Belotero Balance is a hyaluronic acid filler formulated to integrate into fine, mobile tissue rather than sit above it. Belotero Balance (+) is FDA approved for moderate to severe facial folds and for volume augmentation of the infraorbital hollow in adults over 21. Coastal Dermatology + Aesthetics injects it at its San Luis Obispo and Santa Maria offices.
What Belotero does for your face
There is a version of tired that sleep does not fix. The shadow under your eye is still there on a Sunday morning after nine hours, because it is not fatigue, it is a hollow, and light falls into it the same way every day. Belotero is one of the few fillers approved to treat exactly that. [1]
It does the same job around the mouth. The fine vertical lines through the lip that lipstick travels into, the crease that has started to run from the corner of your mouth downward, the softening along the smile lines. These are shallow, constantly moving areas where a firmer gel sits above the tissue instead of in it, and shows as a ridge or a bluish line the moment the light changes.
What lets Belotero go there is how the gel is built. Merz calls it a Cohesive Polydensified Matrix, or CPM. In plain terms it disperses through fine tissue and supports it evenly rather than holding its shape as a distinct lump, which is precisely why it works in the places other fillers are too heavy for.
What Belotero is good at
- The hollow under the eye, with an FDA-approved indication for that area rather than an off-label workaround
- The fine vertical lines around the lips that make lipstick bleed
- Softening smile lines without adding weight to the lower face
- Sitting shallow in thin skin without showing an edge or a bluish cast
- Being reversible, which matters more under the eye than anywhere else on the face
- Small, conservative corrections where a syringe of something firmer would be too much
The minimum age on the Belotero Balance (+) indication, which covers both moderate to severe facial wrinkles and folds and volume augmentation to improve the infraorbital hollow. [1]
How treatment works
We work out what is casting the shadow
Before anything else, we look at what is actually creating the darkness. Several different things cause it and filler is the answer to one of them, so identifying which one you have is what makes the result look right. That is the whole point of the consultation.
Shallow, and less than you think
Belotero can be placed superficially in tissue where a firmer gel would show as a ridge. Under the eye the amount that works is far smaller than most people expect, and the difference between a good result and an obvious one is measured in fractions of a syringe.
Review before adding
We treat conservatively and look again once the swelling has gone. Coming back to add a little is routine here and completely undramatic. Correcting an overfilled under-eye is neither.
The property that defines this filler. Belotero is formulated to disperse through fine, mobile tissue and support it evenly rather than sit as a discrete bolus. Merz calls the gel technology Cohesive Polydensified Matrix, or CPM, and it is why Belotero is used where a firmer gel would show its edges.
What is actually causing the shadow
Under-eye darkness is at least four different problems wearing the same face, and only one of them is a filler problem. This is the most useful thing on this page, so it is worth two minutes.
A hollow. The tissue that used to sit under your eye has thinned, so there is a genuine dip and the light falls into it. This is the one Belotero treats, and the one it treats well.
Pigment. The skin itself is darker in that crescent, often for reasons that run in families. Filler underneath does nothing to a stain on the surface. Pigment responds to topical treatment and to the right kind of light-based work.
Thin skin. The skin is translucent enough that the blue-violet vessels underneath show through it. Adding volume can help a little by pushing the surface forward, but the real answer is thickening the skin, which is a resurfacing and collagen question rather than a filler one.
A fat pad sitting forward. Puffiness rather than hollowness, sometimes with a hollow directly below it. Filling around a bulge makes the bulge more obvious. This is a surgical conversation and we will say so.
Most people have some combination of two. Working out which ones you have, and in what proportion, is the whole job, and it takes a face in the room and good light. It is exactly what your consultation buys, and it is credited toward whatever you decide to do.
Distinct causes of under-eye shadowing, of which filler treats one. Anyone offering you a syringe before they have worked out which one you have is guessing.
Areas we treat
Under the eye
Fills the hollow that makes you look tired regardless of how you slept, in the one area with a labeled indication behind it.
Around the mouth
Softens the fine vertical lines through the lip border that lipstick travels into.
Smile lines
Eases the fold from nose to mouth with a gel light enough not to weigh the lower face down.
Lips
Subtle definition and hydration rather than volume, for people who want the shape back and not the size up.
Corners of the mouth
Lifts the small downturned crease that reads as an expression you are not making.
Real results
Before & after
These are our own patients, photographed at our offices and published with their consent. Individual results vary. There are more in the practice’s private gallery, and we are happy to show you cases similar to yours at your consultation.
Individual results vary. Photos shown are unretouched patients of Coastal Dermatology + Aesthetics, published with consent.
Dr. Kilcline is the best dermatologist! Best experience ever! Love her new beautiful facility and location.
The Coastal difference
Under-eye work is not a beginner's area
The hollow under your eye sits over vessels that connect to the circulation around the eye itself. That is the reason this area is treated carefully everywhere it is treated well, and the reason an approved indication makes it a treatable area rather than a routine one. Your assessment and your injection both happen inside a board-certified dermatology practice, by people who look at this anatomy every day for medical reasons as well as cosmetic ones.
It is also the area where matching the treatment to the cause pays off most. If your shadow is pigment or thin skin rather than facial volume loss, there are better tools for it and you will leave with a plan built around the right one. When it is the wrong tool, the right one is usually something else we do: resurfacing for the skin, a neuromodulator for the lines that come from movement, or a firmer gel from the JUVÉDERM family where the correction needs real structure.
Is it right for you?
Belotero is probably a good fit if:
- You look tired in photographs no matter how much you have slept, and there is a visible dip under the eye
- The fine lines around your mouth have started catching lipstick
- You have been told elsewhere that your under-eye area is too delicate for filler
- You want a small, careful correction rather than a visible change
- You want something you can have dissolved if you change your mind
We will steer you somewhere else if:
- Your under-eye darkness is pigment or very thin skin, where filler will not help
- There is significant puffiness from a fat pad sitting forward, which is a surgical conversation
- You have an infection or active breakout in the area, which needs to clear first
- You are pregnant or breastfeeding, when we defer elective treatment
- What you want is structural lift in the cheek or jaw, where a firmer gel is the right tool
Not sure which of these you are? Almost nobody is, and working it out is the appointment. That is why the consultation is with a dermatologist and why the fee comes back to you.
What to expect afterward
Expect some swelling and a real chance of a bruise, especially under the eye, where the skin is thin and bruises show. Plan it around your calendar rather than the week of an event. The area can feel firm or slightly uneven for the first week and that settles as the gel integrates.
In the first week, do
- Use a cool compress for the first day if we told you to
- Sleep with your head slightly elevated for a couple of nights
- Wear sunscreen, and sunglasses if you have a bruise
- Come back for the follow-up, which is where we judge the real result
In the first week, don’t
- Press, rub or massage the area unless we specifically asked you to
- Judge it while you are swollen, and do not chase a small asymmetry on day three
- Book a facial, a peel or a laser in the same two weeks
- Ignore anything that feels wrong, which is the only instruction that really matters
Call us about anything severe, worsening, or simply not what we described: significant or increasing pain, skin that changes color or goes pale or dusky, any change in your vision, or signs of infection. Do not wait to see whether it settles. We would far rather hear from you.
Concerns treated
Belotero is the filler we choose when the area is delicate and the correction needs to be small. Pick a concern to see how we approach it.
What treatment costs
Belotero is priced by the syringe, and the under-eye area is one of the rare places where a single syringe often covers both sides with product left over. We tell you the number for your plan at your consultation, before you commit to anything.
We do not treat off a promotional price and we do not sell you a full syringe if half of one is the right correction. Under the eye in particular, less is usually the better answer.
Treatment time
15 to 30 minutes for most areas
Downtime
Minimal, though bruising near the eye is common and worth planning around
Results appear
The same day, with the real result at about two weeks
Results last
Varies by area and by person, and we give you the range for yours
Belotero Balance® frequently asked questions
Hyaluronic acid fillers can be dissolved. The FDA notes that filler not made from materials such as hyaluronic acid may be difficult or impossible to remove. Under the eye, that is not a footnote. It is the reason this is the material we use there. [2]
Offered at
Ready to start? Request your consultation
Fill out the form below, book online in Santa Maria (opens online scheduler), or give us a call. Cosmetic and aesthetic appointments need no referral. For medical dermatology, we are accepting new patients by referral from your primary care physician; send the referral across and then use the same form.
Cosmetic consultations are $125, paid at booking and credited toward the cost of treatment.
Sources and medical review
1. BELOTERO BALANCE® (+) Important Safety Information, Merz Aesthetics. Indicated for injection into the mid-to-deep dermis for correction of moderate-to-severe facial wrinkles and folds, such as nasolabial folds, and for volume augmentation for the improvement of the infraorbital hollow in adults over the age of 21. Long-term safety and effectiveness beyond 96 weeks have not been investigated. https://www.belotero.com/hcp/ · Regulatory / Prescribing Information
2. U.S. Food and Drug Administration. “Dermal Fillers (Soft Tissue Fillers).” Notes that the duration of effect depends on the filler material and the area injected, and that it may be difficult or impossible to remove filler material that is not made of materials such as hyaluronic acid. https://www.fda.gov/medical-devices/aesthetic-cosmetic-devices/dermal-fillers-soft-tissue-fillers · Regulatory
Content on this page is for educational purposes and is not a substitute for professional medical advice. Belotero Balance® is a registered trademark of Merz Pharma. Individual results may vary. Common effects after filler include swelling, bruising, tenderness and temporary firmness or asymmetry, and bruising is more visible in the thin skin under the eye. Serious complications are uncommon but can occur; call the practice immediately about increasing pain, skin color change or any change in vision. Cosmetic consultations are $125, paid at booking and credited toward the cost of treatment.