Hyaluronic acid (HA) fillers placed correctly in the tear trough carry a strong safety record: a 2023 meta-analysis of more than 2,500 patients found a 91 percent satisfaction rate and low complication rates. The eye area is different from the rest of the face, though. Skin here is thin, blood vessels sit close to the surface, and the wrong depth or product can cause visible discoloration or lingering swelling.
Flora Levin MD, FACS is an oculofacial plastic surgeon who completed fellowship training in ophthalmic plastic and orbital surgery at the New York Eye and Ear Infirmary and has since performed thousands of eyelid procedures. That background gives her surgical-level insight most general injectors don't have. Read on to see how she evaluates candidates and what keeps the treatment safe from start to finish.
Who Is a Good Candidate for Under-Eye Filler?
Not everyone with dark circles is a good fit for filler. During a consultation, Dr. Levin examines the under-eye area and explains her reasoning if filler isn't the right choice for you.
Good candidates typically have:
- Minimal or no under-eye bags
- Skin with healthy tone and elasticity
- Hollowness caused primarily by volume loss rather than sagging
Patients with noticeable bags or loose eyelid skin usually see better results from surgical options such as lower blepharoplasty or skin-tightening laser treatments.
What Makes This Treatment Safe?
Only a few HA fillers are formulated for safe use around the eyes, and Dr. Levin selects specific types based on this anatomy. The filler has to be placed deep beneath the skin and muscle; injected too close to the surface, it can create a persistent bluish shadow known as the Tyndall effect.
Dr. Levin most often uses a blunt-tipped microcannula rather than a sharp needle. A 2020 prospective study on tear trough treatment found no major complications when a cannula was used with conservative filler volume. Combined with careful patient selection, this approach keeps under-eye filler safe and natural-looking in Dr. Levin's hands.
What to Expect During and After Treatment
Treatment starts with a consultation to confirm you're a good candidate. Some patients choose a numbing cream beforehand, though many find ice sufficient and prefer to skip the irritation numbing cream can cause. The injection itself takes only a few minutes.
Most patients return to normal activities the same day. Mild swelling is common for three to five days, and bruising is possible but less frequent. Dr. Levin recommends skipping exercise for 24 hours and avoiding heat or massage near the treated area for two weeks. Results typically last 10 to 12 months, and a follow-up visit two weeks after treatment allows for a touch-up if needed.
Filler corrects hollowness. Fine lines respond better to treatments like laser resurfacing or microneedling, which patients can ask about separately.
Flora Levin MD, FACS: Trusted Expertise for Safe, Natural-Looking Results
Safe results start with an accurate diagnosis and end with a provider who understands eyelid anatomy at a surgical level. Dr. Levin built that precision over years directing the Oculoplastics & Orbital Surgery Section at Yale New Haven Hospital, and she brings it to every consultation as a board-certified oculofacial plastic surgeon. If you're wondering whether under-eye filler is right for you, schedule a consultation to find out.
This information is provided for educational purposes only and does not replace a consultation with a board-certified plastic surgeon. Outcomes, risks, and suitability vary from patient to patient.
