Tear trough filler restores lost volume to the tear trough groove. The hollow that runs from the inner corner of the eye down onto the cheek — using a small, precisely placed amount of reversible hyaluronic acid filler. The groove exists because a ligament tethers the skin to the bone there. As the fat beneath the eye deflates and descends with age, or from genetics in younger patients, that tether becomes a visible hollow that casts a shadow. That shadow is the commonest real cause of dark circles. Filler placed deep on the bone of the eye socket, beneath the muscle, lifts the floor of the hollow so the shadow disappears and the lid flows smoothly into the cheek. Typically 0.5–1ml is used across both sides. Results are immediate, settle at two weeks, last 12–18 months and can be fully dissolved with hyaluronidase. At Medisha Clinic it is a doctor-only procedure performed exclusively by Dr Nish Shah MD with Teosyal PureSense Redensity 2 — the filler designed specifically for the under-eye — using The Medisha Method under-eye protocol.

Dr Nish uses Teosyal PureSense Redensity 2 for every tear trough, and nothing else under the eye. It was the first filler designed specifically for this area and it is built around the two things that go wrong there. First, swelling: most fillers are water-absorbing, and under the thinnest, slowest-draining skin on the body that means puffiness for weeks; Redensity 2 combines a low concentration of cross-linked and non-cross-linked HA so it binds very little water and settles within days. Second, the blue tint under the skin: Redensity 2’s low stiffness lets it lie smooth and it is formulated to resist showing blue through thin skin. It also contains lidocaine for comfort and a complex of amino acids, antioxidants, minerals and vitamin B6 that supports the skin. It has a ten-year clinical track record and a 2025 prospective study in Aesthetic Plastic Surgery describes it as the product of choice for the tear trough. It is CE-marked and used across Europe, Canada and Asia. It is not sold in the United States. Using a lip or cheek filler under the eye is one of the commonest reasons under-eye filler has to be dissolved.

At Medisha Clinic in Mayfair, tear trough filler is £450 — a single fixed price covering both sides, treatment with Teosyal Redensity 2, the immediate assessment and a complimentary 4-week review at which any refinement is included. Consultation with Dr Nish is £50, fully redeemable against treatment, so if you go ahead your total is £450 and there are no other charges. Where a deflated cheek is deepening the trough, cheek filler can be added from £350 (tear trough and cheek together from £800). Correction of under-eye filler placed elsewhere, with hyaluronidase and re-treatment, is quoted at consultation. The clinic is at 58 South Molton Street, Mayfair, London W1K 5SL, three minutes from Bond Street station.

Because the under-eye is, with the nose, the least forgiving filler area on the face. The skin is the thinnest on the body, so anything placed too superficially shows as a lump or a bluish tint. The blood vessels under the eye run through the area and connect to the blood supply of the eye, so an injection into a blood vessel can cause loss of skin from a blocked blood supply or, rarely, visual loss. The fluid drainage is slow, so the wrong product or too much of it causes puffiness that can last months. Managing those risks requires knowledge of the plane beneath the muscle, cannula technique checking each deposit is clear of blood vessels, the right low-swelling product, the judgement to use very little. Hyaluronidase prepared in the room with the competence to use it immediately. Dr Nish Shah is a medically trained doctor and the Senior International Clinical Trainer at Derma Medical, where he teaches this protocol to other doctors. It is codified as The Medisha Method under-eye protocol.

It fixes the commonest type completely and the others partly or not at all, which is why the diagnosis at consultation is the most important part of the treatment. Dark circles have three causes. A hollow casting a shadow: filler removes the hollow, the shadow goes, and the improvement is often dramatic. Vascular show-through — bluish or purple vessels visible through thin skin: filler helps a little by adding a layer over the vessels. But polynucleotides, which thicken the skin and calm the congestion, are the better tool, often used four weeks after filler. Pigment — brown melanin in the skin: filler does nothing, and pigment treatments are needed. Most patients have a mix. Dr Nish uses stretch and light tests at consultation to establish which you have, and will tell you plainly if filler is not the answer.

Not when it is diagnosed, chosen and placed correctly, and puffiness is precisely what the under-eye protocol is designed to prevent. Under-eye puffiness after filler comes from four errors: treating a patient who already has fat bags or fluid retention. Placing the filler in the skin rather than deep on bone. Using too much, and using a water-absorbing filler that swells. At Medisha, patients with true bags are told so and referred for eyelid surgery. Filler goes beneath the muscle on the bone of the eye socket by cannula. Volumes are conservative (typically 0.5–1ml across both sides), and the filler is Teosyal Redensity 2, designed for this area specifically because it binds very little water. The end point is the disappearance of the shadow, not a full trough, and any refinement is added at the 4-week review rather than risked on the day. If you have been left puffy by filler elsewhere, it can be dissolved and re-treated correctly.

Typically 12–18 months, which is longer than most facial filler because the under-eye barely moves and the HA is broken down slowly. Some patients find a result persisting well beyond 18 months, especially after a second treatment. Longevity varies with your metabolism and lifestyle factors such as intense exercise and sun exposure. When the effect fades a small top-up restores it because Dr Nish uses only reversible HA, the filler can also be dissolved at any point if you wish.

Most patients describe pressure rather than pain. Topical anaesthetic is applied for 20 minutes, a tiny bleb of local anaesthetic numbs the single cannula entry point. Redensity 2 contains lidocaine because a cannula is used there is one entry point per side rather than multiple needle passes. Downtime is short: the result is visible immediately, most patients return to work the next day. Because Redensity 2 binds so little water, swelling is usually mild and settles within 2–3 days rather than the weeks common with other fillers here. Bruising, if it occurs, clears within 5–10 days and can be covered with make-up after 24 hours. The final result is assessed at two weeks. For two weeks avoid rubbing the area, sleeping face-down, facials and eye masks. For 48 hours avoid vigorous exercise, alcohol and heat.

They treat different causes of the same complaint. Tear trough filler restores volume to a hollow, removing the shadow it casts. It is immediate, structural and reversible, and it is the treatment for a visible groove. Polynucleotides regenerate the under-eye skin at a cellular level — thickening thin, translucent skin and calming vascular congestion — without adding any volume. They are the treatment for bluish, vascular dark circles and crepey skin, and they build over a course of three to four sessions. Sunekos Performa does a similar job for skin quality via amino acids. Many patients have both a hollow and thin skin and are treated in sequence: Redensity 2 first, then polynucleotides or Sunekos Performa four weeks later. Dr Nish performs all three, so the recommendation follows the diagnosis rather than the menu.

Usually not, and a good clinic will tell you so. True eye bags are fat pads pushing forward pushing forward beneath the eye. Fluid puffiness is fluid congestion. Filler adds volume to an area that already has too much, so it makes both worse, and filler placed into bags is among the most commonly dissolved in London. For genuine fat bags the correct treatment is lower eyelid surgery, and Dr Nish will refer you. For fluid puffiness, lifestyle and fluid measures come first. There is a middle group — a slight bag with a deep trough beneath it. Where very conservative Redensity 2 placed only in the trough can smooth the transition, and Dr Nish assesses this case by case with you looking in the mirror.

This is the area where the risks of filler are most concentrated, which is exactly why it is doctor-only at Medisha and why the product is chosen for the area. Expected, temporary effects: mild swelling for 2–3 days with Redensity 2, bruising for up to 10 days, mild tenderness. Uncommon risks: a blue tint under the skin (the blue tint under the skin). Prolonged puffiness (from a water-absorbing product, too much of it or fluid disruption — avoided by Redensity 2, conservative volume and cannula). Asymmetry (assessed and adjusted at the 4-week review). Infection (rare, sterile technique), and a blocked blood vessel. The serious risk, minimised by cannula, checking for blood vessels, small deposits, reversible HA and hyaluronidase prepared in the room. Warning signs are skin blanching or mottling, disproportionate pain or any change in vision; Dr Nish provides his direct number and these require same-day assessment.

Because under the eye the specialist’s judgement and the choice of filler are the treatment. Dr Nish Shah MD is a medically trained doctor, a specialist in under-eye and advanced facial filler, Brand Ambassador and Key Opinion Leader for dermal fillers with a global manufacturer. Senior International Clinical Trainer at Derma Medical where he teaches this procedure to other doctors. Every tear trough treatment is his, using The Medisha Method under-eye protocol: diagnosis of the cause of your dark circles and assessment of your cheeks first; Teosyal Redensity 2. The filler designed specifically for this area — placed on bone by cannula checking each deposit is clear of blood vessels. Conservative volumes. Hyaluronidase in the room, and a 4-week review with refinement included. £450 fixed; £50 consultation redeemable. 58 South Molton Street, Mayfair, London W1K 5SL, three minutes from Bond Street. Also Marylebone.