No filler under the eyes

Dark circles, sunken tear troughs, and tired-looking lower lids are among the most common concerns of our patients. So too are malar bags — swellings over the upper cheekbone that are often mistaken for under-eye bags. Patients typically want a quick solution, usually with hyaluronic acid.

Our clear position on this: in most cases, hyaluronic acid does not belong beneath the eye.

The problem with the lower-lid region

The skin beneath the eye is extremely thin. It lies directly over fine blood vessels and delicate lymphatic channels, and is embedded within anatomically complex structures. Even minor changes in volume are already visible.

Dark circles are partly genetic; they frequently arise from:

• Volume loss at the transition between the lower lid and the cheek
• a sunken tear trough
• thinning skin
• light and shadow effects

The problem is structural and multifaceted — not merely superficial.

Why hyaluronic acid is problematic here

Hyaluronic acid can bind large quantities of water within the tissue. In the lower-lid area, this becomes a problem.

1. Swelling due to water binding

The filler effect of hyaluronic acid occurs because hyaluronic acid — depending on the preparation — binds up to 1,000 times its own weight in water. As the lower-lid region (under-eye bags, malar bags) is susceptible to this, hyaluronic acid is contraindicated in most cases.

2. Material migration

Hyaluronic acid does not always remain exactly where it was injected. Facial movement, gravity, and tissue pressure can cause the material to shift.

3. Tyndall effect

When placed too superficially, the material shows through the skin with a bluish tint.

4. Lymphatic disruption

Particularly with inadequate technique, the delicate lymphatic channels in the lower lid can be impaired. This predisposes to chronic oedema.

Artificial malar bags: a common consequence of inappropriate injections

Artificial malar bags are, unfortunately, a frequent phenomenon.

Malar bags are swellings in the region of the cheekbone. They can be genetically determined, but also arise as a result of unsuitable hyaluronic acid treatments.

What happens? When hyaluronic acid is placed in the tear trough or lower lid using an unsuitable preparation or at the wrong depth, the material can accumulate in the region of the malar fat pad over months or even years.

This results in:

• new swellings
• worsening of existing malar bags
• unnatural transitions
• persistent fluid retention that fluctuates in severity

These artificial malar bags are often mistaken for under-eye bags.

Particularly concerning: hyaluronic acid can remain detectable long after treatment and continue to cause problems.

Important note: hyaluronic acid and laser treatment for malar bags

We strongly advise against treating malar bags with hyaluronic acid or laser.

Both modalities:

• generally improve the situation only 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 exacerbates them.

Where hyaluronic acid or laser treatments have already been performed, we provide individualised advice on appropriate corrective measures.

Why we rely on autologous fat instead

Autologous fat is the body's own tissue. It integrates biologically and does not attract additional water.

Microfat:

• provides gentle volume augmentation
• corrects the sunken tear trough
• creates soft transitions

Nanofat:

• acts primarily in a regenerative capacity
• improves skin quality
• promotes collagen formation
• reduces fine crêpe lines

The most important difference: autologous fat behaves like the body's own tissue.

When autologous fat is appropriate

• for a sunken tear trough
• volume loss beneath the eye or at the upper lid, also suitable for "hollow eyes"
• thin, crepey skin around the eye area

For pronounced under-eye bags and true malar bags, other strategies are required.

Long-lasting refreshed appearance

We have observed over many years that patients who have the lower-lid region stabilised at an early stage experience significantly fewer problems later on with pronounced shadows, skin laxity, or irregular transitions.

Consultation at artethic® Dr. Karl Schuhmann & Kollegen

Whether your concern is a tear trough, under-eye bags, or malar bags can only be determined through a personal examination. Please book your appointment for this purpose.