Tear Trough (Under-Eye) Filler

In the UK, the authority only approves license for biodegradable dermal fillers. These fillers are being absorbed gradually over time and are therefore not permanent. The officials have banned permanent dermal fillers in the UK and rightly so because they are dangerous and may cause irreversible damage to your skin. Chin fillers are long-lasting but not permanent, Juvéderm Voluma lasts 12-18 months, whereas the latest Juvéderm Volux lasts 18-24 months.

Dermal fillers are pharmaceutical-grade, gel-like injectables designed specifically to restore volume, provide lift, smooth out wrinkles, and fill in deep folds. They are very popular due to their effectiveness and versatile nature. We use them to rejuvenate, volumise, plump, and sculpt attractive facial contours. New ways of using dermal fillers are constantly being discovered. Depending on their ingredients, some dermal fillers have added benefits such as stimulating collagen and improving skin hydration. Dermal fillers have become a true contender to plastic surgery over the years, helping people avoid invasive and expensive cosmetic operations.

Hyaluronic acid (HA) fillers are the most popular and safest type of dermal fillers. They consist of stabilised, non-animal-based hyaluronic acid. The HA gel is skin-friendly and integrates well with the tissues, closely resembling the hyaluronic acid that exists naturally in the body. Hyaluronic acid fillers improve skin texture by helping the skin retain hydration, and they are long-lasting yet dissolvable.

As we get older, not only will we have less collagen under our skin, but we will also lose facial volume in the deep fat compartments. Collagen maintains the tightness and elasticity of our skin, whereas deep fat pads provide structural support to our facial features. Without volume, the under-eye area becomes hollow and dark. Without collagen, the skin appears wrinkly and lax. When compounded by lack of sleep, dehydration, and pigmentation from sun damage, these dark circles can become very prominent and often make us look tired, old, and even gaunt.

Dark circles are also linked to genetics, with certain ethnicity groups, such as South Asians, being more susceptible. Those who suffer from allergies, hormone imbalance, early menopause, and insomnia may notice the development of dark circles and eye bags much earlier than everyone else.

Prevention is better than cure. Getting sufficient sleep, adequate water intake, and protection from sun damage can reduce the rate of the ageing process. Eye creams and concealers can be helpful in some cases, but when dark circles and eye bags become more severe, medical treatment may be required.

If the skin is very saggy and baggy, you may want to consider surgical excision of excess skin and repositioning of the peri-orbital structures. This procedure is called blepharoplasty. It is a form of plastic surgery and can be expensive, invasive, and associated with a long recovery period.

If your primary concern is under-eye hollowing, tear trough fillers can be an excellent solution. Volume loss is what fillers treat best. Tear trough fillers can restore supporting volume, smooth the skin, and reduce tired-looking dark circles. By rejuvenating the under-eye area, you can look fresher, more youthful, and more energised.

Tear trough fillers can indeed help with certain eye bags. By improving the volume deficit below the eye bags and smoothing the transition in the surrounding skin, eye bags can appear softer and less noticeable.

Please remember that dermal fillers are injectable treatments and are used primarily for replenishing depleted volume and smoothing uneven contours. Tear trough fillers cannot remove loose skin; surgical excision is required to address excess skin tissue.

If eye bags are very prominent and heavy, particularly when the surrounding skin is thin, loose, and lax, surgical blepharoplasty may be a more appropriate option. Careful assessment is therefore essential to determine whether tear trough fillers are suitable for treating eye bags.

Choose hyaluronic acid (HA) fillers for facial injection because they are safer. Any other fillers are riskier; the reason is HA fillers can be easily and quickly dissolved by hyaluronidase (e.g. Hyalase). This is an important safety net should we ever need to remove it.

Pharmaceutical companies do not harvest HAs from animals or human beings; they made them synthetically in the laboratories. The products are sterile, vegan-friendly, and safe. HA fillers are not permanent, but they are very long-lasting. Your body’s natural existing hyaluronidase enzymes will slowly disintegrate the HA fillers, turn them into water and absorb the water. No residuals will remain. HA fillers are non-toxic, biodegradable, and safe. Millions of people worldwide have tried them.

Tear trough fillers are made of transparent hyaluronic acid gel. When a transparent gel is injected under the skin, it does not change the existing skin tone on the surface. Tear trough fillers can lighten dark circles to a certain extent if the darkness is caused by volume loss or by prominent underlying blood vessels that give a bluish tinge.

Existing pigmentation on the outer surface of the skin will not change with tear trough fillers, in the same way that freckles or moles do not change colour as a result of the treatment.

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Hyaluronic acid (HA) filler is the safest filler to use in the tear trough area. In fact, it should be the only type of filler considered when treating dark circles. There are many HA fillers on the market. Popular brands with long safety track records include Juvéderm©, Teosyal©, Restylane©, and Belotero©, to name a few, with new brands emerging regularly to compete in this industry. At Harley Street MD, we prefer Juvéderm© Vycross range fillers, which are premium dermal fillers manufactured by the world’s leading pharmaceutical company, Allergan©.

The tear trough is a very delicate area, and careful selection of the filler is especially vital to achieving a smooth, natural look. Thick HA products must be avoided because they can attract too much water and cause swelling, which is undesirable. No fillers are designed the same; different fillers have different properties. They vary in elasticity, viscosity, rheological characteristics, and hyaluronic acid content. As a result, not all fillers are suitable for, or licensed for, under-eye injection.

At Harley Street MD, we are experts in tear trough correction and specialise in treating this delicate area. We have treated thousands of patients to date. We use only the highest-quality products, and for under-eye fillers, we recommend Juvéderm© Volbella. Juvéderm© Volbella is ultra-soft and provides a natural-looking yet long-lasting result. In our opinion, its quality is far superior to many other brands.

Improper use of dermal fillers, especially when injected by inexperienced or unqualified personnel, can potentially lead to blockage of blood vessels. When blood flow to the eye is compromised, this may result in blindness. Fortunately, the risk of this devastating vascular complication is extremely rare. However, we understand that a low incidence rate does not make the impact any less significant.

Given the seriousness of this complication, extensive effort, time, and resources have been invested worldwide to better understand and prevent it. International literature reviews have been conducted to identify all reported cases globally so clinicians can learn from them. One such study was conducted by Beleznay et al. and published in the Aesthetic Surgery Journal in 2015, with an updated report released in 2019 to reflect ongoing complication rates and prevention strategies.

According to the February 2019 report, the total number of documented cases of vision loss secondary to injectable treatments worldwide was 146. While this number is extremely small when considered against the vast number of filler treatments performed globally, the findings remain important. The updated report concluded that among all reported cases, the injection site with the highest risk was the nasal region (56.3%), followed by the glabella (27.1%), forehead (18.8%), and nasolabial folds (14.6%).

Contrary to common assumptions, tear trough fillers are considered very low risk compared with these higher-risk areas. Of the 48 new cases reported between the 2015 and 2019 literature reviews, only two cases were associated with tear trough injections. In other words, if vision loss were to occur following filler treatment, only around 4% of cases would be linked to the tear trough area. It is also important to reiterate that, out of all filler treatments performed worldwide, only 146 cases of vision loss have ever been reported.

At Harley Street MD, we have never had a case of blindness associated with injectable treatments, regardless of the area treated. We adopt rigorous prevention strategies and continually update our practice in line with international guidelines to minimise risk and ensure the highest standards of patient safety when performing dermal filler treatments.

Filler selection is very important. We insist on choosing only ultra-soft fillers when it comes to tear trough correction. Soft hyaluronic acid (HA) with a lower G-prime in rheology is less likely to cause obstruction, even if accidentally injected into a blood vessel.

We advise using only a cannula for all tear trough correction, as research has shown that a cannula is less likely to pierce blood vessels due to its blunt tip. Injection with a needle is far more dangerous and riskier in the tear trough area. Needles can easily puncture blood vessels and increase the risk of intravascular embolisation.

At Harley Street MD, we follow strict complication-prevention strategies by injecting only small amounts of product, slowly and with minimal pressure each time. Avoiding large boluses of product in a single location helps to reduce the risk of vascular occlusion.

We strongly recommend that this procedure is carried out only by a doctor. A thorough understanding of anatomy, including the location and depth of facial blood vessels, is essential in reducing the risk of blindness. Injectors must avoid high-risk locations and inject only within safe tissue planes and depths.

Lastly, preparation for the worst is essential. Clinics must have hyaluronidase readily available, and doctors must be trained to recognise the symptoms of vascular occlusion and have the knowledge, skills, and equipment to dissolve fillers quickly in an emergency.

Under-eye fillers are very safe, but due diligence is essential. Choose your injector wisely. We recommend that only qualified and experienced experts in tear trough correction perform this treatment. Avoid thick fillers, say no to fillers with normal or high viscosity, and always insist on soft fillers only. Choose cannula over needle for a safer approach and better results. Ensure the clinic is CQC-registered and fully equipped with appropriate emergency medication and protocols.

Under-eye fillers should only be carried out by experts in this field who have specialised in tear trough correction. The learning curve is very steep, with very little margin for error.

Poorly trained or inexperienced injectors may lack sufficient anatomical understanding, micro-dexterity, and the advanced training required to correct subtle volume loss in an area with complex vasculature and vital structures. This is not a procedure that should be performed in a beauty salon, MedSpa, or someone’s home.

You need specialists who have carried out countless tear trough correction procedures and who are proficient in using specialised micro-cannulas to safely navigate high-risk under-eye zones. The technique requires precise placement of soft hyaluronic acid fillers in micro-droplets across multiple tissue planes to achieve safe, natural results.

This treatment should only be performed by a qualified GMC-registered specialist in a CQC-registered medical clinic with immediate access to emergency hyaluronidase. This is essential for your safety.

At Harley Street MD, your treatments are only performed by GMC-registered doctors with a licence to practise. We are registered, accredited, and endorsed by the JCCP (The Joint Council for Cosmetic Practitioners) and the CPSA (The Cosmetic Practice Standards Authority). This means we have met the highest standards of care and clinical practice. The JCCP and CPSA are recognised regulators of the non-surgical aesthetic industry in the UK. By choosing us, you are choosing a clinic that actively advocates public protection and patient safety.

Our premises are registered with the Care Quality Commission (CQC), the independent regulator of health and social care in England. We are regularly monitored and assessed by the CQC to ensure that only the highest quality of care is provided to the public. This confirms that the clinic is safe, effective, caring, responsive to patients’ needs, and well-led. We have received a verifiable “GOOD” rating following CQC inspection.

We strongly believe in a client-centred approach. We listen. We respect. We are committed to excellence in everything we do, and we believe that years of experience truly matter.

It matters who performs your filler treatment. Dr Chia Tan, founder and lead doctor of Harley Street MD, is a UK-trained medical doctor who specialises in cosmetic medicine. He qualified in 2003 and has worked as a reputable aesthetic specialist since 2008. He has thousands of satisfied patients and has been featured in magazines as well as appearing on television, including The Health Show, where he explains the latest cosmetic procedures to the public. He is a Certified Advanced Injector by Allergan® and is one of the very few experts worldwide proficient in the advanced injection technique known as MD Codes™.

Dr Chia Tan is a full member of the British College of Aesthetic Medicine (BCAM), a prestigious and highly selective medical college in the UK that promotes outstanding, safe, and ethical aesthetic practice. Full BCAM membership requires rigorous cross-examination of qualifications, years of specialist training, clinical experience, and evidence of ongoing professional development. Only true specialists in this field are eligible for BCAM membership.

Dr Chia Tan has a broad range of specialist interests, reflected in his extensive list of professional post-nominal titles. In addition to being a Member of the British College of Aesthetic Medicine (MBCAM), he is a Member of the Royal College of Surgeons of Edinburgh (MRCS Ed), a Member of the European College of Aesthetic Medicine & Surgery (ECAMS), a Member of the Royal College of General Practitioners (MRCGP), and a Fellow of the Higher Education Academy (FHEA). He is fully registered with the General Medical Council (GMC) and holds a Licence to Practise. He is a dedicated clinician who continues to learn, refine, and advance his expertise.

Dr Chia Tan is a tear trough correction expert who specialises in complete peri-orbital transformation. His signature Triple Layer Technique is not only effective in lifting tear trough hollowing, but also helps to blend surrounding structures, soften peri-orbital wrinkles, and hydrate the under-eye skin. This technique is achieved by using a specialised micro-cannula to deposit a controlled amount of ultra-soft hyaluronic acid (HA) into three different tissue planes in the under-eye area.

By replenishing volume loss in the deep sub-periosteal tissue plane, we provide structural support at the foundation level and lift the under-eye hollow directly from its base. Fillers injected in this plane increase longevity and are less likely to cause swelling.

Next, injection is performed in the medium-depth sub-muscular layer to soften under-eye wrinkles and reinstate the natural contour of the area. The hyaluronic acid is carefully moulded and massaged to blend seamlessly with adjacent structures, creating a smooth and natural transition.

Finally, the often-neglected superficial epidermal layer is addressed. Depositing ultra-soft hyaluronic acid in this layer hydrates the under-eye skin, rejuvenates the area, and softens very fine lines.

The signature Triple Layer Technique goes further still. By using a blunt micro-cannula in a precise manner, micro-dissection is performed in the under-eye area to gently release adhesions or tethering to underlying blood vessels. This is particularly beneficial for patients with blood-vessel-related bluish discolouration contributing to dark circles.

At Harley Street MD, we respect tissue anatomy. Every element of our signature technique has a purpose, and every drop of filler is injected with precision and intention.

Micro-cannula, commonly known as a “cannula”, is a disposable, single-use, hollow metal tube with a blunt tip. A cannula is an upgraded version of the traditional needle. Its introduction has completely revolutionised the cosmetic industry and transformed the advanced procedures that can now be offered by aesthetic specialists. This injectable instrument allows for better results with a lower risk profile.

Unlike a traditional needle with a sharp tip, a cannula has a rounded, blunt end. This design helps protect against puncturing or piercing blood vessels during injection. As a result, it significantly reduces the risk of bruising, trauma, swelling, and vascular embolisation. Overall, the safety profile of a cannula is considerably higher than that of a needle.

A needle is short and rigid, whereas a cannula is long and flexible. Because it is longer, a cannula can reach tissue depths that are inaccessible using a conventional needle approach. At around 50 mm in length, it allows a specialist to treat a large area through a single entry point, which would otherwise require multiple needle punctures. Fewer entry points mean a lower risk of bruising. The flexibility of a cannula also allows it to glide past blood vessels without damaging them, even when they lie along its path—something a rigid needle cannot do.

Another important advantage of a cannula, often overlooked by inexperienced injectors, is its ability to help advanced specialists identify the correct tissue plane during treatment. By interpreting the tactile feedback felt as the cannula moves through tissue, experts can detect subtle changes at different depths and accurately navigate to the intended plane. This skill develops with experience and is key to achieving precise product placement.

A cannula is manoeuvred horizontally, which aligns with the natural orientation of tissue planes. By depositing filler horizontally within these planes, results tend to appear more natural. In contrast, a needle is injected vertically and travels in a rigid straight line, offering little to no tactile feedback due to its sharp tip. Clinical studies have confirmed that cannulas are often superior to needles in terms of product placement accuracy.

Is cannula better than needle? When it comes down to safety alone, cannula certainly triumphs over needle. With a blunt tip, cannula is considerably safer when operating near a danger zone and can minimise the risk of vascular complication. When the gauge size of the cannula used is 25G or larger, the risk of intra-arterial embolisation is very low. The risk of bruising is also significantly lower, as unlike a needle, cannula does not require multiple puncture points.

Does this mean needle is completely unsafe? No, not really. Needle by and large is still considered safe, especially in the hands of an experienced injector. A good injector will always take extra precautions and practise safe injection techniques. Aspiration prior to injection and slow injection of only small volumes at a time are all good preventative measures when using a needle. Having said that, when all variables are standardised, cannula is indeed safer than needle.

How about the result? Safer does not necessarily mean a better result. There are many instances and exceptions where a needle can outperform a cannula in achieving a better cosmetic outcome. A needle is very precise. In the right situation, a bolus of filler injected using a needle directly into a single point can be exact, precise, and result in a very aesthetically pleasing outcome.

When choosing a specialist for dermal filler injection, choose one that is great in using both cannula and needle. Do not just choose an injector, choose an expert. A true expert should be proficient in both techniques. Without being confined by either one injection method, an expert can then be allowed to be creative, flexible, and free to sculpt, correct and perfect your result; just the same as you will never restrict a sculptor to use only one tool to create a masterpiece. You should only choose an expert that have spent years mastering both techniques, someone that always adopts the best approach to give you the finest possible outcome safely. An expert is brave to aim for excellence, and yet careful to always ensure your safety comes first.

When deciding between cannula or needle technique, we recommend choosing the technique that gives you the best outcome and execute that technique safely. When both techniques will give you the same result, choose the safest technique. It is not easy to be an expert in any field, you need years of experience, you need to get pass steep learning curves and have verifiable results to prove your consistency of excellent works. Do not be persuaded by outdated injector who may have years of experience in using needles, but do not know how to use a cannula.

Lastly, when it comes down to tear trough fillers, cannula is the game changer. It provides the best of both worlds, not only it allows for better product placement, better result and it is safer too. We highly advocate that this procedure should only be done by cannula method. At Harley Street MD, we use our signature ‘Triple Layering’ technique when injecting under-eye fillers. We use 25G 50mm cannula in performing this technique.

Yes, you can. British College of Aesthetic Medicine (BCAM) consensus confirms that non-surgical aesthetic procedures like dermal fillers can be offered right after the consultation. As it is a non-permanent procedure, we do not require a long cool off period like plastic surgery would.

We often allocate a 1-hour slot for new patients who have never had the treatment before, so that we have sufficient time to talk you through the treatment, explain potential side effects, and assess your suitability for the procedure.

If you are happy to proceed after your consultation, you will be guided to complete a consent form and may have the treatment performed on the same day. If you are unsure and prefer a cool off period, we are more than delighted to give you all the information you need and await your decision.

We will recommend you avoid taking vitamin E, Omega 3 supplements, and Ginkgo Biloba for 2 days, as they can increase your bruising risk. Please do not take any aspirin for at least 7 days before the treatment. If you take aspirin for medical reasons, please consult your doctor.

Avoid alcoholic beverages for 1 day and avoid exercise on the day of the procedure.

We do recommend you have something to eat and drink before the procedure. Make sure you are not low in blood sugar or dehydrated before any non-surgical procedure.

Please inform the doctor if you are concurrently having any other treatment around the eyes or cheeks. If you have recently had laser or chemical peel treatment in these areas, please allow at least 2 weeks before your tear trough treatment.

We will numb the area first. At Harley Street MD, we will perform a local block to numb the area with local anaesthetics, which will considerably make the whole procedure far more comfortable. This is beneficial for both the patient and the injector to achieve optimal results. We will also apply 4% lidocaine cream to the treatment area for added effect. We draw the treatment area to ensure symmetry; this helps us mark the volume deficit area and the entry point. Each procedure is bespoke, and marking allows precision in our work.

We subsequently disinfect the under-eye area with antiseptic to minimise the risk of infection. This procedure should only be performed in an aseptic environment. We will use a 23G needle to gently create an entry point for our 25G cannula. Fillers will be injected from this entry point to address the dark circles. We use our signature ‘Triple Layering’ technique for the best result. We may gently massage the area intermittently to create the smooth, natural look we aim to achieve.

If a top-up is needed (after swelling has subsided), additional filler is charged at £450 per syringe, since new product is required. The follow-up appointment itself remains free of charge.

The whole process takes typically 30-45 minutes, including application of numbing cream, preparation, and procedural treatment. Consultation and treatment can be done within the one appointment slot.

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Tear trough injection is not painful. You may feel some minor discomfort and a sensation of pressure during the treatment. Local anaesthetic injections can feel slightly sharp, but only for 2–5 seconds, after which the numbing effect takes hold. We also apply topical numbing cream and local anaesthetic injections to ensure your comfort. The fillers we use contain additional lidocaine, making the treatment as comfortable as possible.

The doctor will be very gentle and careful throughout the procedure. You may consider taking paracetamol before the treatment; however, please avoid anti-inflammatory medications such as ibuprofen or aspirin, as they can increase the risk of bleeding and bruising.

You will see improvement immediately after the treatment. It is a very rewarding procedure. Initially, you may notice some mild redness and subtle swelling, which is expected because you have just had injections. Do not worry — these will subside very quickly within a couple of days. Recovery time is minimal. You can return to your normal daily activities immediately after the treatment, and most people do not need to take any time off work.

It takes around 2 weeks to see the final result, so please be patient. Hyaluronic acid fillers take approximately 10–14 days to integrate with the surrounding tissues. Please allow time for the HA to settle into the area and for any potential swelling or bruising to subside. As hydration improves over time, dark circles will appear lighter and brighter, and the under-eye area will look smoother and more hydrated.

If this is your first time, you may consider scheduling your treatment toward the end of the week so you can rest over the weekend for extra peace of mind. We do not recommend having this treatment if you have an important social event in the following few days. Please remember that it takes around 2 weeks to see the final result.

The results from tear trough fillers typically last between 6-18 months. Longevity of the fillers vary between individuals. We all have different metabolism, genetic, skin elasticity and lifestyle, though majority of people are likely to need to repeat the procedure once per year.

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Each syringe has 1 ml of hyaluronic acid filler. Is 1 ml a lot? No, it really is not. You most likely would have overestimated the true volume of a single millilitre of fluid, like everyone else. I bet you do not know it takes 5 syringes of filler to fill a teaspoon, and 16 syringes to fill a tablespoon. When you manage to apprehend the exact size of a tablespoon, you soon realise a single syringe of filler (1/5 of a teaspoon) does not contain scary amount of filler as you initially thought.

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People who have very mild under-eye hollowing may achieve a good result with one syringe of soft filler. More commonly, patients will require two syringes in total, with 1 ml used for each eye to achieve an optimal outcome. Very rarely, three syringes may be required in the tear trough area.

At Harley Street MD, we aim to deliver natural-looking results. Tear trough correction is one of our specialist areas and is among the most frequently requested treatments at our clinic. In many patients, the tear trough groove extends laterally, where the outer part of the eye socket becomes more visible, creating a gaunt or hollow appearance. This outer area that requires lifting is often referred to by specialists as the lateral SOOF (sub-orbicularis oculi fat).

Some patients present with a continuous depression along the entire orbital rim, extending from the medial to the lateral side. This is described as a Class III tear trough deformity. Each class of deformity requires a bespoke treatment approach, and therefore the number of syringes needed varies between individuals to achieve the best possible result.

As aesthetic specialists, we are trained to assess the ageing process of the whole face. The tear trough forms part of the mid-face. When you notice tired-looking under-eyes, you may have overlooked volume loss in the temples or cheeks. Treating the tear trough alone may not be sufficient if the mid-face is saggy and has lost its natural ogee curve. In these cases, a total mid-face transformation is necessary to restore harmony to the facial features.

By using MD Codes™ (a trademarked injection technique), step by step, we restore temporal volume loss, lift the mid-face by supporting the zygoma and maxilla, enhance light reflection on the apples of the cheeks, and smooth the tear trough hollow from medial to lateral. In these cases, we typically use 4–6 syringes to deliver a non-surgical mid-face lift.

The smoothness of the under-eyes is then extended to match the rest of the mid-face, resulting in a more youthful, lifted, and well-rested appearance.

Under-eye fillers are contraindicated in patients who:

• Are pregnant or breastfeeding
• Have a known hypersensitivity to hyaluronic acid fillers
• Have infection or severe inflammation at the injection site such as shingles
• Have recent skin resurfacing procedure such as laser, chemical peel, or micro-needling. Please allow 2 weeks recovery period before treatment.

You should tell your doctor prior to receiving dermal filler treatment if you:

• Have multiple severe allergies or anaphylaxis of any kinds
• Have or have had a breathing problem, such as severe asthma
• Have or have had bleeding problems or are taking blood thinning medication

Dermal filler is not licensed in women who are pregnant or breastfeeding. That does not automatically suggest it is unsafe; it simply means the manufacturers have not performed clinical trials in this group.

It is unlikely for the licensing to change any time soon, as there is minimal financial benefit for manufacturers to run such trials, and even with approved licensing, most women would still not have treatment during pregnancy according to statistics.

If you are currently trying for a baby, it is therefore advisable to delay any cosmetic procedure.

If you find out you are pregnant after the procedure, do not worry, as dermal filler is not thought to be dangerous to developing babies.

Observational studies that followed women who discovered they were pregnant after treatment did not find any harm to their babies.

Hyaluronic acid in dermal fillers closely resembles your body’s own natural hyaluronic acid. It is gradually broken down by your body and safely metabolised into water.

You may fly shortly after dermal filler injection during an emergency; there is no perceived life-threatening danger in doing so.

If flying is not essential, there are certain factors you should be aware of. According to the medical literature on the safety of flying after dermal filler treatment, there is a professional consensus to delay air travel for one week following treatment. Reduced atmospheric pressure in an aircraft cabin may worsen swelling and bruising associated with dermal fillers, and people are generally more prone to water retention when flying. This is particularly relevant for long-haul flights. For this reason, we recommend waiting at least one week before travelling by air where possible.

At Harley Street MD, we recommend a follow-up appointment for assessment and any potential further treatment. We therefore prefer our clients to remain in the area for up to two weeks after the procedure, in case you wish to have a top-up, correction, or require assessment for any complications.

Serious side effects of under-eye filler are very uncommon. Non-surgical procedures are not without risks or potential complications. You may notice the following:

• Discomfort or pain at the site of injection
• Temporary swelling
• Temporary bleeding
• Bruising (extensive bruising is very rare and is only temporary; it can usually be covered with concealer)
• Allergic reaction: itching, welts, wheezing, dizziness
• Vasovagal syncope or faintness due to injection, especially in needle-phobic individuals (please make sure you have something to eat and drink before the treatment and do not hold your breath during injection; always tell your doctor if you are needle-phobic)
• Infection (avoid putting makeup on the treated area for at least 4 hours, ideally one day; if infection occurs, it can be treated with antibiotics)
• Granuloma formation (rare)
• Vascular injury including skin necrosis (very rare)
• Loss of vision (extremely rare; we are experienced in tear trough treatment and all necessary precautions are taken to minimise your risk)
• Periorbital oedema or bumps (you may need to have the filler dissolved)
• Greyish tinge discolouration – Tyndall effect (you may need to have the filler dissolved)
• Asymmetry or migration of filler (please ensure you sleep on your back and avoid pressure on the treated area for at least 2 days)

You can carry on with your day pretty much as usual immediately after the treatment. For optimal results and to avoid complications, we recommend the following:

• Do not rub or massage the treated area for a few hours after treatment
• Avoid strenuous exercise for 2 days, as it may increase the risk of swelling and bruising
• Avoid alcohol for 2 days
• Try to sleep on your back for at least 2 days and avoid leaning on the injected area
• Avoid putting on makeup for at least 4 hours, ideally for a full day after treatment
• You may take arnica or bromelain tablets, which can be bought over the counter. These are natural supplements that may help reduce bruising. Pineapples contain high levels of bromelain, and ingestion may help speed up recovery from bruising
• You may take paracetamol to reduce pain as necessary
• Avoid extreme heat exposure such as sun tanning, sunbathing, or sauna use for 2 weeks
• Avoid laser treatment or chemical peels on the treated area for 2 weeks
• It is not uncommon for the treated area to feel firm or hard for a few days. It takes around 2 weeks for hyaluronic acid to integrate with the surrounding tissues. Once fully settled, this sensation should resolve
• Contact the clinic if you experience any complications or side effects

There is minimal downtime for under-eye filler. Immediately after the injections, you may notice mild redness and swelling on the injection sites; these typically subside quickly. Bruising is rare, but if it happens it can take 3 to 5 days to resolve. Concealers are useful. You can consider taking Arnica or Bromelain supplements to speed up any bruising recovery. You can go back to work and go about your usual activities immediately after the treatment; most people do not need to take any time off work for this procedure. It takes 2 weeks to see the full effect of treatment.

Under-eye fillers are entirely reversible. Unlike plastic surgery, this is one of the many reasons non-surgical procedures are becoming increasingly popular. You can dissolve hyaluronic acid fillers easily; this is exactly why we advocate using only HA fillers for tear trough correction.

Hyaluronidase (e.g. Hyalase) is an enzyme that can break down and degrade the fillers easily, turning the filler into water. Hyaluronidase may work instantly within seconds, but its dissolving effect can also continue for up to 3 days. The result of dissolving is often only apparent around day 5–7, after the body has absorbed all the fluid associated with the process. Most of the time, a single dissolving session is sufficient. This means that if you ever change your mind, it is quick and simple to remove all the fillers. This acts as a significant safety net for many people, especially those having the treatment for the first time.

Requests to remove all injected fillers are rare. In most scenarios, you are more likely to require only a minor tweak to reduce some swelling. In these cases, we introduce a tiny amount of hyaluronidase to smooth out the concerned area. If we performed the tear trough fillers for you, we will dissolve them for you, however many sessions are required. This service is free when presented within 3 months of treatment; otherwise, a charge of £250 will apply per session.

Dermal fillers commonly take up to 2 weeks to show results. When any mild swelling from the injection has subsided and hyaluronic acid has fully integrated with the surrounding tissues, you may subsequently notice the need for more filler to perfect the result. It is not unusual; for safety reasons, we never over-correct tear trough deformity, allowing contingency for potential hydration boost from hyaluronic acid. Being careful and cautious allows us to deliver natural results.

During your complimentary follow-up (usually recommended at around 2 weeks after treatment), if insufficiency in volume becomes apparent after the resolution of swelling, we will recommend a further top-up. We charge £450 per syringe.

People are afraid that once the filler wears off, the skin may lose its elasticity and sag. They worry filler may over-stretch the skin because of the added volume. Contrary to this fear, filler is anti-ageing, and it improves the quality of your skin. Filler replenishes lost volume by lifting the saggy area. If done subtly and in proportion to the existing facial features, you will have a natural and youthful-looking result.

At Harley Street MD, we do not advocate excessive, improper overfilling to a point of gross anatomy distortion. Never focus on a single facial area in isolation; always take a holistic approach and plan your treatment with symmetry and proportion in mind. Filler placement needs to be sophisticated, and results need to complement your natural beauty. Always choose a medical expert and not be lured by unqualified beauty therapists.

Hyaluronic acid is a natural moisturiser for the skin. It keeps the hydration your skin needs. HA filler can therefore slow down the ageing process. This is an anti-ageing procedure that many people choose to maintain. Under-eye hollow will worsen at a much faster rate unless you support its structural integrity. HA breaks down slowly over time, allowing the skin time to return to its original state. Areas you have had fillers before will be healthier and more youthful than areas without.

Do not allow all your fillers to wear off. We recommend repeating treatment every 10–12 months for optimal results, both to protect and to improve upon the original outcome. Why not take advantage of booking your next session right after your treatment? We will send you a reminder when it is closer to your appointment.