Tear trough filler places small amounts of hyaluronic acid into the hollow between the lower eyelid and the cheek to reduce shadowing. It suits a narrow group of people with a genuine hollow, thicker skin and no fluid retention. In many others it makes the area look worse.
| Classification | Medical device, injected. High-risk anatomical site |
|---|---|
| Volume | Very small. Measured in fractions of a millilitre per side |
| Onset | Immediate, though the area is unusually slow to settle |
| Settling | Four to six weeks, longer than elsewhere on the face |
| Duration | Often longer than other sites, sometimes well over a year |
| Reversal | Hyaluronidase, which is used here more often than anywhere else |
| Main failure | Puffiness and fluid retention rather than an improved hollow |
The skin of the lower eyelid is the thinnest on the body. Beneath it sits a thin muscle, then, in a well-defined pocket, the fat that cushions the eye. The tear trough itself is a groove created where a ligament tethers skin to the bone of the eye socket rim.
Every property of this area amplifies error. Thin skin shows anything placed too superficially, including as a grey-blue line. Poor lymphatic drainage means hyaluronic acid, which attracts water, can hold fluid here for months. And the vessels connected to the eye run close by, which places this among the highest-risk sites for the rare complication of visual loss.
This is not a beginner's area, and it is not a lunchtime treatment. It is the site where a practitioner's willingness to refuse matters most.
The people who do well share several features:
Poor candidates are more numerous. Fluid retention, prominent fat pads, very thin crepey skin, pigmentation rather than shadow as the cause of darkness, a negative vector where the eye sits forward of the cheek, and prior filler that has not been assessed all make this a treatment to decline or to postpone.
Press gently below the eye and lift the skin, or look at the area with a light held below your face rather than above. If the darkness disappears when the shadow is removed, it is structural and filler may help. If it remains, it is pigmentation or thin skin showing vessels, and filler will not treat it.
A large proportion of under-eye hollowing is not an eyelid problem at all. When the cheek loses volume and descends, the junction between eyelid and cheek lengthens and deepens. Filling the trough directly in that situation places product into a hollow that will simply reappear above it.
Experienced practitioners frequently treat the cheek first, review, and then decide whether anything is needed under the eye at all. Often the answer is that very little is. This is slower and involves more than one appointment, and it produces the result people were actually asking for.
The frequency with which this area is dissolved is itself informative. Ask any practitioner how often they dissolve tear trough filler, including their own, and listen to whether the answer sounds like experience or like marketing.
Full guidance is on the aftercare page.
Read how to choose a clinic in London before committing to this area in particular.
Only if the darkness is caused by a shadow from a hollow. Where it is pigmentation or visible vessels through thin skin, filler will not help and may make the area look heavier.
Often longer than filler elsewhere, sometimes well beyond a year, partly because the area moves so little.
Hyaluronic acid attracts water and the lower eyelid drains poorly. Persistent puffiness usually needs dissolving rather than waiting.
Uncomfortable rather than painful, though the area bruises easily and can be tender for days.
Frequently yes. Much under-eye hollowing follows mid-face volume loss, and treating the cheek can reduce or remove the need for anything under the eye.
It is among the higher-risk filler sites, including the rare risk of visual loss. It should be done by someone experienced specifically in this area, with hyaluronidase on site.
Hyaluronic acid can be dissolved. This area is dissolved more often than any other, which is worth knowing before you decide.
Treatment
The highest-leverage area on the face, and the easiest one to ruin by degrees.
Read
Treatment
A medical device, not a medicine. That single fact explains most of what is wrong with the market.
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Treatment
Hydration delivered into the skin rather than onto it. A course, not an appointment.
ReadThis website sells nothing and books nothing. It exists so that you walk into a consultation already knowing which questions separate a careful practitioner from a confident one, and already knowing when the correct answer is to leave without treatment.
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