Under Eye Filler Singapore — Tear Trough Filler, Explained

Under eye filler Singapore: what it is, and how it works

The tear trough is the groove that runs from the inner corner of the eye downward and outward along the bony rim of the socket. Skin and the orbicularis muscle are tethered to the bone there by the tear trough ligament, so as cheek tissue descends and the fat pads either side thin, a step forms. Light from above misses the groove, and it reads as a shadow rather than as pigment, which is why people look tired when they are not.

Under eye filler raises the floor of that groove. A cross-linked hyaluronic acid gel of low elastic modulus and relatively low concentration is placed supraperiosteally, on the bone at the inferior orbital rim and deep to the orbicularis oculi muscle, in amounts far smaller than most people expect. Softer gels of this class integrate into thin tissue with less visible edge and less water uptake than the firmer gels used for the cheek or chin. Lower eyelid skin is about 0.5 mm thick, thin enough for gel placed too superficially to scatter light and show blue.

Hyaluronic acid can be broken down with hyaluronidase, an enzyme injected where the product sits. That reversibility is why hyaluronic acid is the class of filler used in the tear trough, and why non-dissolvable fillers have no place there. Where earlier filler is already the cause of puffiness, the first step is ultrasound-guided hyaluronidase, not more filler.

Am I suitable for under eye filler?

You may be suitable if a groove along the bony rim casts a shadow, the skin over it is reasonably firm, and there is no bag of fat above it. Most people who ask are not sure which they have, so these questions help before you book.

Pregnancy, breastfeeding, a cold sore or inflamed skin near the eyes means waiting. A known allergy to hyaluronic acid products or lidocaine, earlier reactions to filler, autoimmune conditions and a bleeding tendency are discussed before anything is planned. Age matters less than anatomy: a younger face with a clean hollow and firm skin suits filler more often than an older one with bags and fluid, but each is assessed on its own. When the answer is no, the reasons are set out on when tear trough filler is the wrong choice.

Which approach: hollow patterns, and needle or cannula

Not every hollow has the same shape, and the pattern decides where volume goes, if anywhere.

Needle or cannula under the eye

Either can be appropriate, and in both cases the gel is placed deep, on the bone beneath the muscle. A blunt-tip cannula, commonly 25 G, enters through a single small point on the cheek and tends to push vessels aside rather than pierce them; it suits longer hollows and the transition into the cheek, and often bruises less. A fine needle allows very precise placement for small, well-defined deficits, with slow injection in small amounts. Neither removes the risk of vascular occlusion, which is why hyaluronic acid is used here, hyaluronidase is kept on hand and the amount is kept conservative.

What under eye filler cannot do: dark circles from other causes

Dark circles are a description, not a diagnosis. Four different things produce them, often more than one at once, and only one is filler-responsive.

• Structural shadow from hollowing. The darkness disappears when light is shone directly into the trough. This is the one cause filler addresses.
• Pigmentation. Brown or grey-brown discolouration present in any light, often familial and more pronounced in the Fitzpatrick III to V skin common in Singapore. Filler does nothing for it.
• Vascular show-through. A purple or bluish tint from vessels seen through thin skin. Filler on the bone can partly mask it, but only partly.
• Eye bags from fat prolapse. Orbital fat pushing forward makes the trough look deeper because the bag beside it is higher. Filler cannot reduce a bag.

How a physician tells a hollow from a bag

The distinction is made by examination, not by photograph. With the head tilted back and the gaze upward, a shadow from a hollow softens while a bulge of orbital fat stays or becomes more prominent. Gentle pressure on the closed upper eyelid pushes orbital fat forward and reveals any prolapse. The skin is stretched to see whether darkness moves with it (pigment) or fades (shadow), and the rim is palpated to judge how much tissue lies over the bone. The self-check is set out on eye bags vs dark circles vs tear trough.

Risks, stated plainly

The lower eyelid is an unforgiving place to inject, and the risks are real.

• Tyndall effect. Gel placed too superficially, or too much of it, scatters light through the thin skin and shows as a bluish tint. It is treated by dissolving the product; see the Tyndall effect.
• Lumps and irregularity. Irregularity that persists once swelling has settled is moulded or dissolved.
• Malar oedema. Persistent swelling of the cheek mounds, more likely with a pre-existing tendency to fluid there. It may need hyaluronidase.
• Over-correction and migration. A trough filled flat, product added repeatedly, or gel placed too superficially can spread and look puffy; see pillow face treatment.
• Vascular occlusion. Rare but serious. Filler entering the infraorbital or angular vessels can block blood supply to the skin and, through connections to the ophthalmic circulation, to the eye; vision loss from filler has been reported in the medical literature. This is why under eye filler belongs with a physician who knows the anatomy, injects slowly on the bone, and keeps hyaluronidase on hand. The warning signs are listed on vascular occlusion after filler.

“Filler fills a hollow. It cannot lighten pigment and it cannot hide a bag.”

Dr Sin YongOn the limits of tear trough filler

What to expect: before, on the day and recovery

Before. Mention blood-thinning medicines and supplements, which raise the chance of bruising, but do not stop prescribed medicines without your doctor's advice. Tell the clinic about earlier filler, fat grafting or eyelid surgery, avoid booking just before an important event, and come without eye make-up if you can.

On the day. Once the tear trough is confirmed as the cause, the skin is cleaned and a topical anaesthetic may be applied; most products used here also contain lidocaine. The entry point is chosen away from the infraorbital foramen and the angular vessels. The gel is deposited on the bone in very small amounts while the contour is watched, moulded by hand, and deliberately left short of a flat correction, because the tissue takes up water afterwards and over-correction has to be dissolved.

Recovery. Recovery varies. Some swelling, tenderness and pinpoint bruising at the entry point are normal, and the area can feel slightly firm or uneven while the gel settles. Cold compresses, sleeping with the head raised and avoiding pressure on the area help early on. The contour is judged once swelling has settled, and any adjustment is decided at review. Pain that is increasing rather than settling, skin that turns pale, mottled or dusky, any change in vision, or a lump or bluish line that persists should be reported to the treating doctor promptly. More detail is on tear trough filler and filler downtime by area.

What decides the cost of under eye filler

The cost is set out at consultation, after assessment, because it depends on what the examination finds. A quote given before the examination is a quote for a treatment not yet planned.

• The product chosen. A soft, low water-binding hyaluronic acid suits thin lower-lid skin.
• The quantity the anatomy calls for, set by the depth of the hollow; a syringe count is a product description, not a plan.
• Trough alone or cheek as well. Cheek support is its own line, and sometimes replaces the trough altogether.
• Dissolving earlier filler, a separate step with its own assessment and review.
• Physician time and the review visit, at which the settled contour is judged.

Each factor is explained on under-eye filler cost factors and how we quote.

How Dr Sin Yong approaches under eye filler

Dr Sin Yong assesses and treats every patient himself, after an in-person examination, and confirms the cause before choosing a product. Where earlier treatment is in the history, he first checks what is actually there, fat, filler or both, scanning with ultrasound before adding anything, because the tear trough is the least forgiving area on the face for over-filling. Residual filler causing puffiness is dissolved with ultrasound-guided hyaluronidase before any new plan. The cheek is assessed at the same visit, and in some faces it comes first.

When the trough itself is treated, a soft, low-concentration hyaluronic acid is placed on the bone in very small amounts and left short of a flat correction, with hyaluronidase on hand throughout. Where a true bag dominates, eye bag removal is discussed instead.

“Saying no is part of the treatment: the under-eye is the one area where the honest answer is most often no filler at all.”

Dr Sin Yong

Tear trough filler in Singapore: when it is the right answer, and when it is not

Tear trough filler treats a hollow: the groove that runs from the inner corner of the eye down onto the cheek, over the ligament that tethers the skin to bone. It is the right answer when that hollow is the main problem, the skin is reasonably thick, and there are no eye bags or swelling below the eye.

It is the wrong answer for eye bags, for puffiness that comes and goes, for pigmented dark circles, and when filler from an earlier treatment is still there. If earlier under-eye filler now looks puffy, lumpy or blue, adding more is not the fix; see under-eye filler dissolving.