Tear trough filler: under-eye hollows, risks, and realistic results

Tear trough filler is one of the most requested and most technically demanding filler treatments. The under-eye area is unforgiving — both anatomically and aesthetically — which makes provider selection more critical here than in almost any other injection site.

What the tear trough is

The tear trough is the groove that runs from the inner corner of the eye diagonally down toward the cheek. When this hollow is pronounced, it creates the appearance of dark circles, shadows, and tiredness regardless of how much sleep you've had.

Tear trough hollowing is caused by multiple factors:
Volume loss: Fat pads under the eye atrophy with age
Skin thinning: The periorbital skin is the thinnest on the face and becomes more translucent with age, making underlying structures more visible
Skeletal changes: The orbital bone remodels over time, changing the contour of the eye socket
Ligamentous laxity: The orbital retaining ligament loosens, allowing the fat pad to descend
Genetics: Some patients have prominent tear troughs in their 20s without significant aging

Filler addresses volume deficit — it does not treat pigmentation, skin quality, or the underlying ligamentous changes.

Why tear trough filler is high-risk

The tear trough area has:

Thin, unforgiving tissue: Product placed incorrectly is immediately visible. Lumps, ridges, and the Tyndall effect (a blue-grey hue caused by light scattering through HA filler too close to the surface) are more likely here than anywhere else on the face.

Orbital proximity: Incorrect injection near the orbit can cause vascular occlusion affecting the ophthalmic artery, which in rare cases can lead to vision loss. This is why the tear trough is considered the highest-risk area for filler.

Complex blood supply: The angular artery, dorsal nasal artery, and infraorbital artery all run in this region. The vascular anatomy here is denser and less predictable than other injection zones.

This is not a beginner injection area. Many experienced injectors will refuse to perform tear trough filler on patients with inadequate candidacy, and will decline to train on it without cadaveric anatomy study. If a provider downplays the complexity, that's a red flag.

Who is a good candidate?

Good candidates:
Hollow tear troughs with adequate skin thickness: Thin skin (which makes any filler visible) is a contraindication
Volume-based hollowing rather than pigmentation or vascular shadowing
Minimal puffiness: Patients with significant under-eye bags (orbital fat prolapse) are not good candidates — adding filler below an existing puffy area makes the puffiness look worse
Realistic expectations: Tear trough filler produces subtle improvement, not dramatic transformation

Poor candidates:
Significant under-eye bags or puffiness — surgery (blepharoplasty) is better
Very thin, crepey skin — filler will be visible and lumpy
Patients prone to swelling or who have had previous filler complications in this area
Dark circles caused by pigmentation rather than hollowing — filler does nothing for pigment

What filler is used

Only soft, thin HA fillers are appropriate for the tear trough. High-viscosity, structural fillers (Volux, Radiesse, Sculptra) must never be used in this area — they are too thick, visible, and not reversible with hyaluronidase (in the case of non-HA fillers).

Appropriate options:
Restylane-L / Restylane Eyelight (Restylane Eyelight is specifically FDA-cleared for tear troughs)
Belotero Balance — thin and flexible; integrates smoothly with thin tissue
Juvederm Volbella — soft and spreadable; less risk of lumping

Most skilled injectors use a cannula rather than a needle for tear trough — the blunt tip significantly reduces vascular risk and allows the filler to be deposited more precisely.

How much product is needed?

Less than you might expect. The tear trough area is small — typically 0.2–0.5 mL per side (0.4–1 mL total) for a full treatment. Overfilling the tear trough is one of the most common errors and is very obvious.

Cost

| Treatment | Volume | Cost range |
|---|---|---|
| Tear trough (both sides) | 0.5–1 mL | $600–$1,600 |
| Tear trough + mid-face | 1–2 mL | $1,200–$3,000 |

Note: Many providers now recommend treating the mid-face (cheek/malar) first before adding tear trough filler — restoring cheek volume often improves the tear trough hollowing without any periorbital injection, reducing risk.

What to expect during and after treatment

Session duration: 20–30 minutes, including numbing (topical cream 30–45 min before, plus injectable lidocaine).

Immediately after: Swelling that will make results look uneven or worse than before. This is normal and expected.

Week 1: Swelling and bruising are common in this area — thin skin bruises easily. Plan for 7–10 days of social downtime.

2–4 weeks post-treatment: True result becomes visible as swelling fully resolves. Evaluate then, not at day 1 or even day 7.

Duration: Results last 9–18 months, shorter than fillers in other areas because facial movement and the thin tissue accelerate metabolism.

The Tyndall effect and lumping

The two most common adverse outcomes:

Tyndall effect: A blue-grey discoloration caused by HA filler placed too superficially. It's not bruising — it's light scattering. The solution is hyaluronidase dissolution. This is why thin, deep placement technique matters.

Lumps and irregularities: Hard nodules under the skin from filler that wasn't evenly distributed. Can sometimes be massaged out early; otherwise requires hyaluronidase.

Both are treatable with hyaluronidase. This is why HA filler is mandatory in this area — the reversibility is a meaningful safety net.

Questions to ask before booking

How many tear trough cases have you done specifically? Can I see before-and-afters?
Do you use a needle or cannula for tear trough injection?
What product do you use and why — is it soft enough for periorbital tissue?
What is your protocol if I develop Tyndall effect or lumping?
Given my anatomy, am I actually a good candidate, or would you recommend treating the mid-face first?

A provider who immediately agrees to fill the tear trough without evaluating whether you're a candidate first is not the provider you want for this treatment.

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