eye rejuvenation. This article explores the differences, indications, and considerations of upper versus lower eye fillers with attention to advanced techniques and clinical applications.
What Are Eye Fillers?
Are mainly injected fillers under the eye, meaning eye fillers, providing less invasive procedures for treating volume loss, hollows, fine lines, or pigmentation around the eyes. As a general rule, most of these fillers are based on cross-linked hyaluronic acid, providing a safe-efficacious alternative to enhancement for the periocular region.
Major Filler Components and Their Action
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Hyaluronic Acid (HA): Given unmatched versatility and biocompatibility, HA fillers such as Restylane and Juvederm stand out as “gold standards” for use near very fine skin surrounding the eyes. While Juvederm Volbella products crosslink at densities sufficient to encourage long duration of action for the exact correction of even the finest lines, they are better known for their use in facial creases.
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Calcium Hydroxylapatite (CaHA): There has been less use of this filler material in Radiesse around the eye area, but its most excellent location in the upper cheek was used to support the tear trough through volumetric structural elevation indirectly.
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Poly-L-lactic Acid (PLLA): This is a biostimulatory filler, usually employed in the induction of long-term collagen deepening, and it is well suited to those with great volume deficit; however, in its injection, it requires rather high levels of expertise to avoid nodularity.
Prevalent Market and its Growth
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Periocular filler treatments were counted to have been over 1.2 million last year and increased by 15% globally from the preceding year; most appealing segments were those aged between 25 and 55 who showed increasing demands.
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According to the American Society for Aesthetic Plastic Surgery, 40 percent of patients sought treatment related to eye fillers due to the presence of dark circles, while 35 percent were interested in filling shallow eyes due to volume loss.
Upper vs Lower Fillers
The main difference lies in the anatomy treated and the desired cosmetic effect achieved. The safe and effective procedures require knowledge of the upper and lower eyelids and function.
Anatomy and Aesthetics
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Fill Eyes in Upper Parts:
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It should be noted that the volume is depleted in this supraorbital region where the presence of a skeletal orbicularis creates a sunken appearance, especially the brow fat pad and orbital rim.
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Sites for filler correction would include the superior sulcus and the temporal hollow, with correction requiring 1-2 ml of filler.
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Objective: Make the forehead/upper eyelid transition more artfully prettier while improving brow projection.
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Lower Eye Fillers:
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Eliminates shadows to refresh the tired look of your eyes by treating the tear trough/nasojugal groove, malar bags, and infraorbital hollows.
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Anatomical consideration: The tear trough area is closely associated with the orbital septum, orbicularis oculi muscle, and infraorbital fat pads, so placement needs to be accurate each time given that the structures in this region are topographically related.
Longevity of Results
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You cannot ignore the upper eyelid and the surrounding tissue that are always at work; thus, fillers in this area may last around 6-12 months.
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Lower eye fillers can last 12-18 months depending on the product used and the metabolic rate of the patient, given that the tear trough area is less dynamic.
Benefits of Upper Fillers
While upper eye fillers are used primarily to restore volume and enhance the contour around the bony rim of the orbit and brow.
Restoration of Volume and Rejuvenation of Eyelids
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Aging is characterized by atrophy of the orbital fat pads and thinning of the dermis. The superior sulcus becomes an unattractive, bowl-like indentation. HA fillers, like Restylane Lyft or Juvederm Voluma, perform best at restoring fullness with minimal downtime.
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The majority of patients, 92%, experience excellent improvement in hollowing after addressing the upper eye fillers. It’s backed by clinical trials and may continue for as long as a year.
Brow Projection and Lift
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The use of advanced techniques in cannulation, such as microcannula injections, allows delivery and precise placement of filler along the brow ridge and results in lateral brow elevation of 2-4 mm, with improved symmetry and decreased hooding of the upper eyelid.
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In this area, products with good viscosity and lift, e.g., Teosyal Ultra Deep, are most used.
Advantages of Lower Fillers
Tear trough deformity, dark circles, and infraorbital bags are common, and lower eye fillers are the treatment of choice.
Dark Circle Correction
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Dark circles are the result of volume depletion and vascular transparency. HA fillers like Belotero Balance lighten pigmentation by reflecting light and plumping up the tissue.
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Indeed, a 2021 study showed that 88 percent of patients presented with marked improvement of tear trough pigmentation after a single session.
Decreased Hollowness and Eye Bags
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Fill the nasojugal groove to smooth the lid-cheek junction. 0.5 to 1 ml of Restylane Refyne or Juvederm Volbella provides a very natural correction with less swelling.
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The orbicularis retaining ligament is supported by lower fillers, which reduce puffiness in patients with mild fat herniation.
How Fillers Work
It’s a highly methodical process, employing highly technical methods that ensure accuracy and safety.
Injection Techniques
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Linear threading: This well-known method is also used for the lower eyelid, which distributes the filler more evenly in the trough zone.
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Blunt-tip microcannulas: These are less likely to cause bruising and vascular complications in the ocular area, and are therefore commonly used.
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Layered approach: For extreme loss of volume, the filler is injected in multiple planes of tissue, blending the transition.
Procedure and Results
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The whole procedure, including consultation and marking, takes 30-45 minutes.
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70-80% of improvement is immediate, and the final outcome isn’t noticed until the filler has properly integrated with the surrounding tissue over the next 10-14 days.
Who Needs Eye Fillers?
Eye fillers attract a broad patient demographic: from younger adults who get the treatment for genetic dark circles to older adults who are looking for anti-aging treatment.
Candidates for Upper Eye Fillers
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Patients in their 35s, 40s, or 50s with deep brow hollowness or upper eyelid laxity.
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Candidates seeking a non-surgical brow lift, with possible results lasting up to a year.
Candidates for Lower Eye Fillers
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Ideal for Grade 1 or 2 tear trough deformities (mild to moderate hollows) with minimal skin laxity.
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In a 2020 survey, 60% of patients aged 25 to 40 wanted lower eye fillers primarily to treat dark circles.
Risks and Side Effects
The orbital region is highly vascularized; while the ocular use of fillers is safe, it carries risks.
Common Side Effects
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Bruising and swelling occur in 10-20% of patients, most cases resolving within 3 to 5 days following conservative management with ice packs and arnica cream.
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Mild asymmetry can often be improved in follow-up sessions, which more than 90 percent of treatments include.
Less Common Complications
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Vascular occlusion: A serious but rare complication, vascular occlusion requires an immediate response with hyaluronidase injections. It is well documented that the application of 50-150 units of hyaluronidase delivered early on will resolve occlusion in more than 95% of cases.
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Tyndall effect: Less than 1% of patients have this issue, typically with superficial injection techniques. This risk is reduced by employing lower viscosity products like Belotero Soft
