Why Dr Low Recommends Polynucleotide Over Traditional Fillers for Under-Eyes

What Does Dr Low Actually See in the Undereye Zone?

The undereye area is among the most frequently treated — and most frequently mismanaged — zones in aesthetic medicine. Over years of practice, Dr Low Chai Ling has developed a clear clinical position on how to approach undereye concerns, and it diverges meaningfully from what is still standard practice in many clinics.

“My shift toward polynucleotide treatment for the undereye was driven by what I was seeing clinically,” Dr Low explains. “I was seeing patients who had been treated with fillers in the undereye repeatedly over years, and the cumulative picture was not what either the patient or their previous doctors had intended. The skin quality was not improving. In some cases, it was getting worse.”

This post reflects Dr Low’s clinical perspective on why polynucleotide treatment — not traditional filler — is often her first recommendation for undereye concerns, and for which patients that recommendation applies.

Why Did Hyaluronic Acid Filler Become the Default for Under-Eyes?

Hyaluronic acid tear trough filler became widely adopted because it is effective — within a specific clinical context. When the primary cause of undereye darkness and hollowing is volume loss in the tear trough or orbital area, filler can correct the contour, reduce shadowing, and produce an immediately visible improvement.

The problem is that not all undereye concerns are caused by volume loss. Many patients — particularly those in their 30s and early 40s — present with dark circles and a tired appearance driven primarily by:

• Thinning skin that makes the underlying vasculature more visible
• Reduced dermal density and structural integrity
• Inflammation in the periorbital skin
• Fine crepey lines on thin, dehydrated undereye skin

In these patients, filler does not address the root problem. It may temporarily obscure it — or, if placed in tissue that lacks the structural integrity to support it, it can migrate, create puffiness, or produce a shadowing effect of its own.

“Filler works by filling space,” Dr Low explains. “If the skin above the filler is thin and cannot adequately conceal the product, you can end up with a visible convexity or a bluish tinge from the Tyndall effect. This is not a failure of the patient or the product — it is a failure of patient selection.”

What Does Polynucleotide Treat That Filler Does Not?

Polynucleotide treatment — using PDRN extracted from salmon — addresses the biology of the undereye skin itself. When injected into the thin dermis beneath the eye, PDRN can:

• Stimulate fibroblast activity and encourage collagen and elastin production
• Improve the thickness and density of the undereye dermis over time
• Modulate local inflammation, which may help with vascular-related dark circles
• Improve the overall tone and resilience of the skin

The effect is not immediate or volumetric — it is biological and cumulative. Over a course of treatment, the undereye skin may become measurably thicker and better able to conceal the underlying structures that create the dark or hollow appearance.

“What polynucleotide does is address the underlying cause in many of these patients — not just mask it,” Dr Low says. “A thicker, healthier dermis is a more durable solution than repeated filler sessions in tissue that is not strong enough to support the product.”

When Does Dr Low Still Recommend Filler for Under-Eyes?

Dr Low’s preference for polynucleotide in many undereye cases does not mean she avoids filler entirely. In patients where:

• True volume loss in the tear trough is the primary driver of hollowing
• The undereye skin has adequate thickness and structural integrity
• The orbital contour requires volumetric correction to restore normal light-reflecting anatomy

…filler remains a clinically appropriate choice. And in patients who present with both thin skin and volume loss, the two treatments can work together — polynucleotide to improve the skin quality and dermal thickness first, then filler for volumetric correction — typically staged with polynucleotide treatment first.

What Are the Risks of Repeated Filler in the Undereye Zone?

Dr Low is candid about what she has observed in patients who have had repeated undereye filler over years:

• Tyndall effect: A bluish discolouration caused by superficially placed HA filler
• Chronic puffiness: Filler that attracts water to the undereye zone can create a swollen appearance
• Migration: Over multiple treatment cycles, filler product can migrate beyond intended anatomical boundaries
• Tissue stress: Repeatedly injecting into thin tissue may over time affect its structural integrity

“The undereye is unforgiving,” Dr Low says. “Small errors in placement, or cumulative overcorrection, become very visible very quickly. The consequences of getting it wrong here are more apparent than almost anywhere else on the face.”

What Is Dr Low’s Clinical Approach for New Undereye Patients?

At consultation, Dr Low assesses the undereye zone for:

1. Skin quality and thickness: Is the dermis thin and crepey? Is there visible vasculature through the skin?
2. Presence of true volume loss: Is there a structural hollow in the tear trough, or is the appearance driven by something else?
3. Pigmentation: Is there post-inflammatory, vascular, or melanin-driven pigmentation?
4. Prior treatment history: Has the patient had filler before? Is there residual product?

Based on this assessment, she formulates a recommendation — which may be polynucleotide alone, filler alone, a combination, or a phased approach.

“I do not have a one-size treatment for undereye concerns. Every patient presents differently. What I do have is a position that the skin quality question must be answered first — and that polynucleotide treatment is underutilised in the undereye zone relative to its clinical potential.”

Frequently Asked Questions

Q: Is polynucleotide treatment safe in the undereye area?
Yes, when performed by a qualified doctor with experience in periorbital injections. The undereye area has specific anatomical considerations. All treatments at SW1 Clinic are performed by our qualified doctors.

Q: How long does a course of undereye polynucleotide treatment take?
A typical course involves three to four sessions spaced two to four weeks apart. Results develop cumulatively over the treatment course and continue to improve for several weeks after the final session.

Q: Can polynucleotide fix Tyndall effect from previous filler?
No. Tyndall effect from HA filler is treated with hyaluronidase to dissolve the product. Once the filler is cleared, a skin quality programme — which may include polynucleotide — can address the underlying skin condition.

Q: I have been told I need filler in my tear trough. Should I get a second opinion?
If you are uncertain, a second consultation is always reasonable. The tear trough area is complex, and the most appropriate treatment depends on a thorough clinical assessment. SW1 Clinic’s doctors are experienced in undereye assessment and will give you an honest view of what treatment, if any, is appropriate.

Q: What skincare does Dr Low recommend alongside undereye treatment?
Sun protection is always the first recommendation. A retinol-based eye treatment and targeted serum can support skin quality between sessions. Dr Low’s recommended daily skincare routine is available at sw1shop.com.

Q: How is SW1 Clinic’s approach to undereye treatment different from other clinics?
Our approach is assessment-first. We do not default to filler for every undereye concern. We evaluate each patient individually and recommend what the clinical picture supports — which may be polynucleotide, filler, a combination, or another approach. Our goal is the best long-term outcome for the patient’s skin, not the most immediately visible intervention.

Book a consultation with Dr Low or our team at SW1 Clinic to receive a thorough undereye assessment and an honest, personalised treatment recommendation.