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Ask the anti-ageing doctor

How to get rid of dark circles – tear trough fillers explained by a doctor

If you’ve got dark circles, a treatment that uses fuller in the lower eyelid or ‘tear trough’ might be helpful. As part of our ‘Ask the anti ageing doctor’ series,  oculoplastic surgeon and aesthetic doctor, Maryam Zamani explains 

The eyes are one of the key areas of our faces where we notice change first, whether you’ve had a sleepless night, or have an allergy, or the inevitable, ageing, causing us to have dark circles. There is a treatment for this called lower eyelid or tear trough fillers.  Dr Maryam Zamani helps us to understand how it all works.

What are lower eyelid fillers?

‘Lower eyelid fillers injections of hyaluronic acid that help to add volume to areas that lack volume and are used to reduce the darkness in the lower eyelid area.

‘Some people think they have dark circles underneath their eyes because they see darkness underneath the eye itself. Some people complain that they have puffy eyes because they notice this dark circle underneath their eyes and they describe that as puffiness.

‘We are all born with three fat pads in our lower eyelids, a medial, a central and a lateral fat pad and when we are young they are back and not pushed out, you can’t see them and we can barely see the difference between the eyelid and the cheek and where that differentiates and distinguishes itself.

‘As we get older and as we age unfortunately everything starts to sag a little bit including the area around the eyes. As we have descent of the mid-face you see the location of where the lower eyelid and cheek hit one another, often called the tear trough.

‘If you have too much volume depletion in the tear trough area you can get what is a very exaggerated dark circle that appears around the eyes and that is actually from volume loss. It’s usually a shadow that’s created by a dip in that area. In these individuals, using a little bit of dermal filler as a replacement for volume loss can help soften that appearance of dark circles underneath the eyes.

                       Before                                                            After

What are the risks?

With all dermal fillers, there are risks associated with the injections, most of which are quite minimal like bruising and swelling. Those can be temporary and other common but not as serious can be over or under correction and pigment changes from bruising. The more serious less frequently found complications include tissue necrosis (when the skin in a small area dies) and blindness.

Can cheek fillers be removed?

‘In the event that you have a complication or do not like the aesthetic outcome of hyaluronic acid fillers, there is a way to remove them or dissolve them, it is called hyaluronidase, generally, this is used as a last resort in the event of a complication.

‘For example, if you have some kind of tissue necrosis or another medical issue that’s happening we tend to use hyaluronidase. As I said this is an injection and is similar to more like a botulinum toxin injection because it’s a very small needle that’s used to place hyaluronidase which is an enzyme that helps dissolve the hyaluronic acid. It works immediately, within 24 hours you will have some of the hyaluronic acid filler dissolved. It is not a precise science, imagine that you have filler in the form of an ice cube and you put hot water on top of it and the hot water melts the ice cube. Hyaluronidase works in a similar fashion, wherever the hyaluronic acid is touched it is melted in that area. If you don’t inject it into the area that has hyaluronic acid it will remain. Sometimes you may need more than one treatment in order to dissolve all the hyaluronic acid that you would like to remove.’

Who can’t have the treatment?

Unfortunately there is a subset of people who do not work well with either dermal fillers or surgery and those are usually ethnicities like south east asian ethnicities where the pigmentation on that skin genetically is predisposed to having a little bit more pigment.

‘Unfortunately in those individuals it is not the shadowing, it is not the out pouching effect, but actually the colour of the skin in the area of the eye and often those patients come in complaining of not only lower eyelid dark circles but upper eyelid dark circles and that is a much harder dark circle eyelid problem to treat.

How much does it cost?

This treatment costs £700

Maryam recommends:

‘Do your research on your injector and the doctor that is going to treat you.

‘Have realistic expectations and look for a doctor who is going to be conservative – there is always the chance to do more.

‘Before you go ahead, ask what they would do in the unlikely event that you are to have a complication, so you can be sure they are able to manage that effectively and well and give you the best long-term outcome possible.’

More anti-ageing explainer videos from Dr Zamani:

Exactly what this anti-aging doctor has had done herself

Do I need Botox? ask the anti-ageing doctor

Do I need cheek fillers? Ask the anti-aging doctor

Do I need nose fillers? Ask the anti-aging doctor

what is botox? Ask there dermatologist by


As a leading Oculoplastic Surgeon and Aesthetic Doctor, Dr Maryam Zamani has garnered a global reputation – both in the US and UK with twelve years of practice and alongside her two fellowships at London’s Imperial College NHS Trust and Chelsea Westminster NHS Trust. Dr Zamani works from her base at the Cadogan Clinic, on Sloane Street and is also the creator and founder of MZ Skin a luxurious yet performance driven skincare range of eight hero products.



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