Tear Trough Filler (Under-Eye Filler) Turkey

What Is Under-Eye Filler?

In recent years, the treatment known as “under-eye filler” has become one of the most discussed procedures in aesthetic medicine. However, it is important to start with the terminology.

In fact, “under-eye filler” is not a medical term used in strict anatomical classification; it is a commonly used clinical expression that describes the treatment of volume loss in the infraorbital region. The main goal is to reduce volume deficiency, hollowness, and the resulting shadowing under the eyes.

For this reason, I prefer using the term “under-eye filler” when speaking with patients.

Is Under-Eye Filler Suitable for Everyone?

The short answer is: No.

Perhaps the most common misconception is that anyone with under-eye concerns is automatically a good candidate for filler treatment.

In reality, under-eye filler is only suitable for a specific group of patients.

Dark under-eye appearance is not always caused by volume loss. In some individuals, the main issue is fat herniation (under-eye bags). In others, skin laxity is the dominant factor. Some patients have pigmentation or visible vascular structures. In certain cases, the bone structure and anatomical configuration of the midface are the primary reasons for a shadowed appearance.

Therefore, not every under-eye problem can be corrected with filler.

The most important step for a successful outcome is proper patient selection.

Why Is the Under-Eye Area Different?

The under-eye region is anatomically very different from other parts of the face.

The skin in this area is extremely thin. Beneath it, instead of a thick fat layer like in other facial regions, there is muscle tissue responsible for eyelid function. Lymphatic drainage works differently. Due to a dense vascular network within the muscle layer, blood vessels can appear as dark discoloration through the thin skin. In addition, connective tissues and structural support elements are much more delicate compared to other facial areas.

For this reason, techniques used for the cheeks, chin, or nasolabial folds do not produce the same success in the under-eye region.

Similarly, a filler product that works perfectly in other facial areas may not be ideal for under-eye treatment.

In under-eye procedures, not only product selection but also the anatomical plane, injection depth, and technique are critically important.

Over the years, different injection techniques have been developed for this area because every patient has a unique anatomical structure. Uniform approaches using the same product, dose, and technique for everyone do not produce natural results.

Why Do Some Patients Have Unsatisfactory Results?

In recent years, a certain negative perception toward under-eye filler has emerged.

One of the main reasons is that the under-eye region is far more complex anatomically than commonly assumed.

The most frequent causes of poor outcomes are:

Incorrect patient selection
Incorrect product choice
Incorrect injection technique

In such cases, complications such as swelling, irregularities, bluish discoloration (Tyndall effect),accentuated eye bags, or an artificial appearance may occur.

In some patients, results may initially appear satisfactory but issues can develop over time. Factors such as lack of sleep, upper respiratory infections, fluid imbalance, or general health changes can lead to temporary swelling, dark circles, or edema becoming more noticeable.

In most cases, the problem is not the filler itself, but rather an anatomical mismatch in treatment planning.

For this reason, under-eye filler is one of the procedures that requires significantly more experience and anatomical expertise compared to other facial filler applications.

What Should Be the Correct Approach in Under-Eye Filler?

During examination, the first question that must be answered is:

“Is the patient’s primary problem really volume loss?”

If the answer is yes, the second step involves a detailed anatomical assessment.

Every patient has a different bone structure, eyeball position, fat pads, connective tissue support, skin quality, and aging pattern.

For this reason, applying the same amount of filler to everyone or using the same injection technique is not appropriate.

In some patients, very small amounts of filler are sufficient, while in others, multiple anatomical layers need to be evaluated together. In certain cases, the goal is to correct volume deficiency, while in others, supporting weakened connective tissues may be the more appropriate approach. In some patients, completely different treatment modalities may be preferred instead of filler.

The aim is not simply to “fill” the under-eye area, but to achieve natural and long-lasting results through accurate anatomical analysis.

When Do I Recommend Surgery Instead of Filler?

One of the most surprising issues for patients during consultation is this:

Not every under-eye problem can be corrected with filler.

In fact, in some cases, choosing not to use filler at all may be the most appropriate decision for the patient.

For example, in individuals with prominent under-eye bags, the main problem is often not volume loss but herniated fat pads displaced forward. In such cases, attempting to correct hollowness with filler may actually make the bags more prominent.

Similarly, in patients with significant skin laxity, structural loss of lower eyelid support, or advanced age-related tissue descent, filler alone is usually insufficient.

In some patients, the cause of under-eye darkness is not volume loss but skin thinness, visible vasculature, or pigmentation.

Therefore, when evaluating the under-eye region, it is essential to assess not only the hollow area but also:

Bone structure
Fat pads
Skin quality
Lower eyelid support
Midface volume
Eyeball position

as a complete anatomical unit.

In some patients, small amounts of filler are the best option, while in others, lower blepharoplasty, repositioning of fat pads, or midface support procedures may provide far more natural and long-lasting results. This decision can only be made after a detailed clinical examination.

Conclusion: Under-Eye Filler Turkey

When the correct patient is selected, appropriate products are used, and the procedure is performed with anatomy-specific techniques, under-eye filler can provide highly satisfying results.

However, this treatment is not suitable for everyone and should not be evaluated in the same way as filler procedures performed in other areas of the face.

When planned by an experienced physician who is well-versed in under-eye anatomy, uses region-specific products, and individually evaluates each patient’s anatomy, under-eye filler can be a valuable treatment option that delivers natural and successful results in selected patients.

A well-performed under-eye filler is not noticeable; it simply makes the person appear more rested, more youthful, and healthier.

Scientific Studies of Altuğ Çetinkaya on Under-Eye Filler

Published Articles, Book Chapters, Oral Presentations, Invited Lectures, Live Demonstrations

Publications:

Bernardini FP, Devoto MH, Cetinkaya A, Zambelli A. Reply re: Calcium hydroxylapatite (Radiesse) for the correction of periorbital hollows, dark circles, and lower eyelid bags. Ophthal Plast Reconstr Surg 2014; 30:529-30.
Devoto MH, Bernardini FP, Cetinkaya A, Zambelli A. Reply re: Calcium hydroxylapatite (Radiesse) for the correction of periorbital hollows, dark circles, and lower eyelid bags. Ophthal Plast Reconstr Surg 2014; 30:440-1.
Bernardini FP, Çetinkaya A, Devoto MH, Zambelli A. Calcium hydroxylapatite (Radiesse) for the correction of periorbital hollows, dark circles, and lower eyelid bags. Ophthal Plast Reconstr Surg 2014; 30:34-9.

Book Chapters:

Çetinkaya A. Skin rejuvenation, botox, fillers, stem cell and latest technologic interventions. Gürdal C, editor. Current Approaches in Oculoplastic Surgery. T Klin Oftalmol; 2018. p.104-12. ISBN: 978-975-9118-90-7
Çetinkaya A. Injectable Fillers in Lower Eyelid Rejuvenation by Shanlee M Stevens, Zahra A Markatia, Christopher R Dermarkarian, Steven G Yoelin, Wendy W Lee. In: Plastic Surgery of Lower Eyelids, ed: Jeremiah P. Tao. Translation ed: Ceyhun Arıcı. Esse Publications, 2025, pages 309-314.

Invited Lectures, Congress Presentations, Hands-on Trainings:

Çetinkaya A. [Practical Applications of Cosmetic Botox and Filler Treatments Around the Eyes]. Ankara Training & Research Hospital Department of Ophthalmology Grandrounds 2026, February 19, Ankara.
Çetinkaya A. [Peri-ocular Soft Tissue Fillers]. Turkish Ophthalmology Society Skills Transfer Course, 2025, December 14. Adana, Türkiye.
Çetinkaya A. OR & Injections Director. Advanced Techniques for Orbitofacial Rejuvenation Using Injectables and Suspension Devices. Course Directors: Robert Alan Goldberg, Pelin Kaynak, Jose Raul Montes. WSOPRAS 2025, April 13, İstanbul Türkiye.
Çetinkaya A. Filler applications. Oculofacial Aesthetic Interventions. Turkish Ophthalmological Society Skills Transfer Course, September 2024, Ankara, Türkiye.
Çetinkaya A. Filler and Botox Complications. Oculoplastic Surgery Complications Panel. 45th Turkish Ophthalmological Society Winter Symposium, January 2024, Konya, Türkiye.
Çetinkaya A. Who Gets Filler and Who Gets Surgery on the Lower Eyelid. Periocular Beautification and Rejuvenation panel. Faceminima International, September 2023, İstanbul, Türkiye.
Çetinkaya A, Altın F. Moderator: Uğurbaş SH. Biotech Industry Applied Course. Gloderm Periocular and Facial Filler Applications. Live Patient Demonstration. 56th TOD Turkish Ophthalmology Society National Meeting, 2022, November 5th, Antalya, Türkiye.
Çetinkaya A, Kaynak P. Moderator: Çiftçi F. Biotech Industry Applied Course. Gloderm Periocular and Facial Filler Applications. Live Patient Demonstration. 55th TOD Turkish Ophthalmology Society National Meeting, 2022, November 6th, Antalya, Türkiye.
Çetinkaya A. Case Presentations on Surgical and Non-Surgical Applications Accompanying Blepharoplasty. Current Approaches in Oculoplasty Panel. TRIO meeting, October 2021, Antalya, Türkiye.
Çetinkaya A. Course Moderator of Didactic Session. Non-surgical Aesthetic Treatments in the Oculofacial region, June 2021, Turkish Ophthalmological Society Online Skills Transfer Course.
Çetinkaya A. Practical Applications Instructor. Non-surgical Aesthetic Treatments in the Oculofacial Region: Periorbital Wrinkles, Neurotoxin applications, Oculofacial Soft Tissue Fillers, Periorbital Thread Suspension and Mesotherapy, June 2021, Turkish Ophthalmological Society Online Skills Transfer Course.
Çetinkaya A. Management of Filler Complications. 3rd Black Sea Innovations in Dermatology Symposium (Online),May 2021.
Çetinkaya A. Oculoplastic Surgery Case Presentations: Lower Eyelid Blepharoplasty, Filler Applications, Ptosis Surgery. FOKUS - Clinical Specialty Series with Interesting Cases. Allergan TV Webinar, November 2020, Ankara, Türkiye.
Çetinkaya A. The Basic Structure of Filler Materials, Proper Material Selection, and Their Uses for Periorbital Rejuvenation. Turkish Ophthalmological Society Skills Transfer Course, March 2020, Izmir, Türkiye.
Çetinkaya A. Rejuvenation Procedures Around the Eyes: Case Presentations. Non-surgical Methods in the periorbital area. Turkish Ophthalmological Association Bursa Division Scientific Meeting, December 2019, Eskişehir, Türkiye.
Çetinkaya A. Case Presentations on Aesthetic Oculoplastic Applications. More than Filler for Lower Lid: Who Needs Filler, Who Needs Surgery, Other Procedures. Current Approaches in Oculoplasty. TRIO Meeting, October 2019, Bodrum, Türkiye.
Cetinkaya A. Augmenting your blepharoplasty outcome with non-surgical treatment options. Turkish Ophthalmology Association Society of Oculoplastic and Reconstructive Surgery Aesthetic Eyelid Surgery and Periorbital Rejuvenation Video Course (Skills Transfer) 2019, May 18, Istanbul, Turkey.
Çetinkaya A. The Basic Structure of Filler Materials, Selection of fillers, and Their Uses for Periorbital Rejuvenation. Turkish Ophthalmological Society Skills Transfer Course, May 2019, İzmir, Türkiye.
Pelin Kaynak, Altuğ Çetinkaya. Course Moderators: Periorbital Cosmetic Approaches: Botulinum Toxin and Filler Applications. Turkish Ophthalmological Society Skills Transfer Course, May 2019, İzmir, Türkiye.
Çetinkaya A. Methods of Eyelid Rejuvenation: Other Non-Surgical Methods. Turkish Ophthalmological Society İstanbul Division Scientific Meeting, April 2019, İstanbul, Türkiye.
Pelin Kaynak, Altuğ Çetinkaya. Course Moderators: Periorbital Cosmetic Approaches: Botulinum Toxin and Filler Applications. Turkish Ophthalmological Society Skills Transfer Course, February 2019, Bursa, Türkiye.
Çetinkaya A. Uses of Filler Materials for Periorbital Rejuvenation (didactic). Turkish Ophthalmological Society Skills Transfer Course, February 2019, Bursa, Türkiye.
Çetinkaya A, Öztürker C. Filler Applications in the Upper Orbital Sulcus and Eyebrow Region, Periorbital Functional Filler Applications. Turkish Ophthalmological Society Skills Transfer Course, February 2019, Bursa, Türkiye.
Pelin Kaynak, Altuğ Çetinkaya. Course Moderators: Periorbital Cosmetic Approaches: Botulinum Toxin and Filler Applications. Turkish Ophthalmological Society Skills Transfer Course, December 2018, Ankara, Türkiye.
Çetinkaya A. Uses of Filler Materials for Periorbital Rejuvenation (didactic). Turkish Ophthalmological Society Skills Transfer Course, December 2018, Ankara, Türkiye.
Çetinkaya A, Öztürker C. Filler Applications in the Upper Orbital Sulcus and Eyebrow Region, Periorbital Functional Filler Applications. Turkish Ophthalmological Society Skills Transfer Course, December 2018, Ankara, Türkiye.
Çetinkaya A. Non-Surgical Rehabilitation in the Periorbital Area: Filler Applications. Turkish Ophthalmological Society Annual Meeting, November 2018, Antalya, Türkiye.
Pelin Kaynak, Altuğ Çetinkaya. Course Moderators: Periorbital Cosmetic Approaches: Botulinum Toxin and Filler Applications. Turkish Ophthalmological Society Skills Transfer Course, October 2018, İstanbul, Türkiye.
Çetinkaya A. Uses of Filler Materials for Periorbital Rejuvenation (didactic). Turkish Ophthalmological Society Skills Transfer Course, October 2018, İstanbul, Türkiye.
Çetinkaya A, Öztürker C. Filler Applications in the Upper Orbital Sulcus and Eyebrow Region, Periorbital Functional Filler Applications. Turkish Ophthalmological Society Skills Transfer Course, October 2018, İstanbul, Türkiye.
Cetinkaya A. When you need more than fillers in the lower eyelid: critical patient selection for fillers versus surgery. AAAMC & AMIS First Euro-Asian International Aesthetic and Anti-Age Medicine Congress 2018, October 5-6, Baku, Azerbaijan.
Cetinkaya A. Cosmetic surgery- non-surgical options in the face including fine threads, focused ultrasound, radiofrequency. The US (+Turkish) perspective on botox and fillers. Nordic Ophthalmology Congress 2016, June 9-12, Aarhus, Denmark.