Understanding Tear Trough Treatments

Last updated: 5 August 2026

Tear trough deformity, the hollow or dark shadow that forms beneath the eyes, is one of the most common concerns patients bring to a clinic. It can make even well-rested individuals appear tired, aged, or unwell. Practitioners specialise in the delicate art and science of tear trough correction, using advanced techniques to achieve natural, refreshed results in this highly sensitive anatomical area.

Anatomy of the tear trough

The tear trough is a natural anatomical groove that runs from the inner corner of the eye (medial canthus) diagonally downward and outward along the junction of the lower eyelid and cheek. This groove is formed by the attachment of the orbicularis retaining ligament to the underlying bone.

Research published in Plastic and Reconstructive Surgery has identified several structural components that contribute to tear trough appearance:

• Orbital fatpseudoherniation of orbital fat creates a bulge above the trough, deepening its appearance
• Suborbicularis oculi fat (SOOF)volume loss in this fat pad creates hollowing beneath the groove
• Skin qualitythe under-eye skin is the thinnest on the body (approximately 0.5mm), making underlying structures highly visible
• Vascularitythe dense capillary network beneath this thin skin contributes to dark circles
• Bone structurethe depth of the infraorbital rim determines the baseline prominence of the trough

Causes of pronounced tear troughs

Several factors can worsen tear trough appearance:

• Ageingprogressive loss of midface volume, skin thinning, and bone resorption
• Geneticssome individuals have naturally deeper infraorbital grooves from early adulthood
• Sleep deprivationfluid redistribution and vasodilation worsen darkening
• Allergieschronic nasal congestion can cause venous pooling beneath the eyes
• Lifestyle factorssmoking, excessive alcohol, and high sodium intake exacerbate the appearance
• Sun exposureUV damage thins the already delicate under-eye skin
• Weight losssignificant weight reduction can deplete the fat pads supporting the under-eye area

Non-surgical treatment options

Hyaluronic acid filler

Hyaluronic acid (HA) filler injection remains the most widely used non-surgical treatment for tear trough correction. When performed by an experienced practitioner, it can produce remarkable improvements in under-eye hollowing. A 2021 systematic review in the Aesthetic Surgery Journal reported patient satisfaction rates of 85-95% for tear trough filler treatment.

The tear trough demands specific product selection and technique:

• Product selectiononly low-viscosity, non-hygroscopic (minimal water-attracting) HA fillers should be used to avoid puffiness and the Tyndall effect (bluish discolouration)
• Injection depthsupraperiosteal placement (directly above the bone) minimises the risk of irregularities visible through the thin overlying skin
• Volumeconservative volumes (typically 0.3-0.5ml per side) are essential; overfilling creates an unnatural appearance
• Techniquecannula-based injection is generally preferred over needle-based approaches, as it reduces bruising risk and allows more controlled product placement

Polynucleotide Injections

Polynucleotide (PN) injectable treatments represent an innovative approach to tear trough management. Rather than adding volume, PNs stimulate fibroblast activity, improve skin quality, and enhance hydration from within. Research in Journal of Cosmetic Dermatology (2022) has shown that PN treatments improve skin elasticity and thickness in the periorbital area, making them suitable for patients who need skin quality improvement rather than volume replacement.

Platelet-rich plasma (PRP)

PRP therapy uses concentrated growth factors from the patient’s own blood to stimulate collagen production and improve skin quality in the under-eye area. Whilst results are more gradual than filler, PRP offers a natural approach that addresses skin quality, dark circles, and mild volume loss simultaneously.

Skin quality treatments

Complementary treatments that improve the appearance of the tear trough area include:

• Chemical peelsgentle superficial peels can improve pigmentation and skin texture
• Microneedlingstimulates collagen in the delicate periorbital skin (using shorter needle depths)
• LED light therapyreduces inflammation and stimulates cellular repair
• Topical treatmentsretinoids, vitamin C, caffeine, and peptide-based eye creams

Important safety considerations

The tear trough is one of the most technically demanding areas to treat with injectable fillers. The periorbital region has a complex vascular anatomy, and the thin skin provides little margin for error. Potential complications, though rare in experienced hands, include:

• Tyndall effecta bluish discolouration caused by filler placed too superficially
• Malar oedemapersistent swelling due to filler migration or lymphatic obstruction
• Irregularities and lumpsvisible or palpable product through the thin skin
• Vascular compromiseextremely rare but serious, requiring immediate management with hyaluronidase

We mitigate these risks through rigorous patient selection (not all patients are suitable candidates for tear trough filler), advanced anatomical knowledge, cannula-based techniques, and having emergency protocols immediately available.

Who is not suitable for tear trough filler?

Honest patient selection is crucial. We may recommend alternative approaches for patients with:

• Significant lower eyelid fat prolapse (eye bags), which may require surgical blepharoplasty
• Very thin, crepey under-eye skin, where filler irregularities would be visible
• Significant festoons (malar mounds), which can worsen with filler
• Unrealistic expectations about the degree of improvement achievable

Frequently asked questions

How long does tear trough filler last?
Tear trough filler typically lasts 9-18 months, often longer than fillers in more mobile facial areas. The under-eye area has relatively little movement, which reduces the rate of filler breakdown. Many patients find that small touch-up treatments maintain results effectively.

Is tear trough treatment painful?
Most patients report minimal discomfort. We apply topical anaesthetic cream before treatment, and most HA fillers contain lidocaine for additional comfort. The cannula technique, which we prefer for this area, involves a single entry point rather than multiple needle punctures.

What is the recovery time?
Most patients experience mild swelling and possibly bruising for 3-7 days. The evidence supports avoiding strenuous exercise for 24 hours and sleeping with an extra pillow for the first two nights. Final results are visible once all swelling has resolved, typically at the two-week mark.

Can tear trough filler be dissolved?
Yes. HA fillers can be dissolved with hyaluronidase at any time if the results are unsatisfactory or if complications arise. This reversibility is one of the key safety advantages of HA-based tear trough treatment.