Tear trough correction at The Naderi Center treats under-eye hollows, shadows and dark circles with the approach that fits their cause, from PRF gel injections to fat injections and lower eyelid surgery. Your plan is made by a physician: double board-certified facial plastic surgeon Dr. Shervin Naderi or board-certified dermatologist Dr. Alexandra Snodgrass.
The short answer: most people do better with something other than tear trough filler. PRF gel suits a mild hollow, fat injections treat a true hollow, and lower eyelid surgery is the answer when under-eye bags cast the shadow.
Should you get tear trough filler?Dr. Naderi’s answer in one minute.
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Your Physicians
Under-Eye Care by Physicians Only
Every injection and procedure under the eyes at The Naderi Center is performed by a physician, at our offices in Reston, Virginia and Chevy Chase, Maryland.
Dr. Shervin Naderi, MD, FACS
Double Board-Certified Facial Plastic Surgeon
More than 20 years in practice. He performs lower eyelid surgery and fat injections and injects filler himself, and has been named to Newsweek’s list of America’s Best Plastic Surgeons four years running.
Short, direct answers first. Each one links to the full explanation further down the page.
How do you fix under-eye hollows without filler?
With PRF gel injections, fat injections or lower eyelid surgery, depending on the cause. PRF gel is made from your own blood and thickens thin under-eye skin, which softens a mild hollow. Fat injections use your own fat and are the longest-lasting option for a true hollow. When bulging fat pads cast the shadow, lower eyelid surgery removes or repositions them.
What is the best treatment for dark circles under the eyes?
The one that matches the cause. A dark circle that is really a shadow from a hollow improves with volume from PRF gel or fat. A shadow cast by under-eye bags needs lower eyelid surgery. Darkness from pigment is a skin problem, treated by our cosmetic dermatology team, and no filler will change the color.
For the select patients who are good candidates for under-eye filler, our physicians prefer Restylane Eyelight, a hyaluronic acid filler the FDA approved in 2023 for under-eye hollows. Most patients do better with PRF gel or fat, because filler in thin under-eye skin can cause swelling and a bluish-gray look that lasts.
The tear trough is the groove that runs from the inner corner of the eye down toward the cheek. Dr. Naderi looks at the under-eye area as a problem with several possible causes, and most people have more than one. The cause decides the treatment.
Bags that cast a shadow
When the fat pads under the eyes bulge forward, they cast a shadow below them that looks like a hollow. Dr. Naderi calls this a pseudo tear trough. Filling the shadow does not help.
Usually treated with: Lower eyelid surgery
A true hollow
Volume loss along the bony rim under the eye leaves a real groove, often sitting just below a bag.
Usually treated with: PRF gel for a mild hollow, fat injections for a real one
Mid-face volume loss
As the mid-face loses fullness, the lower eyelid looks longer. Restoring the mid-face shortens the distance from the lashes to the orbital rim, which rejuvenates the whole area.
Usually treated with: Fat injections, or filler placed deep on the bone
Thin, crepey skin
Under-eye skin is the thinnest on the face. As it thins further, it shows the color and shape of what lies beneath it.
Usually treated with: PRF gel, which stimulates collagen
Loose skin and texture
Lax, wrinkled skin under the eyes adds to a tired look, alone or along with a hollow.
Usually treated with: Laser resurfacing
Pigment
Some dark circles are true pigment in the skin. Adding volume does not change color, and our physicians will tell you which kind you have.
Usually treated with: Skin treatments from our cosmetic dermatology team
A quick self-check for the four most common causes. Tap to enlarge.
Your Options
Four Ways to Treat Under-Eye Hollows
A side-by-side look at the treatments our physicians use, from least to most involved. Many patients combine two, such as lower eyelid surgery with fat injections.
Swipe the table to compare →
PRF gel injectionsNon-surgical
Tear trough fillerNon-surgical
Fat injectionsSurgical
Lower eyelid surgerySurgical
Best for
A mild hollow, or thin and crepey skin
Select patients with thicker skin, enough soft tissue under the eyes and no bags
A true hollow, and mid-face volume loss
Under-eye bags, often with a hollow beneath them
Performed by
Dr. Alexandra Snodgrass
Physicians only: Dr. Naderi or Dr. Snodgrass
Dr. Shervin Naderi
Dr. Shervin Naderi
Setting
In the office, with numbing cream
In the office
Operating room, general anesthesia
Operating room, general anesthesia
Treatments
Two to start, 6 to 8 weeks apart, then once a year
One visit, with touch-ups as needed
Usually one procedure
One procedure
Downtime
Mild swelling or bruising for a few days
Swelling settles in about two weeks
Swelling and bruising for 1 to 2 weeks
1 to 2 weeks off work; presentable in about 10 to 14 days
Cost
$2,300, then $1,800 for maintenance within a year
$1,500 per syringe
Facial fat grafting, $5,500 to $15,000+
$8,000 to $15,000
Prices from our menu of services. Surgical prices are Dr. Naderi’s surgeon’s fee; anesthesia and surgical facility fees are separate.
Dark circles from pigment or thin skin are a skin problem, not a volume problem. Our cosmetic dermatology team treats those with skin care and skin treatments.
The four treatments side by side, from least to most involved. Tap to enlarge.
A Note on Tear Trough Filler
Why We Do Far Less Tear Trough Filler Today
Tear trough filler became extremely popular almost two decades ago, and the practice used to do a lot of it. Over time, doctors learned that in people with thin skin or little soft tissue under the eyes, filler can look good for a few weeks and then cause swelling and a bluish-gray bag, similar to a Tyndall effect, that can last for years.
“If you want something non-surgical, it’s PRF gel injections. If you want something more permanent, it’s fat injections, micro and nano fat. Stay away from tear trough fillers for most people. Some of you still can, but not most.”
Dr. Shervin Naderi
Where filler still has a place
Deep in the mid-face. Filler placed on the bone of the mid-face can lift and shorten the lower eyelid without putting product in the thin skin under the eye. Learn more about cheek filler.
The right candidate. Some patients, usually with thicker skin, enough soft tissue and no bags, are still good candidates for tear trough filler itself. For them, our physicians prefer Restylane Eyelight, which the FDA approved in 2023 for under-eye hollows.
Filler does not travel. When an under-eye area looks as if filler has moved, that space was usually given more than it could hold.
Physicians only. Every injection is given by a physician, and we keep hyaluronidase, which dissolves hyaluronic acid filler, in both offices.
Unhappy with under-eye filler placed elsewhere? See filler correction.
Non-Surgical
PRF Gel: Your Body’s Natural Filler
PRF, platelet-rich fibrin, is made from a small sample of your own blood and prepared as a thick gel (EZ Gel). It is not a filler that is sculpted into shape. It stimulates collagen to thicken the under-eye skin, and because it is a gel it also has a soft, filler-like effect.
Dr. Alexandra Snodgrass performs PRF under the eyes. Plan to arrive about 30 minutes early for numbing cream. The area looks a little puffy at first, and mild swelling or bruising usually settles within a few days. Treatment starts with two sessions, an initial treatment and a maintenance treatment 6 to 8 weeks later, then once a year.
“We’re doing so much more PRF versus tear trough filler, because this is not going to get lumpy and bumpy. It is not going to be reflective on the surface.”
Watch a PRF treatmentDr. Snodgrass treats the under-eyes with PRF gel.
Longest Lasting
Fat Injections for a True Hollow
For a real hollow under the eyes, Dr. Naderi recommends fat injections. A small amount of your own fat is taken by gentle liposuction, purified and placed as micro and nano fat along the tear trough. Most people who need tear trough volume also need some volume in the mid-face, so both are usually treated together.
Technique matters. Dr. Naderi injects fat perpendicular to the area being filled, because fat placed at the wrong angle can leave a lumpy, sausage-like ridge that is very hard to fix. Fat injections are done in the operating room under general anesthesia, on their own or with lower eyelid surgery or a facelift. Recovery generally takes one to two weeks, and the final result is typically seen at about three months.
Fat transfer to the mid-face, under the eyes and the temples.
When Bags Cast the Shadow
Lower Eyelid Surgery for Under-Eye Bags
When large fat pads bulge forward, no injection will fix the shadow they cast. Dr. Naderi performs lower eyelid surgery only through an incision hidden inside the eyelid, so there is no visible scar, and he removes or repositions the fat that causes the bags.
Because a true hollow often sits below the bag, he frequently adds fat grafting to smooth the transition from the eyelid to the cheek, which can give an even better result. Repositioning the eyelid fat is mainly for patients who don’t have fat to spare elsewhere. Surgery is done in the operating room under general anesthesia, and lower eyelid surgery costs $8,000 to $15,000 for Dr. Naderi’s surgeon’s fee, which includes all follow-up visits. Anesthesia and facility fees are separate.
“Traditional tear trough filler would not be suitable.”
“Dr. Snodgrass is amazing! I came in for tear trough fillers and Botox. She explained to me that my under eyes actually had a combination of issues and that traditional tear trough filler would not be suitable. Instead she suggested mid face filler which at first seemed counter productive as I have full cheeks but I trusted her judgment and oh my gosh….I’ve never been happier. I can’t stop staring at my face and taking pictures. … I am so over the moon and will be coming back to maintain these results.”
“She went over everything she saw in my face & recommended a different approach.”
“Went to my 1st appt to get tear trough fillers after doing a lot of research… She went over everything she saw in my face & recommended a different approach. I’m super happy with my results.”
★★★★★R.J.Google reviewDr. Snodgrass
“This took care of the hollows and gave me a slight cheek lift.”
“Dr Naderi is a true artist. He knows what you need better than you do. As an example, I came in to see him for under-eye hollows. Instead, he suggested injecting voluma into my cheeks. This took care of the hollows and gave me a slight cheek lift. My under-eye area had always been my “problem” area, that I would camouflage with makeup. After Dr. Naderi’s injections of voluma it looked like my best area and I found that I needed very little makeup around that area. …”
★★★★★M.Patient reviewDr. Naderi, mid-face filler
“I will only trust Dr. Naderi with my face.”
“I will only trust Dr. Naderi with my face. I had my under eyes corrected with filler and couldn’t be more happy with the results.”
“Dr Naderi did an amazing job and my face finally looked normal again thanks to him.”
“Dr Naderi is an amazing doctor with a wonderful staff. I went to a different clinic for fillers under my eyes and they did a terrible job. My undereyes were uneven bruised and lumpy. I made an appointment to see Dr Naderi because he is the only person I trust with my face. Dr Naderi did an amazing job and my face finally looked normal again thanks to him. …”
“I especially appreciate that the doctor simply gives me what I need.”
“For a number of years, I’ve had issues with dark circles and some hallowing under my eyes. … I had fillers injected into my tear troughs in 2019 and I was very pleased with the results. … I especially appreciate that the doctor simply gives me what I need, and doesn’t place too much volume in my troughs. … Since I like the natural look provided here, I will be returning, when the filler dissolves and I need another refresher.”
Pre-surgical medical clearance and lab tests, usually covered by your medical insurance
Prescription medications, usually covered by your medical insurance
Your consultation fee goes toward the cost of surgery. Insurance does not cover cosmetic under-eye treatment. Financing through Cherry is available for qualifying patients.
Naderi Center Loyalty Program
Earn 10% Back on Every Injectable Visit
Earn 10% of every Botox and filler treatment back in reward dollars, and use them toward your next injectable visit: Botox, Dysport, Daxxify, fillers, Sculptra or Kybella. A $1,000 filler visit earns $100. You can combine it with Allē, ASPIRE and REVA.
One-time $50 enrollment. Reward dollars expire one year after they are issued and cannot be combined with other discounts outside of Allē, ASPIRE and REVA.
Monthly payment plans for surgery and treatments, including 0% APR options for qualifying patients. Checking whether you qualify won’t affect your credit score.
Mild swelling, small pinpoint marks and bruising are normal. Swelling after PRF usually settles within a few days, and swelling after filler settles in about two weeks.
Ice gently, 20 minutes on and 20 minutes off, for up to 48 hours after filler.
No strenuous exercise for 24 hours.
Don’t massage, rub or poke the area. Avoid facials and rough scrubbing for 72 hours.
Both are done in the operating room under general anesthesia. Plan on one to two weeks off work. Most eyelid surgery patients look presentable at about 10 to 14 days, avoid strenuous exercise for a month and see their final result at three to six months. After fat injections, the final result is typically seen at about three months.
Follow-up visits are at one week, one month and typically three months.
Bruising, swelling and small irregularities are the most common side effects of under-eye injections. In thin under-eye skin, filler can also cause long-lasting puffiness or a bluish-gray look, which is why we steer most patients away from it.
A rare but serious risk of any filler is injection into a blood vessel, called a vascular occlusion, which can damage the skin and, near the eyes, affect vision. That is why under-eye injections should be done by an experienced physician who knows the anatomy.
What we do about it
We keep hyaluronidase in both offices, so hyaluronic acid filler can be dissolved quickly if needed. Call us right away if you have severe or worsening pain, skin that turns white, gray or blotchy, or any change in your vision.
Fat injections and eyelid surgery carry the usual risks of surgery and anesthesia, which Dr. Naderi reviews with you before you decide. Anesthesia is given by board-certified anesthesiologists who supervise nurse anesthetists.
Locations
Tear Trough Correction Near Washington DC
Our physicians treat under-eye concerns in Reston, Virginia, close to McLean, Great Falls, Vienna, Arlington and Alexandria, and in Chevy Chase, Maryland, close to Bethesda, Potomac and Northwest Washington DC. Maryland patients can read more about tear trough correction in Bethesda and Chevy Chase.
It depends on the cause. PRF gel injections suit a mild hollow or thin skin, fat injections are the longer-lasting choice for a true hollow, and lower eyelid surgery is needed when under-eye bags cast the shadow. Many patients do best with a combination.
Should I get tear trough filler?
For most people, Dr. Naderi says no. In thin under-eye skin, filler can cause swelling and a bluish-gray bag that can last for years. Some patients, usually with thicker skin, enough soft tissue and no bags, are still good candidates, and our physicians will tell you honestly whether you are one of them. When filler is the right choice, our physicians prefer Restylane Eyelight.
What is a pseudo tear trough?
When the fat pads under the eyes bulge forward, they cast a shadow that looks like a hollow. Dr. Naderi calls this a pseudo tear trough. It is treated with lower eyelid surgery, not filler.
Can filler get rid of dark circles?
Only when the dark circle is a shadow from a hollow. Dark circles caused by pigment or thin skin are a skin issue, and adding volume will not change the color.
Can filler fix under-eye bags?
No. Injections can soften a hollow, but they cannot remove bags. When bulging fat pads cast the shadow, lower eyelid surgery is the treatment.
Who performs tear trough treatment at The Naderi Center?
Physicians only. Dr. Shervin Naderi, a double board-certified facial plastic surgeon, performs lower eyelid surgery, fat injections and filler. Board-certified dermatologist Dr. Alexandra Snodgrass performs PRF gel injections and filler.
How much does tear trough correction cost?
PRF gel injections are $2,300 for the initial treatment and $1,800 for maintenance within a year. Tear trough filler is $1,500 per syringe, facial fat grafting is $5,500 to $15,000 or more, and lower eyelid surgery is $8,000 to $15,000 for Dr. Naderi’s surgeon’s fee, which includes follow-up visits. Anesthesia and surgical facility fees are separate.
How many PRF treatments will I need?
Usually an initial treatment and a maintenance treatment 6 to 8 weeks later, then one treatment a year to keep the result.
Are fat injections under the eyes done in the office?
No. Fat injections are done in the operating room under general anesthesia, on their own or with lower eyelid surgery or a facelift.
Does lower eyelid surgery leave a scar?
Dr. Naderi performs lower eyelid surgery only through an incision hidden inside the eyelid, so there is no visible scar.
Can filler placed elsewhere be dissolved?
Hyaluronic acid filler can be dissolved with hyaluronidase, which we keep in both offices. Our physicians evaluate filler from other practices and plan the correction with you.
Can I combine treatments?
Yes. Lower eyelid surgery is often combined with fat injections, and laser resurfacing can tighten under-eye skin. Your physician will explain which combination fits your goals.
Where can I get tear trough treatment near me?
At The Naderi Center in Reston, Virginia and Chevy Chase, Maryland, close to Washington DC, McLean, Great Falls, Vienna, Arlington, Alexandria, Bethesda and Potomac. PRF gel and under-eye filler are available in both offices. Maryland patients can read more about treatment in Bethesda and Chevy Chase.
Medically reviewed by Dr. Shervin Naderi, MD, FACS, double board-certified facial plastic surgeon. Last reviewed .
Begin with a Conversation
Bring us your questions about tired-looking eyes. Meet Dr. Naderi or Dr. Snodgrass in Reston, in Chevy Chase, or virtually.
