Under-Eye Filler vs. PRF and Why I Have Changed My Approach

In My Chair: Under-Eye Filler vs. PRF and Why I Have Changed My Approach 

Early in my career, I injected filler directly into the tear troughs and saw beautiful results.

Smooth. Bright. Refreshed.

At nine months, a year, even several years later, it could still look great.

Until one day, it didn’t.

Over the years, I also started seeing more patients come into my practice with under-eye filler placed by other providers. Some were dealing with puffiness. Others had swelling or heaviness that developed long after the filler was originally injected.

Seeing those long-term outcomes was enough to make me pause.

Because the more faces I followed over time, the more I realized something important:

A beautiful immediate result does not necessarily tell you how that treatment will age.

After more than 20 years of injecting, that has changed the way I approach the under-eye area.

Today, I rarely place filler directly into the tear trough.

Why I Changed My Approach to Under-Eye Filler

Hyaluronic acid filler attracts water.

That matters under the eyes because the skin is thin and the lymphatic system in this area is delicate.

The face also continues to age around the filler.

Midface support changes. Volume shifts. Ligaments become more lax. The relationship between the lower eyelid and cheek changes.

Meanwhile, filler placed years ago may still be there.

What once looked smooth and seamless can eventually begin to look heavy or puffy. Sometimes you only notice it in certain lighting or photographs.

I ended up dissolving under-eye filler in patients that had it placed more than 10 years ago.

That experience has made me much more selective about when and where I use filler around the eyes.

Where PRF Fits In

PRF, or platelet-rich fibrin, is a completely different approach.

Rather than using a hyaluronic acid gel to create volume, PRF uses components from your own blood to support tissue repair and collagen production.

It is not an instant fix.

The improvement happens gradually as the quality of the skin improves.

I especially like PRF for patients with thin or crepey under-eye skin. It can also help improve the overall appearance of darkness when skin quality is contributing to it.

One of the biggest reasons I like PRF around the eyes is simple: we are improving the tissue rather than leaving a water-attracting filler underneath very thin skin.

But Here Is the Bigger Issue

A lot of what people call a “tear trough” is not actually just a tear trough problem.

It is often a midface support problem.

As we age, or after significant weight loss, the cheek loses some of the support it once provided to the lower eyelid.

That makes the lid-to-cheek transition more noticeable. It can create the shadow people see when they look in the mirror.

Simply filling that shadow does not necessarily correct what caused it.

In some patients, it can actually make the area look heavier.

This is why I look beyond the under eye itself.

I want to understand what is creating the shadow before I decide how to treat it.

PRF may be appropriate when skin quality is the bigger issue.

If loss of midface support is contributing, carefully placed filler or a biostimulator may make more sense.

There are also patients who benefit from a combination approach. And there are patients who may just need a surgical solution for the fix.

The Best Under-Eye Treatment Depends on Your Anatomy

There is no universal “best” treatment for under-eye hollows.

And I don't automatically choose PRF simply because someone is concerned about their under eyes.

The goal is to figure out why the area looks the way it does first.

That discernment comes from watching outcomes over decades, not months.

My approach has changed because my experience has changed it.

Twenty years of injecting, following my own patients and treating patients who come to me with problems from previous treatments has taught me to think much further ahead than the immediate before-and-after photo.

If you are considering treatment for under-eye hollows, dark circles, or a tired appearance, we can first figure out what is actually causing it. Then we can decide what makes sense for your anatomy and your long-term result.

Laurie Peterson, RN, CANS

Aesthetic Nurse Injector | Carlsbad, California