the overfilled look

The most important thing is to see a practitioner who is qualified to carry out the treatment, and don't be afraid to say no. Not everyone is a good candidate for the treatment, but go ahead anyway. “I see it time and time again, people who have colour discolouration or other problems getting it done, but it's not for them. If you're not hollow, obviously it's just going to look overfilled,” says Dr El Muntasar.

Dr Hemming notes that this area is for advanced injectors who have experience injecting in both the tear trough but also “building the deep fat pads in the SOOF [suborbicularis oculi orbital fat pad] underneath,” to give the right balance to the face.
 
Finally, as noted before, the product chosen determines the treatment outcome, so this is where it pays to see a practitioner who has knowledge on multiple products for various areas and results. For tear trough filler, Dr Hemming opts for products like Redensity 2, which is (newly) FDA-approved for the under eye area. Additionally, she uses polynucleotides for skin tightening to give benefits without the swelling.

How to correct overfilled under eyes

So you’ve found yourself with overfilled under eyes–what now? Thankfully, it’s fixable.
The first thing to consider is how long ago you had the treatment as there may be some initial swelling. If that’s the case, Dr El Muntasar advises taking some antihistamines and giving it time.

If it’s been more than four weeks, see your injector for a follow-up and possible correction. If your injector won’t see you for a follow-up, it’s advisable to visit someone more qualified.

In cases where filler has become lumpy, HA dermal filler can be “broken down rapidly using an enzyme called hyaluronidase injected [into the skin], explains Dr Hemming. She stresses the importance of seeing a qualified injector to carry out corrective treatment.

“This should be done by someone used to the removal of dermal filler with hyaluronidase as the enzyme is not specific for synthetic HA and will also break down the body's natural HA chains,” Dr Hemming explains. “HA filler breaks down with time so some patients are prepared to wait until the filler naturally reduces.”

Alternatives to under eye filler 

The great news is that there are a number of alternative treatments that can help resolve certain concerns without the need for under eye filler, if you’re not a good candidate.

Polynucleotides work fantastically for skin tightening, according to Dr Hemming. “This treatment works by stimulating the patients’ DNA into repair and often reduces redness and pigmentation in the process too.”  

Radio frequency microneedling is ideal for skin laxity. Dr Hemming includes treatments like radio frequency microneedling, specifically Secret RF and Secret Pro.

Dermal fillers elsewhere on the face could work, too. Dr El Muntasar notes that sometimes people think they need under eye filler because the front of the cheek is fairly flat. However, he notes that adding the “smallest bit of midface support using dermal fillers in the front of the cheek helps support the under eye and lift it up a little.” Whether or not he uses hyaluronic acid-based filler depends on the patient. His preference is Ellanse which is a collagen stimulator, giving collagen support in addition to an improvement in the skin. He notes that for patients who want more volume, dermal filler with HA is used.

Skin boosters promote general skin quality and appearance; Dr El Muntasar likes a skin booster, specifically Teoxane Teosyal Redensity 1 to give an overall brightening to the area.