Eye Area Treatments — From Crow’s Feet to Hollow Temples

Last updated: 5 March 2026

The periorbital area — the skin and structures surrounding the eyes — is one of the most expressive and also one of the most delicate regions of the face. It is often the first area to show signs of ageing and is one of the most common treatment requests at Axiom Aesthetics. From fine lines and dark circles to hollowing and loss of support, the eye area presents unique challenges and opportunities for aesthetic enhancement.

Anatomy of the Eye Area

Understanding the anatomy is essential for appreciating both the possibilities and the limitations of eye area treatments:

The Periorbital Skin

The skin around the eyes is the thinnest on the entire body — approximately 0.5mm compared to 2mm elsewhere on the face. It contains fewer sebaceous glands, minimal subcutaneous fat, and is supported by delicate underlying muscles (the orbicularis oculi). This thinness is why blood vessels and discolouration are so visible in this area.

The Orbital Fat Pads

The eyes are cushioned by fat pads within the bony orbit. With age, the septum (membrane) that holds these fat pads in place weakens, allowing fat to herniate forward — creating the characteristic “eye bags” or puffiness beneath the eyes. Simultaneously, fat can be lost from other periorbital areas, creating hollowing.

The Tear Trough

The tear trough is the groove that runs from the inner corner of the eye diagonally towards the cheek. This depression deepens with age as fat is lost from the cheek and the tear trough ligament becomes more prominent. A deep tear trough creates a shadow that makes the under-eye area appear dark and hollow.

The Temple Region

The temples are often overlooked but play a crucial role in upper face aesthetics. Temporal fat loss is one of the earliest signs of facial ageing, creating a hollow, gaunt appearance that affects the entire upper face and can make the eyes appear sunken.

Common Eye Area Concerns and Treatments

Crow’s Feet (Lateral Canthal Lines)

Crow’s feet are the fan-shaped lines that radiate from the outer corners of the eyes. They are dynamic wrinkles, caused by the contraction of the orbicularis oculi muscle during smiling, squinting, and laughing.

Treatment Options

• Botulinum toxin: The gold standard treatment. Small doses (8-12 units per side) are injected into the orbicularis oculi to relax the muscle and soften the lines. Results develop over 5-14 days and last 3-4 months. This is one of the most satisfying and predictable treatments in aesthetic medicine
• Skin boosters: Hyaluronic acid or polynucleotide skin boosters can improve the skin quality in the crow’s feet area, making the fine lines less visible even when the muscle contracts
• Laser resurfacing: Non-ablative fractional lasers can improve the texture of crow’s feet skin, reducing the visibility of static lines that remain at rest
• Microneedling: With shallow needle depths (0.25-0.5mm), microneedling can improve periorbital skin quality and fine line appearance

Under-Eye Dark Circles

Dark under-eye circles have multiple causes, and effective treatment requires identifying the correct type:

Vascular Dark Circles

Visible blood vessels showing through thin skin create a bluish-purple discolouration. This is most common in patients with fair, thin skin and is often hereditary. Treatment options include polynucleotide skin boosters (which thicken the skin, reducing vessel visibility), caffeine and vitamin K-based eye creams, and PRP (platelet-rich plasma) injections.

Pigmentary Dark Circles

Excess melanin in the under-eye skin creates a brownish discolouration. This is more common in darker skin types and can be hereditary or aggravated by sun exposure and rubbing. Treatment options include topical lightening agents (vitamin C, arbutin, kojic acid, azelaic acid), gentle chemical peels with caution, and consistent sun protection.

Structural Dark Circles (Tear Trough Hollowing)

Shadow cast by a deep tear trough creates the appearance of dark circles even when the skin itself is not discoloured. This is the most common cause of dark circles in patients over 35. Treatment options include tear trough filler (hyaluronic acid), midface volumisation to lift and support the under-eye area, and polynucleotide injections to improve tissue quality.

Under-Eye Bags

Puffy under-eye bags result from herniated orbital fat, fluid retention, or a combination of both:

Treatment Options

• Dermal filler (camouflage approach): Rather than treating the bags directly, filler placed below and beside the puffiness can smooth the transition between bag and cheek, creating a more even contour. This approach requires an experienced practitioner with thorough knowledge of periorbital anatomy
• RF and HIFU: Can provide modest skin tightening in the lower eyelid area, reducing mild puffiness
• Lifestyle modifications: Reducing sodium intake, sleeping elevated, managing allergies, and addressing any underlying medical causes can reduce fluid-related puffiness
• Surgical referral: For significant fat herniation, lower blepharoplasty (surgical removal or repositioning of the fat) may be the most effective option

Upper Eyelid Concerns

Hooded Eyelids

Loss of skin elasticity and fat descent in the upper eyelid creates hooding — excess skin that droops over the eyelid crease. Mild hooding can be addressed with:

• Botulinum toxin brow lift: Strategically placed injections to elevate the brow, indirectly opening the eye area
• HIFU/RF: Skin tightening of the upper eyelid and brow area
• Plasma pen/fibroblast treatment: Controlled micro-injuries to the upper eyelid skin, causing contraction and tightening

Significant hooding that affects vision or cosmetic appearance may require surgical upper blepharoplasty.

Sunken Upper Eyelids

Volume loss in the upper eyelid can create a hollow, skeletal appearance. Subtle hyaluronic acid filler placed carefully in the upper eyelid can restore a youthful fullness. This is an advanced technique requiring significant practitioner experience due to the delicate anatomy.

Hollow Temples

Temple hollowing is one of the earliest and most ageing changes in the upper face. As the temporal fat pad depletes, the temples become concave, and the temporal ridge becomes prominent. This creates a gaunt, aged appearance that affects the perception of the entire face.

Treatment Options

• Dermal filler: Hyaluronic acid or Radiesse filler can be injected into the temples to restore convex fullness. The results are immediately transformative — patients often describe this as one of the most impactful single treatments they have had
• Biostimulators: Sculptra is particularly effective for temple volumisation, as it provides gradual, natural-looking filling through collagen stimulation
• PRP: Can improve tissue quality in the temple area, though its volumising effect is modest compared to fillers

Safety Considerations for Eye Area Treatments

The periorbital area requires particular caution due to its delicate anatomy:

Tear Trough Filler Safety

Tear trough filler is one of the most technique-sensitive treatments in aesthetic medicine. Complications can include:

• Tyndall effect: A bluish discolouration caused by filler placed too superficially. Minimised by using the correct product and injection depth
• Overfilling: Creating puffiness worse than the original hollow. Conservative amounts (0.3-0.5ml per side) are essential
• Migration: Filler spreading beyond the intended area. Proper product selection and placement technique are critical
• Vascular complications: Rare but serious. The periorbital area has a rich blood supply connecting to the ophthalmic artery system. Only experienced practitioners should perform under-eye injections

Polynucleotides for the Eye Area

Polynucleotide skin boosters have emerged as a safer alternative to HA filler for under-eye rejuvenation. They improve skin quality, reduce dark circles through tissue thickening, and carry lower risks of the complications associated with HA filler in this area. They do not provide the volumising effect of filler but can produce excellent results for patients with mild to moderate under-eye concerns.

Creating an Eye Area Treatment Plan

At Axiom Aesthetics, we approach eye area rejuvenation comprehensively:

1. Assessment: Identify the specific concerns (lines, dark circles, hollowing, puffiness, laxity) and their causes
2. Prioritisation: Address the most impactful concerns first
3. Staged approach: Build results over multiple sessions rather than attempting comprehensive correction in one visit
4. Maintenance: Plan ongoing treatments to sustain results
5. Homecare: Prescription-strength eye treatments to support professional results

Frequently Asked Questions

Is tear trough filler safe?

Tear trough filler is safe when performed by an experienced, qualified practitioner who understands the periorbital anatomy and uses appropriate products and techniques. The under-eye area has a complex vascular anatomy, and only thin, flexible fillers designed for superficial placement should be used. At Axiom Aesthetics, we use evidence-based protocols, conservative volumes, and cannula techniques when appropriate to maximise safety. All our periorbital treatments are performed by our most experienced practitioners.

How long does under-eye filler last?

Under-eye filler typically lasts 9-18 months, which is often longer than filler in more mobile areas of the face. The relatively static nature of the tear trough means the filler experiences less mechanical stress, and the lower metabolic rate of this area means slower product breakdown. Some patients retain results for up to 24 months. We recommend a review at 12 months to assess whether a small top-up is needed.

Can Botox treat under-eye wrinkles?

Botulinum toxin is primarily effective for crow’s feet (lateral lines) rather than the fine lines directly under the eyes. The muscle responsible for under-eye wrinkles (the inferior orbicularis oculi) must remain functional for proper blinking and tear drainage. Over-relaxation can cause problems with lower eyelid support. Very small doses can sometimes be used conservatively under the eye, but this is an advanced technique with limited applications. Under-eye lines are generally better addressed with skin boosters, polynucleotides, microneedling, or laser.

What is the best treatment for hereditary dark circles?

Hereditary dark circles are often the most challenging to treat because the underlying cause (thin skin, prominent vasculature, or pigmentation) is genetically determined. The most effective approach depends on the type: vascular dark circles respond well to polynucleotide injections and PRP, which thicken the skin and reduce vessel visibility; pigmentary circles benefit from topical lightening agents and gentle peels; hollow-related shadows respond to tear trough filler. Often a combination approach is most effective. While hereditary dark circles cannot be permanently eliminated, significant improvement is achievable with the right treatment strategy.

At what age should I start eye area treatments?

Prevention is ideal — starting a good eye cream (containing retinol, peptides, or vitamin C) in your mid-twenties helps protect the thin periorbital skin. Professional treatments for the eye area are typically most relevant from the mid-thirties onwards, when crow’s feet, early hollowing, and skin quality changes begin to appear. However, patients with hereditary dark circles or premature under-eye concerns may benefit from treatment at any adult age. A consultation can help determine the right time and approach for your individual concerns.