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Eliminate Dark Circles Under Your Eyes with Lower Eyelid Fillers

Do you find your lower eyelids to have dark circles? Do they seem hollow or sunken?
There are now some great options that can help your lower lids seem brighter, smoother, and younger looking.

What’s the cause of dark under-eye circles? Eyelid skin is some of the thinnest skins in all of the body. Because of this, a large portion of the light that hits the lower eyelid is absorbed rather than reflected. That makes the skin in this area appear darker. In addition, convexity or depression along the bony orbital rim increases shadow formation in this area, which exacerbates the dark circles.

What’s the solution? Until recently, the only option for improving the dark circles has been makeup application to alter the lower lid color. This can be a time-consuming and demanding endeavor for female patients and a non-starter for the majority of male patients. Lasers, skin peels and microneedling are often tried, but they do not affect the dark circles in a meaningful way. Non of the above solutions address sunken skin in the lower eyelid area, also known as a tear trough deformity. Facial fillers have dramatically altered our ability to address this cosmetic concern.

Facial fillers can inflate and smooth the depression in the lower lids and alter the light reflection of the lower lid skin. This smooths the lower lid contour and lightens the perceived color of the skin under the eyes. There are multiple treatment choices for facial fillers in the lower lid, including autologous fat and nano-fat (taken from your own body) or commercially available fillers, including hyaluronic acid fillers (Juvederm®, Restylane®, and Belotero®), Poly-L-Lactic acid (Sculptra® Aesthetic™) and calcium hydroxylapatite (Radiesse®).

How do you choose, and what is the best option? Before choosing, let’s consider the advantages and limitations of each option.

Filler options:

Autologous fat: This treatment requires a separate procedure to anesthetize and remove fat from the lower body (abdomen, flank, or the thigh). The fat is then prepared and injected into the lower eyelid area. Fat grafting can be performed more globally to augment other facial areas at the same time. Fat grafting has the longest lasting benefit. The disadvantage of fat grafting is the need for a separate procedure to harvest fat, increased cost and possible lumpy appearance of the lid from the fat globules.

Nano fat: This is a relatively new procedure where similar to autologous fat transfer, fat is harvested from the lower body. The harvested fat is then passed through a series of small screens to disrupt the fat cells while preserving the fat-derived stem cells. Nano fat which is comprised of these stem cells, is then injected into the lower eyelid with tiny cannulas. Nano fat injections do not cause lumpiness and have shown to be remarkably beneficial for skin rejuvenation.

Hyaluronic Acid (Juvederm, Restylane, Belotero): Hyaluronic acid is a complex molecule that exists naturally in our bodies. The product is a clear synthetic gel that is available as off-the-shelf injections to augment and contour the face. These fillers are smooth and easy to contour to the desired configuration. The results typically last about a year. A big advantage of hyaluronic acid fillers is that they can be easily dissolved if so desired.

Poly-L-Lactic acid (Sculptra Aesthetic): This is a biocompatible synthetic material in powder form. The chemical composition is similar to what is used in absorbable sutures. The powder is dissolved in sterile water before injection. It stimulates collagen formation in the areas of injection though a process that may take a few months before the full results are realized. Results can last up to two years. The disadvantage is possible nodule formation.

Calcium hydroxylapatite (Radiesse): This is a white, paste-like facial filler that is composed of phosphate and calcium suspended in a gel carrier. It is injected into the lower lid at the level of the bony orbital rim to fill and contour the lower lid to a more desirable configuration. It can last about 18 months. Disadvantages include possible nodule formation and the possibility that the white color of the paste may be visible.

Summary of pros and cons

Filler type Pros Cons
Hyaluronic acid Ease of treatment
Very natural appearing
Reversible (can be dissolved)
Can be molded during treatment
Shortest lasting
Fat transfer Longest lasting
Sources from your own body
Requires separate procedure to harvest fat
Longer recovery
Absorbs faster in smokers and elites athletes
May appear lumpy
Nano fat transfer Excellent skin booster
Best improvement of dark skin
Very smooth results
Potential inadequate volume augmentation
Poly-L-Lactic acid Excellent collagen booster
Lasts longer than HA
Results may take up to 6 months to manifest
May cause granulomas or nodules
Longer lasting May cause nodules
May be too white in appearance

The procedure:

When fat transfer or nano fat transfer is performed, the initial step is a minor liposuction to harvest fat from an area in the lower body (abdomen, flank or thigh). A local anesthetic is used for liposuction. The small incision for liposuction is closed with a fine suture. The fat is then prepared either as standard fat transfer or it’s passed through a series of small screens to create nano fat, which is rich in stem cells. The fat preparation is then loaded into small syringes.

The actual injection technique is similar for fat transfers and synthetic fillers. The face is anesthetized with topical cream and then cleaned and sterilized. The facial fillers, which are in 1cc syringes, are then attached either to a needle or a cannula (a blunt needle) and injected into the skin at the proper depth in small aliquots. Synthetic fillers can be manually molded to improve contouring. We monitor your skin, eyes and lower eyelids during the injections to ensure proper placement of the filler and avoid complications. Expert knowledge of anatomy in the face and eyelids and expertise in injection techniques (needle and cannula) are necessary pre-requisite for any clinician performing lower eyelid filler injections.


When liposuction is performed, there is minor discomfort and a possibility of bruising in the fat harvest region. The filler injection can also result in minor bruising in the lower eyelid region. Typically, there is minor swelling that goes away within three days. Applying ice packs can reduce the extent of swelling.

What Dr. Khosh's Patients Say


Based on 174 reviews

Meredith G.
Saw Dr. Khosh for a fractured nose. He reset my nose beautifully (and with little discomfort to me) and then discussed some of my sinus issues with me upon my follow up visit. Never felt like he was rushing me out and felt very confident in his abilities. I would highly recommend to anyone needing plastic or reconstructive options!
Jackie C.
Great front office, really good experience after what was a terrible accident. I was made to feel comfortable. Dr. Khosh is very good at what he does. I'm still healing but I'm confident of the results
Kaitlin M.
Dr. Khosh takes exceptional care of his patients. He has operated on me twice, each time making me feel extremely comfortable and satisfied with the results. His staff is also very kind and knowledgeable.
Diana G.
Dr. Khosh & his staff Susan & Christine are absolutely amazing! They were so supportive & helpful from beginning to end & they are just wonderful people. Thank you guys I truly appreciate everything you guys have done for me. I would recommend them to anyone & everyone!
Joann M.
After visiting and being evaluated by several doctors, I kept going back to Dr. Khosh. His tranquil spirit and professionalism were captivating. Thank you for a job well done and keeping me calm throughout the entire process. A special thanks to your staff Susan and Christine for all of their support as well. Hi highly recommend Dr. Khosh.
Leah G.
Upon hearing of the overwhelmingly positive experience a friend of mine had in choosing Dr. Khosh as her surgeon, I decided to make an appointment for my own septoplasty/rhinoplasty/turbinate reduction. Although I was slightly skeptical as the praise I had heard seemed a bit hyperbolic, all uncertainty dissipated after meeting the Doctor and his staff. My pre- and post-operative experience was excellent in terms of concerns adequately addressed prior to the surgery and mitigation of any bruising in the convalescent period. Despite my apparent predisposition to rather slower healing, a year after the surgery, my nose looks really pretty and my breathing entirely unobstructed! I highly recommend Dr. Khosh!
Courtney G.
AMAZING!!!!!! I had Dr Khosh perform lipo on my chin/neck and my result is unbelievable! Better than I could have expected! I met with a couple of surgeons and the second I met with Dr Khosh I knew he was the one I was going with. He was compassionate and explained every detail of what would take place during the surgery and what to expect during recovery. I even emailed a few times during recovery with various questions and he got right back to me asap which was really comforting! I honestly fully recommend Dr Khosh, he did an amazing job and is an amazing person.
Frieda S.
i can finally breathe!! Dr. Khosh made the entire experience a breeze, it was truly a pleasure to be under his care. I am forever thankful and highly recommend him. Not only does his work speak for himself, but he has excellent bedside manner. His kindness and patience is above and beyond. He takes the time to answer to every question you have to help you understand the process while at the same time making you feel so comfortable. From the first consultation i knew i was in good hands. I am so pleased with the result and forever thankful.
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