Polynucleotides vs Tear Trough Filler: Which May Suit Under-Eye Hollowing, Crepey Skin or Dark Circles?

Clinical guidance from Dr Nyla Raja MBChB (Hons), MRCGP (Dist), DFFP, DPDermatology - GMC No. 6057913

Dr Nyla Medispa offers both polynucleotides and tear trough filler, but they are not interchangeable treatments. Tear trough filler may help soften a hollow contour and the shadow it creates. Polynucleotides are intended to support skin quality without adding volume.

The most appropriate option depends on why the under-eye area appears tired. A true tear trough hollow, thin or crepey skin, pigmentation, visible blood vessels, fluid retention, and under-eye bags can all be described as “dark circles”, but they may require different approaches.

The short answer: match the treatment to the cause

When tear trough filler may suit under-eye hollowing

A tear trough is the groove between the lower eyelid and upper cheek. When volume loss or facial anatomy creates a depression here, it can cast a shadow that makes the eyes appear darker or more tired, even where the skin colour itself has not changed.

Tear trough filler uses hyaluronic acid to soften this transition. In a suitable patient, small, precisely placed amounts may reduce the appearance of hollowness and improve how light falls across the under-eye area. The aim is subtle correction, rather than visible fullness.

Filler may be considered where the principal concern is a stable hollow rather than puffiness or skin texture. It does not treat brown pigmentation, prominent vessels, or crepey skin in the same way. Research supports hyaluronic acid filler as an option for tear trough deformity, although the published evidence also underlines the importance of careful technique and appropriate patient selection in this anatomically complex area. A systematic review and meta-analysis of hyaluronic acid for tear trough deformity provides useful context on the evidence base.

When polynucleotides may suit crepey or thin under-eye skin

Polynucleotides are injectable treatments intended to improve skin quality, hydration, firmness, and elasticity. They do not replace lost volume or reshape the tear trough. This distinction matters: a treatment that improves the quality of thin skin will not fill a pronounced hollow in the way that hyaluronic acid filler can.

For patients whose main concern is fine creasing, crepey texture, or a fragile-looking under-eye area, a gradual skin-quality approach may be more appropriate than placing filler beneath already thin tissue. Improvements develop over time and are generally more subtle than the contour change that can follow appropriately selected filler treatment.

Clinical evidence for polynucleotides in the under-eye area is still developing. Published research suggests possible short-term improvements in skin-quality measures, but studies remain relatively limited and longer-term data are needed. Read the systematic review of polynucleotides in peri-orbital rejuvenation.

Why “dark circles” need a more precise assessment

Dark circles are not one condition. They may be structural, pigmented, vascular, or mixed. A hollow may create a shadow; thin skin may allow the underlying muscle and vessels to show through; pigmentation may produce a more brown or grey tone; and eye bags can cast their own shadow beneath the lower eyelid. Many people have more than one contributing factor.

This is why neither tear trough filler nor polynucleotides should be viewed as a universal dark-circle treatment. Filler may improve darkness caused predominantly by shadowing from volume loss. Polynucleotides may be considered when skin quality and fine texture are important contributors. Neither is intended to remove true pigment in the same way as a targeted pigmentation treatment. Reviews of periorbital discolouration similarly classify dark circles according to structural, vascular, pigmentary, and mixed causes. Read the clinical review of periorbital hyperpigmentation.

When filler may be unsuitable around the eyes

Under-eye filler is not automatically the right response to a tired appearance. Prominent fat pads, significant skin laxity, persistent swelling, or fluid retention can change both the likely benefit and the risk of an unsatisfactory result. Where there is existing puffiness, adding volume may not create the smoother result a patient is hoping for.

An in-person assessment is particularly important because the lower eyelid and mid-cheek must be considered together. In some cases, treatment of the cheek, skin quality, or another underlying concern may be more appropriate than direct tear trough filler. Patients with pronounced bags or excess skin may require advice on alternatives beyond non-surgical injectable treatment.

What to expect from each option

Tear trough filler

Results can usually be seen soon after treatment, although temporary swelling, tenderness, redness, or bruising may occur and the area needs time to settle. At Dr Nyla Medispa, tear trough filler is planned around individual anatomy, with the aim of maintaining a natural-looking lower eyelid-to-cheek transition.

Because this is a delicate area, treatment should be performed by an appropriately trained and experienced medical practitioner. Most side effects are temporary, but complications can occur, including rare but serious vascular complications. Patients should follow their clinician’s aftercare guidance and seek urgent medical advice if they develop severe or worsening pain, marked skin colour changes, or any visual disturbance after filler treatment.

Polynucleotides

Polynucleotide treatment is generally a gradual process, with the focus on progressive improvement in skin quality rather than instant volumisation. Temporary redness, small raised injection marks, swelling, tenderness, or occasional bruising can occur after treatment.

They may appeal to patients who want to address early textural change without changing the shape of the under-eye area. However, they should not be expected to correct a deep anatomical hollow to the same extent as carefully selected filler.

Can polynucleotides and tear trough filler be combined?

Sometimes, but only when there is a clear reason to treat more than one concern. A patient may have both structural shadowing from volume loss and thin, crepey skin. In that situation, filler and a skin-quality treatment address different layers and objectives.

Combination treatment is not automatically better. The priority is to identify what is most noticeable, what may be improved safely, and whether one carefully chosen treatment is sufficient. A staged approach may be preferable so that the response to each treatment can be assessed accurately.

The key point

For under-eye hollowing caused by volume loss, tear trough filler may be the more relevant option. For thin, crepey, dehydrated-looking skin, polynucleotides may be more suitable because they support skin quality without adding volume. If the concern is predominantly pigment, visible vessels, eye bags, or fluid retention, neither treatment should be assumed to be the answer without a detailed assessment.

The most useful question is not simply “polynucleotides or tear trough filler?” It is: “What is causing my under-eye appearance?” Once this has been assessed, treatment can be selected with a clearer, safer, and more natural-looking objective.