Medically reviewed by

Dr. Pim Thaweewitayarut — Board-Certified Dermatologist

MSc in Dermatology, King’s College London · Best Thesis Award in Acne Treatment

Do you still look tired no matter how much you sleep? Does concealer work less well than it used to—or not at all? For many people, the cause is structural: a hollow beneath the lower eyelid that casts a shadow no amount of rest or skincare can fix.

The good news is that this is one of the most treatable concerns in aesthetic medicine, when the right approach is chosen for the right cause. This guide explains why the under-eye area changes, how to identify which type of concern you have, and what to look for when choosing a clinic in Bangkok.

Table of Contents

The Short Answer

Under-eye filler (tear trough filler) is a hyaluronic acid (HA) injectable placed beneath the lower eyelid to restore volume lost due to bone resorption, fat pad descent, and skin thinning. It works best on shadow-based, structural darkness — not dark circles caused by pigmentation. Results are visible immediately, there is generally no mandatory downtime, and the effects typically last 9–18 months, which lasts longer than lip fillers because this area moves less. At Bibi Clinic, we use VISIA® imaging before treatment to determine the specific issue you’re experiencing.

What Is Under-Eye Filler and How Does It Work?

The under-eye area changes with age for three interconnected reasons. The orbital rim—the bony edge of the eye socket—gradually recedes, reducing the skeletal support beneath the soft tissue and causing the tear trough to deepen. The suborbicularis oculi fat (SOOF), the fat pad directly beneath the lower eyelid, thins and descends over time—in some people, this can begin as early as their mid-20s, driven more by genetics than by age. Periorbital skin, the thinnest skin on the face, also becomes more transparent as collagen and elastin decline, allowing underlying blood vessels and muscles to show through.

Together, these factors create a structural hollow that casts a shadow—a look that makes you appear tired no matter how much sleep you’ve had. This shadow cannot be corrected with skincare, cold compresses, or concealer; it can only be resolved by restoring the lost volume beneath the skin.

What type of dark circles do you have?

• Shadow-based (structural): caused entirely by the hollow casting a shadow—the primary indication for filler. A useful self-test: hold a light source below your face and tilt your head back; if the shadow lessens or disappears, the cause is structural.
• Pigment-based: caused by melanin deposits in the skin itself. Fillers add volume but have no effect on skin color, and may create an overfilled appearance without addressing the actual issue—laser or topical skin-brightening treatments are more appropriate in this case.
• Vascular: A purplish-blue tint caused by blood vessels showing through very thin skin. Fillers can help by adding tissue between the skin and the blood vessels, but treatments that improve skin quality are usually the primary approach.

At Bibi Clinic, we use VISIA® skin analysis before any treatment to objectively assess your concerns, and your physician will be straightforward about whether fillers are the right treatment for you—or whether a different approach would be more suitable.

Who Is It Suitable For?

Under-eye fillers are most effective for people whose primary concern is structural—such as hollowing, the depth of the tear trough, and shadow-induced dark circles. At Bibi Clinic, the physician evaluates all of these factors individually during the consultation.

• Adults with visible hollowing or a groove beneath the eye.
• Those whose darkness is primarily due to shadows, not pigmentation.
• People who look more tired than they actually feel—an anatomy-driven discrepancy between appearance and reality.
• Adults of any age—tear trough hollowing can be significant even in one’s late 20s if there is a genetic predisposition.

This treatment is generally not suitable during pregnancy or while breastfeeding; for severe lower eyelid fat pad protrusion (true eye bags, which may require surgical evaluation); for dark circles caused solely by pigmentation; during an active infection or periorbital inflammation; or for individuals with bleeding disorders or those taking anticoagulant medication. Your physician will determine whether this treatment is appropriate for you and will inform you directly if fillers are not the right option.

Results, Duration, and Downtime

The typical lifespan is 9–18 months — generally longer than lip fillers, since the tear trough area has less movement. How long the results last depends on the specific product used, your individual metabolism, the amount of filler injected, and lifestyle factors such as UV exposure and smoking. Individual results may vary; these figures are clinical averages and do not guarantee specific outcomes for any patient.

There is generally no required downtime, and most patients resume their normal activities the same day, although bruising is more common around the eyes than in other areas treated with fillers—it may be worth setting aside 5–10 days if you have an important event coming up. For 24–48 hours afterward, avoid rubbing or touching the eye area, intense exercise, alcohol, and saunas; sleep with your head slightly elevated, avoid applying makeup under your eyes for at least 24 hours, and apply SPF 50 daily.

Possible side effects

• Common (expected, temporary): Bruising, which is more common here than in other areas treated with fillers, typically resolves within 5–10 days; swelling peaks at 24–48 hours and resolves within one to two weeks; temporary asymmetry is reassessed at the 2-week follow-up.
• Uncommon: the Tyndall effect (a bluish tint caused by filler injected too superficially), which can be treated with hyaluronidase and is rare when performed by an experienced practitioner; prolonged swelling lasting more than two weeks; lumpiness if the filler migrates or is distributed unevenly, which can usually be massaged out or dissolved.

Under-Eye Filler vs. Other Options

Choosing the wrong treatment for your specific concern won’t help—and may actually make things look worse. Here’s a quick guide to matching your concern with the right treatment.

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Pricing at Bibi Clinic in Bangkok

Pricing for treatment is based on the filler brand and the volume required, which depend on the anatomy of your tear troughs and your goals. The pricing information below is listed transparently; your exact volume is determined during your consultation and is never estimated in advance.

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At Bibi Clinic, treatment is physician-led, featuring a full-face assessment and personalized dosing, as well as support in English, Japanese, and Thai. For the complete, up-to-date menu, see the Filler Treatment Page.

Frequently Asked Questions

I’m in my late 20s and my under-eye hollows are genetic—is filler appropriate at this age?

Yes. Genetic tear trough hollowing responds well to fillers at any age in adults. The prejuvenation approach — treating a structural concern conservatively before it becomes more pronounced — is clinically sound, and very small volumes are typically appropriate for younger patients.

How can I tell if my dark circles are caused by hollowing or pigmentation?

A useful self-test: Hold a light source directly below your face and tilt your head back. If the darkness lessens or disappears in this position, it is caused by shadows, and adding filler will help. If it persists regardless of the lighting angle, it is likely pigment-based, and a pigmentation treatment is more appropriate. Your doctor will confirm this during your consultation using VISIA® imaging.

Will my eyes look puffy or swollen after getting fillers?

Mild swelling is expected for 24–48 hours. Significant puffiness is almost always the result of over-treatment—either using too much product or a product that attracts too much water. Bibi Clinic’s conservative approach is designed to prevent this, and the 2-week follow-up evaluates the results once the swelling has subsided.

What is the Tyndall effect, and how can I prevent it?

The Tyndall effect is a bluish discoloration caused by filler injected too superficially into the skin, usually due to an inappropriate product or injection depth. It is rare when treatment is performed by an experienced physician using products specifically designed for the periorbital area, which is why product selection and technique are just as important as the amount injected.

Is there any downtime after tear trough filler?

No mandatory downtime. Most patients resume their normal activities the same day. Bruising is more common around the eyes than in other areas treated with fillers, so it’s a good idea to plan for 5–10 days if you have an important event coming up.

References

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Individual results may vary. Please consult a qualified medical professional before undergoing any aesthetic treatment. Bibi Clinic’s physicians will assess your personal suitability during a consultation.