Medically reviewed by

Dr. Pim Thaweewitayarut — Board-certified Dermatologist

MSc Dermatology, King’s College London · Best thesis award in acne treatment

Do you still look tired no matter how much you sleep? Does concealer help less 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 that has been lost to bone resorption, fat pad descent, and skin thinning. It works best on shadow-based, structural darkness — not pigment-based dark circles. Results are visible immediately, there is generally no mandatory downtime, and effects typically last 9–18 months, longer than lip filler because this area moves less. At Bibi Clinic, VISIA® imaging is used before treatment to confirm which type of concern you actually have.

What Is Under-Eye Filler and How It Works

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 letting the tear trough groove 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 the mid-20s, driven more by genetics than age. Periorbital skin, the thinnest skin on the face, also becomes more transparent as collagen and elastin decline, letting underlying vessels and muscle show through.

Together, these create a structural hollow that casts a shadow — a look that reads as fatigued regardless of how much sleep you’ve had. This shadow cannot be resolved with skincare, cold compresses, or concealer, only by restoring the volume deficit beneath the skin.

Which type of dark circle 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 darkness reduces or disappears, it is structural.
• Pigment-based: caused by melanin deposits in the skin itself. Filler adds volume but has no effect on skin colour, and may create an overfilled look without addressing the actual concern — laser or topical brightening treatments are more appropriate here.
• Vascular: a purplish-blue tint from blood vessels showing through very thin skin. Filler can help by adding tissue between skin and vessels, but skin-quality treatments are usually the primary approach.

At Bibi Clinic, VISIA® skin analysis is used before any treatment to objectively categorise your concern, and your physician will be direct about whether filler is the right treatment for you — or whether a different approach would serve you better.

Who Is It Suitable For?

Under-eye filler works best for those whose primary concern is structural — hollowing, tear trough depth, and shadow-based darkness. At Bibi Clinic, the physician assesses all of this individually at consultation.

• Adults with visible hollowing or a groove beneath the eye.
• Those whose darkness is primarily shadow-based, not pigmentation.
• Those who look more tired than they feel — an anatomy-driven mismatch between appearance and reality.
• Adults of any age — tear trough hollowing can be significant even in the late 20s with a genetic predisposition.

Treatment is generally not suitable during pregnancy or breastfeeding, for severe lower-eyelid fat pad protrusion (true eye bags, which may need surgical assessment), for purely pigment-based dark circles, during active infection or periorbital inflammation, or for those with bleeding disorders or on anticoagulant medication. Your physician will confirm suitability and will say so directly if filler is not the right fit.

Results, Duration and Downtime

Typical longevity is 9–18 months — generally longer than lip filler, since the tear trough area involves less movement. Longevity depends on the specific product used, your individual metabolism, how much volume was placed, and lifestyle factors like UV exposure and smoking. Individual results vary; these figures are clinical averages, not a guarantee for any specific patient.

There is generally no mandatory downtime, and most patients resume normal activities the same day, though bruising is more common around the eyes than in other filler areas — it can be worth budgeting 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, skip under-eye makeup for at least 24 hours, and apply SPF 50 daily.

Possible side effects

• Common (expected, temporary): bruising, more common here than in other filler areas, typically resolving in 5–10 days; swelling peaking at 24–48 hours and resolving within one to two weeks; temporary asymmetry that is reassessed at the 2-week follow-up.
• Uncommon: the Tyndall effect (a bluish tint from filler placed too superficially), managed with hyaluronidase and rare in experienced hands; prolonged oedema lasting more than two weeks; lumpiness if filler migrates or distributes unevenly, usually massaged out or dissolved.

Under-Eye Filler vs. Other Options

Choosing the wrong treatment for your specific type of concern won’t help — and may make things look worse. Here is a quick reference for matching concern to treatment.

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Pricing at Bibi Clinic in Bangkok

Treatment is priced by the filler brand and the volume required, which depend on your tear trough anatomy and goals. The menu below is listed openly; your exact volume is confirmed at consultation, never estimated in advance.

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At Bibi Clinic, treatment is physician-led, with a whole-face assessment and personalised dosing, and support in English, Japanese and Thai. For the full, current menu, see the filler treatment page.

Frequently Asked Questions

I’m in my late 20s and my tear troughs are genetic — is filler appropriate at this age?

Yes. Genetic tear trough hollowing responds well to filler at any adult age. 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 do I know if my dark circles are from hollowing or from pigmentation?

A useful self-test: hold a light source directly below your face and tilt your head back. If the darkness reduces or disappears in this position, it is shadow-based and filler will help. If it persists regardless of lighting angle, it is likely pigment-based, and a pigmentation treatment is more appropriate. Your physician will confirm this at consultation using VISIA® imaging.

Will my eyes look puffy or swollen after filler?

Mild swelling for 24–48 hours is expected. Significant puffiness is almost always the result of over-treatment — 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 reviews results once swelling has resolved.

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

The Tyndall effect is a bluish discolouration caused by filler placed too superficially in the skin, usually from an inappropriate product or injection depth. It is rare when treatment is performed by an experienced physician using periorbital-specific products, which is why product selection and technique matter as much as the amount injected.

Is there downtime after tear trough filler?

No mandatory downtime. Most patients resume normal activities the same day. Bruising is more common around the eyes than in other filler areas, so it can be worth budgeting 5–10 days if you have an important event.

References

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