Sunken Under-Eye, Wrinkles, and Fine Lines: Filler vs. Collagen Stimulators
Hello, this is Do-hoon Kim, Director of ODE Clinic.
As patients enter their mid-30s, common concerns begin to emerge around the eye area—such as tear trough hollowness, fine wrinkles, and crow’s feet. The combination of volume loss and reduced skin elasticity often creates a fatigued appearance, and makeup may start to crease more easily.
However, the periorbital region is one of the most delicate and technically demanding areas to treat. Compared to other parts of the face, the skin is significantly thinner and contains complex anatomical structures.
Based on extensive clinical experience in under-eye procedures, I will outline how to approach each concern and which treatments are most appropriate.
1. Accurate Diagnosis: The Foundation of Treatment
Before selecting any procedure, it is essential to clearly identify the underlying cause of the concern.
The under-eye area may present with:
Volume loss (hollowness)
Deep structural wrinkles
Fine lines and reduced elasticity
Additionally, dark circles can arise from multiple causes, including:
Loss of volume
Protruding fat pads
Pigmentation from repeated friction
Thin, translucent skin revealing underlying vessels
Without a precise diagnosis, simply choosing treatments like “eye Thermage” or “Rejuran” may lead to unsatisfactory outcomes.
At ODE Clinic, individualized consultations are performed to determine the most appropriate approach based on each patient’s anatomy.
2. Types of Under-Eye Concerns
(1) Under-Eye Wrinkles
The under-eye skin is extremely thin (approximately 0.5 mm) and produces minimal sebum, making it highly susceptible to dryness. Repeated muscle movement in this area further contributes to wrinkle formation, ranging from deep-set lines to fine creases.
(2) Translucent / Vascular Dark Circles
In some individuals, the skin is so thin that underlying structures become visible, resulting in a bluish or purplish discoloration.
(3) Pigmented Dark Circles
Frequent friction or irritation can lead to melanin accumulation, causing a darker, uneven tone that may extend toward the nasal bridge.
(4) Structural / Hollow-Type Dark Circles
Volume loss or sagging of the fat pad (SOOF) can create a sunken appearance. This is often associated with reduced volume in the mid-face, which can further accentuate the hollowing.
3. Key Precautions for Under-Eye Procedures
(1) Skin Thickness
The under-eye skin is only one-third to one-quarter as thick as other facial areas. As a result:
Any irregularity or lump becomes highly visible
Overproduction of collagen may lead to noticeable nodules
For this reason, procedures with high variability or nodule risk should be approached with caution.
Clinical Note
In my practice, I generally avoid injecting collagen stimulators such as Juvelook Volume, Sculptra, or Radiesse directly into the under-eye area, as I have encountered multiple cases of fibrosis or lump formation referred from other clinics.
(2) Complex Anatomy
The periorbital region contains multiple critical structures, including:
Orbicularis oculi muscle
Orbital septum
Tear trough ligament
Because of this complexity, achieving natural results requires a high level of precision and experience.
4. Treatment Strategy: Hollowness vs. Wrinkles
Based on current clinical experience, treatment selection should be tailored to the specific type of concern, rather than applying a single solution universally.
(1) Under-Eye Hollowness
Primary Recommendation: Under-Eye Filler
Restylane Eyelight
For tear trough hollowness, hyaluronic acid fillers remain the most predictable option. Given the thinness of the under-eye skin, even minor overcorrection can lead to visible irregularities. Collagen stimulators, while effective in other areas, are difficult to precisely control in this region.
Key advantages of fillers:
Immediate and controllable volume correction
High predictability in shaping
Reversibility (can be dissolved if needed)
“Can the filler move?”
Minor settling may occur, but significant migration is uncommon. Products like Restylane Eyelight have fine particle size and strong tissue integration, allowing them to maintain shape effectively.
“Is there a risk of blindness?”
While vascular complications are theoretically possible, they are far more common in areas such as the nose, glabella, and forehead. Under-eye procedures are typically performed using blunt cannulas, significantly reducing this risk.
Alternative Options (for patients avoiding fillers):
Ultracol 200
Re2O Fine
Ultracol 200 (PDO-based) provides controlled collagen stimulation with minimal nodule risk due to its relatively fast biodegradation.
Re2O Fine, derived from human dermal matrix (hADM), contains fine particles suitable for delicate areas such as the under-eyes.
(2) Under-Eye Wrinkles
Rejuran i
This treatment uses polynucleotides (PN) derived from salmon DNA to support cellular repair and regeneration. It is particularly effective for improving overall skin quality and fine wrinkles, with a strong safety profile.
Laetigen i
Laetigen i is composed of high-purity atelocollagen in liquid form, allowing for direct dermal injection even in thin skin areas. Compared to Rejuran, it may produce more noticeable improvements, although temporary swelling can occur.
(3) Elasticity & Fine Lines (Non-injection Option)
For patients seeking non-invasive solutions:
Thermage Eye
Density
XERF
Radiofrequency-based treatments improve skin elasticity and fine lines by stimulating collagen remodeling. They are particularly suitable for patients who prefer to avoid needles or wish to enhance results alongside injectable treatments.
5. Frequently Asked Questions (FAQ)
Q. What is the difference between under-eye fat repositioning surgery and filler?
A. In cases of severe fat protrusion, surgical repositioning may be necessary. However, for mild cases, fillers can effectively camouflage the hollow areas, creating a smoother contour. Each approach has its own advantages and limitations.
Q. Can treatments be combined?
A. Yes. Combination therapy often produces superior results. For example, patients with significant wrinkles may benefit from pairing Laetigen i with RF-based treatments such as Thermage Eye.
Final Takeaway
The under-eye area requires a highly individualized approach. Because of its thin skin and complex anatomy, selecting the correct treatment depends on accurately identifying the root cause of the concern.
Rather than relying on a single solution, the most effective outcomes are achieved through precise diagnosis and tailored treatment planning.
This concludes the guide from
Do-hoon Kim, ODE Clinic.
Gangnam Dermatology Clinic, ODE Clinic
8th Floor, 340 Gangnam-daero, Gangnam-gu, Seoul, Korea
+82-2-569-0222
Author: Dr. Dohoon Kim, Chief Director of ODE Clinic
Specialty: Anti-aging (Lifting, Volumizing, etc.)
Medical Disclaimer: This post is for informational purposes only. All medical procedures carry risks of side effects such as bruising, swelling, infection, or nodules. Please consult with a qualified medical professional before undergoing any treatment.