Tear trough filler: is it right for you?

What is the tear trough?

The tear trough is the groove that runs from the inner corner of the eye down towards the cheek. With age, or simply because of the way your face is built, this groove can deepen and cast a shadow. The result can be a tired look that sleep does not fix.

Tear trough filler places a small amount of soft hyaluronic acid filler to soften that hollow. When it suits the person, the change can be subtle but meaningful. When it does not, it can make things look worse. That is why assessment matters so much.

What filler can and cannot do

Filler can help when the main problem is volume loss: a hollow or groove that creates a shadow.

Filler is not usually the answer for:

• Under-eye bags, where fat pads push forward. Filler can make them look more prominent.
• Puffiness or fluid retention, which can be worsened by filler in this area.
• Dark pigmentation, where the skin itself is darker. Filler does not change skin colour.
• Very thin or crepey skin, where a skin-quality treatment may be more appropriate first.

Who tends to suit it

• People with a visible hollow or groove under the eyes.
• Reasonable skin thickness and quality in the area.
• Little or no puffiness or bagging.
• Realistic expectations: the aim is a fresher, less shadowed look, not a perfect one.

Who usually does not

• People whose main concern is bags or puffiness.
• People with swelling under the eyes that comes and goes.
• Anyone who is pregnant or breastfeeding, has an infection in the area, or has reacted to filler before.

The risks

All injectable treatments carry risks, and the under-eye area needs particular care. The most common side effects are bruising and swelling, which usually settle within one to two weeks. Less common problems include:

• Small lumps or unevenness.
• A bluish tinge if filler sits too close to the surface of the skin.
• Prolonged swelling under the eyes.
• Infection or delayed inflammation.
• Rarely, filler can block a blood vessel and damage the skin or other tissue. This is a serious complication that needs urgent treatment, and very rarely it can cause permanent loss of vision.

Careful assessment and technique lower these risks but cannot remove them, which is one reason this treatment should only be carried out by a medically trained practitioner who can assess you properly and manage complications. Hyaluronic acid filler can sometimes be dissolved after a clinical assessment, but dissolving is a medical treatment with its own risks and cannot guarantee a return to how you looked before.

If your vision changes after filler, call 999 or go to A&E straight away and tell them you have recently had filler.

Alternatives worth knowing about

• Polynucleotides aim to improve the quality of thin, crepey under-eye skin without adding volume.
• Cheek filler can sometimes improve the under-eye area indirectly, by restoring support in the mid-face.
• Skincare and sun protection can help with texture and pigmentation over time.
• Surgical opinion. For significant bags, a referral to discuss surgery may be the honest advice.

What to expect if you go ahead

If you are suitable, a conservative amount of filler is placed, often with a blunt cannula to reduce bruising. You will be given aftercare advice, including sleeping with your head slightly raised and avoiding rubbing your eyes. Results often last around 9 to 12 months and can last longer, because the area moves relatively little.

The best next step

Because suitability varies so much, the only reliable way to know whether tear trough filler is right for you is a face-to-face assessment. At a consultation, your under-eye area is assessed, your options are explained honestly, and you will be told if filler is not the right choice.