During consultations for aegyo-sal filler, there are a few things I hear more often than expected.

 

“My under-eye area looks too flat.”

“I just want it to look slightly fuller when I smile.”

“But I’m worried it might look puffy if it’s overdone.”

That concern is completely understandable.

 

Aegyo-sal may seem like a very small area, but because it sits right under the eyes, even a small change can noticeably affect the overall impression of the face.

 

That is why this procedure can look unnatural if we simply add too much volume.

Rather than creating a large volume, it should be designed delicately, almost as if drawing one thin line that matches the eye shape and the overall facial mood.

 

Simply put, aegyo-sal filler is not a procedure that makes the area “big.”

 

It is closer to a procedure that softly refines the line under the eyes.

 

2. What is aegyo-sal filler?

 

Aegyo-sal refers to the small volume line that appears just below the lower eyelid.

It may be easier to understand if you think of it as the slightly raised area under the eyes when someone smiles.

 

This area is also related to the movement of the orbicularis oculi muscle, the circular muscle around the eyes.

 

So naturally, aegyo-sal is not a structure that should protrude excessively when the face is relaxed.

 

It is closer to a soft volume that becomes more visible when smiling or making facial expressions.

 

Aegyo-sal filler is a method of enhancing this line with a small amount of filler when the area looks too flat or when the under-eye area looks hollow and gives a tired impression.

 

However, there is an important point here.

 

Treating under-eye hollowness and designing aegyo-sal are not the same thing.

 

If the tear trough is deep or dark circles are prominent, creating only aegyo-sal may actually make the lower shadow stand out more.

 

On the other hand, if someone already has prominent under-eye fat, adding more volume can make the area look puffy or heavy.

 

That is why we first need to assess the under-eye structure and distinguish whether the face is suitable for aegyo-sal design or whether under-eye hollowing should be addressed first.

 

3. What changes can we see in the before-and-after photos?

If you look at the before-and-after photos above, the under-eye line before treatment appears relatively flat, and the area just below the lower eyelid lacks subtle three-dimensionality.

 

It is not that the eyes themselves look small, but rather that the thin curve supporting the area under the eyes seems insufficient.

 

After treatment, a very fine volume line appears under the eyes, making the eyes look slightly more defined yet still soft.

 

The important point here is that the aegyo-sal does not look overly swollen or bulky.

 

A natural aegyo-sal is not a wide or thick bulge.

 

It is closer to a thin line that starts under the pupil and continues softly toward the outer corner of the eye.

 

In the photo, the key change is not that a large amount was added, but that the subtle curve under the eyes makes the overall impression look a little livelier.

 

To create this kind of result, the placement of filler is more important than the amount.

 

If it is placed too high, the lower eyelid may look heavy.

 

If it is placed too low, it may look like under-eye puffiness rather than aegyo-sal.

 

Because the skin in this area is thin, filler placed too superficially may show through or create a bluish color change.

If too much is injected, the area may look awkward when smiling.

 

That is why aegyo-sal filler can create a noticeable change with a very small amount, but even a slight excess can also become very noticeable.

 

4. How do studies explain under-eye filler?

Example: Figure 1 or Figure 5 from the Urdiales-Gálvez paper

 

One useful paper related to under-eye filler is a 2021 study by Urdiales-Gálvez and Farollch-Prats.

 

This paper does not focus specifically on aegyo-sal alone.

 

It discusses tear trough deformity and treatment strategies for fillers around the eyes.

 

However, because aegyo-sal filler is also performed within the same under-eye anatomical region, the concepts discussed in this paper can still be helpful.

 

If you look at the figures in the paper, the under-eye area is not treated as one simple zone.

 

It is divided into several regions, such as the central under-eye area, medial under-eye area, lateral under-eye area, and the connection with the anterior cheek.

 

This is important.

 

If the under-eye area looks hollow, it does not mean filler should always be injected directly into that hollow alone.

 

Depending on the facial structure, the anterior cheek support, tear trough, and lateral eye line all need to be assessed together.

 

The paper also explains that the under-eye area is anatomically challenging, and that good outcomes require an understanding of both facial structure and the characteristics of hyaluronic acid fillers.

Example: Figure 10 from the Urdiales-Gálvez paper

 

If you look at the before-and-after images in the paper, the treatment is not simply about filling the tear trough.

 

The temple, cheekbone, and under-eye connection are considered together to refine the overall lower eyelid and midface line.

 

This material cannot be applied directly to aegyo-sal filler in the exact same way, but the core message is the same.

Filler around the eyes is not a procedure that simply creates one large line.

 

It is a procedure that balances the surrounding structures so they look harmonious.

 

The same applies to aegyo-sal.

 

It is not enough to simply create a line under the eyes.

 

Dark circles, under-eye fat, anterior cheek hollowing, skin thickness, and tendency for swelling all need to be considered together.

 

That is why in an actual consultation, we need to check whether aegyo-sal suits the person’s eyes, whether under-eye hollowing should be treated first, and whether any previous filler remains in the area.

 

5. What should you be careful about with aegyo-sal filler?

Because aegyo-sal filler is performed close to the eyes, bruising, swelling, asymmetry, unevenness, translucency, and the Tyndall effect can occur.

 

This area has thin skin and tends to swell easily, so if too much filler is injected, it may look like a tired under-eye area rather than a pretty aegyo-sal line.

 

People with prominent under-eye fat, those who easily develop allergies or swelling, and those who already have under-eye filler remaining should be assessed more carefully.

 

After the procedure, it is also better to avoid strong massage, sauna, alcohol, and excessive exercise.

 

Rather than judging the result immediately while swelling is still present, it is better to observe how the area settles over several days to one or two weeks.

 

If severe pain persists, or if there is a change in skin color, severe swelling, or any visual disturbance, the clinic should be contacted immediately.

To summarize, aegyo-sal filler can help create a small volume line under the eyes, making the eyes look softer and livelier.

 

However, the important point is not adding a large amount.

 

The result depends on how accurately the position, thickness, length, symmetry, and under-eye structure are assessed and designed.

 

As shown in the attached before-and-after photos, a natural change is not created by making the area overly swollen.

It comes from refining the under-eye line in a thin and soft way.

 

The eye area is a region where even a small difference can look significant.

 

That is why, with aegyo-sal filler, it is better to first ask, “Does this design truly suit my under-eye structure?” rather than simply asking, “Can filler be injected here?” :)

 

This was Director Won Dae-han.

 

Thank you for reading.

 

Source:
Urdiales-Gálvez F, Farollch-Prats L.
Management of Tear Trough with Hyaluronic Acid Fillers: A Clinical-Practice Dual Approach.
Clinical, Cosmetic and Investigational Dermatology. 2021;14:467-483. DOI: 10.2147/CCID.S301117.