Which filler is best for treating under eye hollows?

One sign of aging is the appearance of a hollow groove between the lower eyelid and the cheek.  This is called the nasojugal fold.  We don’t fully understand why this fold becomes more prominent with age, but changes in the soft tissue and skull contribute to its appearance.

Under eye hollow before and after

Before and after filling under eye hollow (the nasojugal fold)

In a youthful face, there is no transition between the lower eyelid and cheek.  It is one clean sweep from the margin of the lower eyelid through the cheek.  With age, the lower eyelid bulges outward and the cheek descends downward with gravity leaving a hollow space between the two.  Filling this space blunts the transition between the lower eyelid and the cheek and gives a more youthful look.

Which filler is best?

Nowadays, there are many fillers available.  However, not all of them are appropriate for filling the nasojugal folds.  Radiesse is too thick, and Sculptra can leave nodules in this area where the skin is thin.  Many people use Juvederm in this area, but I feel that Restylane is the best choice.

I like to use Restylane in the nasojugal folds because it stays where it is placed, lasts about 10 – 12 months in this area, and can be sculpted easily.  I don’t like to use Juvederm because it tends to draw fluid into the area where it is injected.  This is great in certain areas like the nasolabial folds, but it can make some people look like they are having an allergy attack if placed in the nasojugal folds because it makes the lower eyelids puffy.

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