Under-eye treatments: tear trough fillers and alternatives
Tired-looking eyes are one of the most common reasons people visit an aesthetic clinic. The under-eye area is also one of the more delicate places to treat, so it helps to understand the cause before choosing a treatment.
What causes under-eye hollows and dark circles
Several things can make the area under the eyes look dark or tired, and they often occur together:
- Loss of volume with age, which deepens the groove between the lower eyelid and the cheek (the tear trough)
- Bulging fat pads under the eye, which cast a shadow below them
- Pigmentation in the skin, common in people with darker skin tones
- Thin skin that shows the blood vessels underneath
- Lack of sleep, allergies and fluid retention
Fillers address hollowness. They do not fix pigmentation or bulging fat, and can make puffiness worse.
Tear trough fillers
A doctor injects a small amount of hyaluronic acid filler, usually with a blunt cannula, along the tear trough to soften the hollow. Products chosen for this area are typically soft and less likely to attract water. Results can last a year or longer because the area moves little.
Why the area carries extra risk
The under-eye area has thin skin and lies close to blood vessels connected to the eye. The general risks of fillers apply, and some are more likely here:
- A bluish tinge under the skin if filler is placed too superficially
- Persistent swelling or puffiness
- Lumps that need dissolving
- Vascular occlusion, which near the eye carries a rare but serious risk to vision
These risks are the reason to choose a doctor with substantial experience in this area, and a clinic that keeps hyaluronidase on hand. See botulinum toxin and dermal fillers.
Alternatives
| Concern | Options commonly offered |
|---|---|
| Pigmentation | Sun protection, topical treatments, some lasers and peels |
| Fine lines and thin skin | Skin boosters, energy-based devices, topical retinoids (not in pregnancy) |
| Bulging fat pads | Lower eyelid surgery (blepharoplasty) by a qualified surgeon |
| Puffiness from fluid | Sleep, allergy management, reducing salt |
Questions to ask
- What do you think is causing my under-eye appearance?
- Is filler the right option, or would another treatment suit better?
- How many under-eye filler treatments do you perform, and how do you manage complications?
Clinics in Thailand
Many Bangkok clinics offer under-eye fillers. Choose a doctor-led clinic, since the under-eye area has a higher risk of complications than most filler sites. Ask for a consultation first, and do not feel obliged to book treatment the same day.
Written by the SurgicalEyes editorial team. Last updated October 2026. See how we prepare and check guides in our medical review policy.