Under-Eye Hollows, Bags and Dark Circles: What Actually Helps

Under-eye concerns split into four different problems, and a 2023 review in Aesthetic Surgery Journal Open Forum sorts them by cause.

One thing to know about that review up front: its author list includes employees of Allergan, the maker of Juvéderm fillers.

• Hollows. Atrophic volume loss — a depression in the tissue under the eye, the infraorbital hollow, known as the tear trough. This is the problem tear trough filler is built for.
• Bags. Bulging or prolapsed fat pads, plus two related findings the review groups with them: malar mounds and festoons.
• Laxity and crepiness. Loose lower-eyelid or cheek skin.
• Dark circles. Color rather than contour. The review traces it to pigmentation — for example, from habitual rubbing in people with allergies — or to thin, translucent skin.

The same review notes why this area is unforgiving to treat: eyelid skin is the thinnest in the human body, under 1 mm thick, which is part of why under-eye treatment is technically challenging.

A 2012 review in Aesthetic Surgery Journal adds a key distinction: lower-eyelid bags and tear-trough hollows are separate problems that can appear together or alone, so the same eye can hold both a bag and a hollow.

Approval here belongs to a product, not to the area.

FDA's general dermal-filler page still lists the periorbital area around the eyes among uses it has not approved, but that page is outdated for the specific products that hold under-eye approvals.

As of October 20, 2026, four US filler products carry an under-eye (infraorbital hollow) indication: Juvéderm Volbella XC (approved 2021), Restylane Eyelight (2023), Belotero Balance (+) Lidocaine (2023) and RHA Redensity Eye / Eye Lido (2026).

Volbella XC's approval, dated May 28, 2021, covers improvement of infraorbital hollowing in adults over 21; Eyelight's, dated May 8, 2023, covers the same in patients over 21.

Every other filler used under the eyes is off-label there — that use is not on any current US label for the product — including Restylane-L, Voluma, Radiesse and Sculptra.

Sculptra's own label says its use in the periorbital area has not been studied, with published literature reporting more nodules around the eyes.

FDA approves dermal fillers for adults 22 and older, for specific uses only.

So who fits the approved use?

The 2023 review draws the candidate line by skin and by fat.

Ideal candidates for under-eye hyaluronic acid filler have smooth, thick skin, minimal laxity and mild-to-no fat pad prolapse, malar mounds or festoons.

Poor candidates have translucent skin, prominent skin laxity, herniated fat pads or existing eyelid or malar swelling.

People of all Fitzpatrick skin types can be candidates.

The Restylane Eyelight label also caps the treatment volume: up to 1 mL per side per session, with anything more left for a follow-up session, because the safety of larger amounts per session has not been established.

Restylane's labels separately warn that rare ischemic events affecting the eye (vision loss) and brain (stroke) have been reported after facial filler treatments, and that many cases requiring medical intervention involved the glabella, nose and periorbital area — sites outside the devices' indications.

For how the injection itself is done, what it costs and how long results last, our under eye filler guide covers the procedure in depth.

Filler adds volume.

A bag is fat pushing the contour the other way, and the 2012 review puts them on opposite sides of the treatment map: lower blepharoplasty removes excess fat, while tear-trough treatments add volume to the depression.

On severe cases the 2023 review is blunt: people with severe under-eye bags and loose eyelid skin are not good filler candidates, because even large amounts of filler would not be able to camouflage the contour irregularity.

Swelling is the risk that connects the two.

Known adverse events of under-eye filler include bruising and swelling, lower-eyelid and malar edema — swelling that can make the area look puffier — and vascular occlusion.

The Restylane Eyelight label warns that people prone to edema may get excessive swelling from fluid build-up.

Two published estimates size this.

A 2021 review of periocular fillers reports that about 90% of adverse events around the eye are mild and self-resolve within a month, but that malar edema — a delayed complication unique to the periocular area — occurred in 11% of patients.

A 2022 systematic review of delayed tear-trough filler complications (28 articles, 52 cases) found swelling was the most common delayed problem, at 42.3% of reported cases, followed by lumps or nodules at 25.0%, appearing on average 16.8 months after injection.

The 2022 review's percentages describe reported cases, not the chance any one patient has of a complication.

We did not find a study that gives a rate at which filler makes bags look worse; the label warnings and the swelling literature above are the statements the evidence supports.

The Eyelight label adds its own balance: it notes puffiness, lumps or swelling that caused negative cosmetic outcomes were rare and correctable, while late-onset problems more than 2 years after injection — delayed inflammation or granulomas — are low in frequency but have been reported.

Two of the four under-eye problems are skin problems — color and texture — and filler is a volume treatment, not a skin one.

The 2023 review says it directly: filler will not address hyperpigmentation, although it may reduce the shadowing effect a hollow casts.

Galderma's website promotes Restylane Eyelight to "correct dark circles," but the product's FDA indication is infraorbital hollowing only, and its own label warns that injecting under the eyes in people with pigmented dark circles may make the discoloration more prominent.

For texture — thin, crepey, wrinkled skin — one option with published numbers behind it is ablative fractional CO2 laser resurfacing of the lower eyelids.

In a 25-patient prospective study, 2 to 3 sessions (average 2.44) gave about 62–66% mean improvement in texture, laxity and wrinkles at 6 months; redness and swelling resolved by 1 week and crusting within 48 to 72 hours.

That is one small, physician-performed study, not a large trial.

The complication data comes from a bigger series: among 424 patients who had ablative CO2 resurfacing of the lower eyelids, post-inflammatory hyperpigmentation occurred in 9.4%, herpes outbreaks in about 0.9%, atypical mycobacterial infection in 0.5% and a small scar in 0.9% — all resolved, with no persistent scarring or ectropion.

Most of those patients had a blepharoplasty at the same time, and the setting was an experienced oculoplastic surgeon's practice.

Energy devices are in the picture too.

Thermage FLX holds FDA 510(k) clearance K170758, dated September 22, 2017, for non-invasive treatment of wrinkles and rhytids, including periorbital wrinkles on the upper and lower eyelids — its cleared text does not say "skin tightening" or "lifting."

Microneedling's authorized uses do not name the under-eye area.

FDA has authorized microneedling devices to improve the appearance of facial acne scars, facial wrinkles and abdominal scars in people 22 or older — under-eye use is off-label — and FDA says the devices are not approved for delivering blood products such as platelet-rich plasma (PRP) into the skin.

AAD calls PRP for skin rejuvenation "still an unproven treatment." Our microneedling, PRP microneedling and CO2 laser guides cover each of these treatments in depth.

For severe bags, the literature points to surgery.

The 2023 review: people with severe fat prolapse and loose eyelid skin may benefit from blepharoplasty to remove or reposition fat.

ASPS, the American Society of Plastic Surgeons, lists what eyelid surgery treats: sagging upper-lid skin, fatty deposits that appear as puffiness in the eyelids, bags under the eyes, drooping lower eyelids that reveal white below the iris, and excess skin and fine wrinkles of the lower eyelid.

AAD frames the trade-off: a surgical lift — eyelid surgery included — gives the most dramatic results, while non-invasive tightening such as ultrasound, radiofrequency and some lasers gives modest tightening and lifting with little or no downtime.

On cost, the figures we hold are ASPS's own: average surgeon's fees of $3,359 for upper and $3,876 for lower blepharoplasty.

ASPS notes those figures are the surgeon's fee only and exclude anesthesia, operating-room facilities and other related expenses.

When an eye has both problems at once — a bag and a hollow — the 2012 review lays out the combined toolkit: lower blepharoplasty removes the excess fat, and the tear trough can then be addressed with hyaluronic acid filler, fat grafting, implants or fat transposition.

For under-eye work, "vetted" starts with a provider who treats the first visit as a diagnosis: which of the four problems you actually have, and whether filler is the right tool for it.

The 2023 review's candidate criteria — smooth, thick skin with mild or no bags, versus translucent skin, laxity or existing swelling — are what that examination should cover.

Training is a screen with a checkable answer, because two manufacturers make it one.

Since December 2023, Restylane Eyelight may be distributed only to providers who completed device-specific training, and Allergan says Volbella XC should only be injected into the under-eye hollows by doctors who completed its training for that area.

Asking "did you complete the maker's under-eye training for this exact product" gets a real answer.

AAD's question list fills in the rest of the script: Are you board-certified?

How many times have you done this exact procedure?

How often do you treat patients with my skin tone and type?

What results can I realistically expect — ask for before-and-after photos of similar skin tones?

What are the risks, recovery time, number of treatments and cost?

Who may legally inject is set by each state's law.

AmSpa, a med spa trade association, describes injecting botulinum toxin as the practice of medicine because it uses an FDA legend (prescription) drug that affects living tissue — but that statement covers botulinum toxin, not filler, and we hold no national source on who may inject filler.

Our guide to med spa laws by state covers each state's own rules.

MedSpaStandard's med spa directory and its treatment-by-city listings are not live yet, so we cannot point you to one here.

What we can point you to is our guide to more skin and body concerns, and the treatment guides this page routes to, each of which covers what the treatment is approved or cleared to do.