No Filler Under the Eyes
Dark circles, sunken tear troughs and tired-looking lower eyelids are among the most common concerns of our patients. As are malar bags – swellings over the upper cheekbone that are often mistaken for eye bags. The desired solution is usually a quick one, most often with hyaluronic acid.
Our clear position: in most cases, hyaluronic acid does not belong under the eye.
The Problem with the Lower Eyelid Region
The skin under the eye is extremely thin. It lies directly over fine blood vessels and delicate lymphatic channels, embedded in anatomically complex structures. Even minor volume changes are immediately visible.
Dark circles are partly genetic, but are often caused by:
- Volume loss at the transition between the lower eyelid and cheek
- a sunken tear trough
- thinning skin
- light and shadow effects
The problem is structural and multi-layered – not merely superficial.
Why Video Consultations Are Not Sufficient for Dark Circles and Malar Bags
When assessing the lower eyelid region, light, shadow and daily form play an important role. Even small changes in lighting make dark circles appear stronger or weaker. Photos are often misleading: camera quality, angle, make-up, image processing and different light sources considerably alter the impression.
Malar bags in particular fluctuate depending on the time of day. Water retention – influenced by temperature, sleep, salt intake or fluid intake – means that swellings can appear much more pronounced on one day than the next. A snapshot via video or photo therefore does not reflect the actual clinical picture.
A reliable decision requires a direct specialist examination in person. Only then can we assess:
- – Skin thickness and skin quality
- – Tissue tension and elasticity
- – Lymphatic drainage
- – Fat distribution
- – Swellings and genuine volume loss
Why Hyaluronic Acid Is Problematic Here
Hyaluronic acid can bind large amounts of water in the tissue. In the lower eyelid area, this becomes a problem.
Swelling from Water Binding
The filler effect of hyaluronic acid occurs because hyaluronic acid – depending on the preparation – can bind up to 1,000 times its own weight in water. Since the lower eyelid region (eye bags, malar bags) is susceptible, hyaluronic acid is contraindicated in most cases.
Material Migration
Hyaluronic acid does not always remain exactly where it was injected. Through facial movement, gravity and tissue pressure, the material can shift.
Tyndall Effect
If the filler is placed too superficially, the material shimmers through the skin with a bluish tint.
Lymphatic Disruption
Particularly with inadequate technique, the delicate lymphatic channels in the lower eyelid can be impaired, which promotes chronic oedema.
Artificial Malar Bags: A Common Consequence of Inappropriate Injections
An unfortunately frequent phenomenon is artificial malar bags.
Malar bags are swellings in the area of the cheekbone. They can be genetically determined, but also arise as a result of inappropriate hyaluronic acid treatments.
If hyaluronic acid is injected into the tear trough or lower eyelid with an unsuitable preparation or at the wrong depth, the material can accumulate in the area of the malar fat pad over months or even years.
This results in:
- new swellings
- worsened existing malar bags
- unnatural transitions
- persistent fluid retention, which presents more strongly on some days than others
These artificial malar bags are often confused with eye bags. Particularly critical: hyaluronic acid can remain detectable long after the treatment and continue to cause problems.
Important Note: Hyaluronic Acid and Laser for Malar Bags
We strongly advise against treating malar bags with hyaluronic acid or laser.
Both procedures:
- usually only improve the situation in the short term
- can cause additional swelling
- worsen the appearance in the long term
Hyaluronic acid frequently migrates into existing malar bags and further amplifies them. If hyaluronic acid or laser treatments have already been performed, we provide individual advice on appropriate corrective measures.
Why We Use Autologous Fat Instead
Autologous fat is the body's own tissue. It integrates biologically and does not attract additional water.
The most important difference: autologous fat behaves like your own tissue.
Microfat
- provides gentle volume augmentation
- corrects the sunken tear trough
- creates soft, natural transitions
Nanofat
- primarily regenerative in effect
- improves skin quality
- promotes collagen production
- reduces fine lines and crepey skin
When Autologous Fat Makes Sense
For pronounced eye bags and true malar bags, other strategies are required.
Long-Term Freshness Effect
We have observed for years: patients who stabilise the lower eyelid region early on have significantly fewer problems with pronounced shadows, skin laxity or uneven transitions in later years.
Frequently Asked Questions
Can hyaluronic acid already injected under the eye be removed?
Hyaluronic acid can be dissolved using a specific enzyme (hyaluronidase). This is particularly useful when swellings or artificial malar bags have developed. Careful patient selection is important, as the enzyme can also affect the body's own hyaluronic acid. The decision should be made exclusively by a specialist physician.
Why do dark circles sometimes look worse after exercise or in the heat?
The lower eyelid region is sensitive to changes in blood flow and fluid distribution. Heat, poor sleep, physical exertion or a salty diet can intensify water retention. This makes malar bags or swellings appear more pronounced. Conversely, dark circles can look less visible when lymphatic drainage is good and the environment is cool. These fluctuations make reliable assessment by photo or video very difficult.
Is treatment with autologous fat permanent?
A portion of the transplanted fat integrates permanently into the tissue, while another portion is reabsorbed in the first few weeks. The final result is assessed after a few months. In addition, skin quality improves through regenerative effects, which can lead to a more stable and natural appearance over time. There is no guarantee of 'forever', as the natural ageing process continues.
Über den Autor
Facharzt für Plastische und Ästhetische Chirurgie & Handchirurg
Mit mehr als 30.000 Eingriffen und mehrjähriger Tätigkeit als Chefarzt führt Dr. Schuhmann seit 2016 als Gründer von artethic® seine Praxen in Düsseldorf und Berlin.