What causes tear troughs and what is tear trough filler?

There are few topics in aesthetic medicine more controversial than tear trough filler. You will hear a wide variety of opinions on the internet from some people hailing the tear trough filler as the holy grail of under eye rejuvenation all the way through to people telling you that the whole concept is the spawn of satan and you should never even think about having it done.

I’m going to explain to you what the tear trough is, when filler in this area is helpful, when you should avoid it and what other procedures may be more appropriate depending on your circumstances.

Understanding Tear Trough Fillers: the basics. What even is a tear trough?

The tear trough is the hollow groove that runs at the junction between the lower eyelid and cheek, right in at the corner of your eye near your nose. It gets it name from the fact tears can collect in this groove (or trough) when we cry. Everyone has one naturally and it tends to get deeper as we lose volume under the eye as part of the ageing process. As the tear trough gets deeper, it creates a shadow which makes the under eye area look darker and more tired.

The Aesthetic Concerns of the Tear Trough Area

Since the tear trough tends to get deeper with age, creating more shadowing and darkness under the eye, it is an area that people often want to improve aesthetically as they age. When you correct the tear trough with some filler injections it usually results in a nice improvement in the appearance of the under eye area. However, ageing of the lower eyelid is not just down to deepening of the tear trough on its own – this is where things get a little more complicated, and is one of the main reasons for the controversy around tear trough fillers.

Ageing of the lower eyelid usually involves a combination of multiple processes. Most people have some volume loss, caused by reabsorption of the bone below the eye (yes, the bones of our face as being reabsorbed and literally disintegrating as we age!).

There can also be herniation of fat below the eye, resulting in prominent bulges of fat under the eye – and this is one of the first sources of mistakes that people make with tear trough filler. If the fat protrusion is minor, then you can use some filler to camouflage it. However, if there is more moderate or severe fat protrusion and you try to camouflage it all then you will simply make the eyelid look smooth but puffy – which is not a good outcome. In these circumstances, you probably need a lower eyelid blepharoplasty to remove the herniated fat.

The other change below the eyelid are to the surface of the skin – which can develop fine lines, wrinkles, crepey texture, or pigmentation changes. Again, some fine lines may get a little better by adding filler to the tear trough but if you have a lot of fine lines then you likely need a different type of treatment – either laser resurfacing, or possible eyelid surgery, to treat this.

The number one mistake people make with under eye filler is to try and use it as a ‘cure-all’ for every other eyelid problem, rather than sticking to its main purpose – which is the hollow junction between the eyelid and the cheek.

Types of Fillers for Under-Eye Rejuvenation

When it comes to under-eye rejuvenation, hyaluronic acid fillers are the most commonly used – although some doctors use your own fat (harvested from elsewhere on the body). I personally use hyaluronic acid and I will explain why. Proponents of fat will tell you that it’s more natural because it’s your own tissue, which is true. However, fat can go lumpy and if that happens to you then it can be almost impossible to correct. If you gain weight in the future, then fat will also grow and what was initially a good result can end up becoming too much. 

Proponents of fat will tell you that hyaluronic acid fillers are a bad idea under the eye because hyaluronic acid retains water and can make you puffy. This is partially true, in that hyaluronic acid does retain water and can make you puffy – which is why choosing the right product, and injecting the correct amount in the correct place is critical to achieving a good result.

I personally chose to use Juvederm Volbella for most of my tear trough filler treatments because it has a relatively low concentration of hyaluronic acid at 15mg/ml. My personal observation is that the lower the concentration of hyaluronic acid in the gel, the less water retention you get and the fewer problems you see with puffiness following treatment. Again, as well as injecting the correct product – you also need to be conservative with the volume injected and you need to be careful not to try and push it too far in an effort to correct other eyelid issues that would be better treated with other modalities like laser or surgery.

The Procedure: What to Expect During Tear Trough Filler Treatment

The tear trough filler procedure begins with a detailed consultation and examination. During the consultation we want to find out about your medical history, any medications you take, any allergies you may have and we want to know about what cosmetic treatments you’ve had in the past – especially around the eye area. This is especially important for tear trough filler consults.

I normally do tear trough fillers using a blunt tipped cannula. This usually means just one sharp needle stick to create an entry point, following which you normally just feel a little movement sensation under the skin – but not pain.

Afterwards there will be some redness and swelling from the injection. You can normally see an instant improvement, although it typically improves over the first couple of weeks as the filler settles in and retains a little water which smooths things over a bit more (we always try to slightly under correct because we know there is going to be a little water retention, even with a good product).

Selecting the Right Injector: Credentials and Experience

Choosing a qualified and experienced injector is paramount to achieving the best results and minimising potential risks with any cosmetic procedure, but this is especially true when treating the tear trough. Having the judgement of how much to inject and where is critical to achieving a good outcome. The reason you see so many mixed reviews of tear trough filler is that it is the most technically challenging procedure to perform and poor planning and technique are usually responsible for bad outcomes.

Potential Risks and How to Mitigate Them

Like any medical procedure, tear trough fillers come with potential risks and side effects. The biggest issue following treatment is a poor cosmetic outcome. This is often caused by either injecting the wrong type of filler, which retains a lot of extra water, or injecting too much gel – either from poor judgement, or a misguided effort to correct other eyelid issues is usually responsible for poor cosmetic outcome. A careful, judicious approach from an experienced doctor should avoid this.

The Longevity of Tear Trough Fillers: What Influences Duration?

The duration of all hyaluronic acid fillers is almost always longer than you expect. The fillers, depending on the product, are licensed to last up to two years – although there is plenty of evidence to show that they can hang around much longer than this. This is especially so in the tear trough. I once had a patient with swollen tear troughs who insisted the swelling couldn’t be due to filler injections because it had been ten years since she had filler. And guess what? I injected some hyaluronidase and the swelling went away. TEN years later. It doesn’t always last that long, but it’s important to consider this when you are thinking about repeating the treatment.

One of the biggest mistakes that people make with tear troughs is repeating the filler treatment too frequently. If you think you are ready for another tear trough filler its important to go through a full assessment again – is it really recurrent tear trough hollowing thats the problem, or is it another age related change that would be best treated with another type of treatment? Just because a tear trough filler worked well for you in the past, doesn’t mean that it will always be the right solution for you. This is where a good relationship with an experienced doctor is critical to ensure the best results.

Cost Considerations and Finding ‘Tear Trough Fillers Near Me’

The cost of tear trough fillers can vary widely, depending on factors such as the type of filler used and the expertise of the doctor. It’s important to remember that while cost is a consideration, the skill and experience of the doctor should be paramount and it’s worth saving a little longer or travelling a little further to get the best treatment.

Conclusion: Embracing a Holistic Approach to Under-Eye Rejuvenation

Tear trough fillers are a great way to rejuvenate the under eye area – provided you get the right advice and technical treatment delivery by an experienced doctor. It’s not a cure for all under eye problems – but a nuanced approach to a particular set of circumstances.