The under-eye is a difficult area. The skin is thin and the vasculature runs through it. In June a review comparing hyaluronic acid filler with polynucleotide in this region was published. The conclusion was not that one is better, but that the two handle different problems.
The authors list the periorbital region among the most demanding areas in aesthetic practice, for three reasons: the skin is thin, the vasculature is complex, and swelling or irregularity occurs easily.
Hyaluronic acid filler remains the reference method for filling a hollow. Two limits are noted: it does not change the quality of the skin itself, and it carries side effects specific to this region.
Filler placed under the eye can show through with a bluish cast: the Tyndall effect, caused by light scattering through thin skin. Malar swelling is also reported. Interest in regenerative options grew from these limits, which is where the review starts.
Purified DNA fragments, typically obtained from salmon. Also known as PDRN. Rather than physically filling a hollow, it supports the skin in repairing itself.
The review lists three actions: dermal remodelling, angiogenesis and reduction of inflammation.
| Good at | Not good at | |
|---|---|---|
| Hyaluronic acid filler | Filling a hollow and shaping it | Does not change skin texture or firmness. Risk of show-through and swelling |
| Polynucleotide | Firmness, hydration and fine lines. Favourable safety profile | Weaker than filler at filling a lost space |
This is where the review is practically useful. "Hollow under-eyes" covers two different things.
One is genuine volume loss casting a shadow. That calls for filling.
The other is skin thinning and roughening so the area reads as dark. Filling does not solve that, and placing filler under thin skin makes the show-through described above more likely.
It depends on whether the problem is volume loss or skin quality. A shadow from genuine hollowing calls for filler; darkness from thin, rough skin does not improve with filling.
The Tyndall effect. Light scatters through thin skin over the filler. It is one reason the review treats this region as demanding.
The review frames them as handling different problems rather than competing, which is why they are often considered together after the cause is separated.
