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What Is Tear Trough Deformity?

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Tear trough deformity is the term for a hollow, shadowed groove that runs from the inner corner of the eye downward and toward the cheek. It’s one of the most common cosmetic concerns we see at Centre for Surgery — and one of the most misunderstood, because patients often confuse it with bags, dark circles, or general "tired eyes." These are related but anatomically findings, and each one requires a different treatment.

This guide explains what tear trough actually is, why it develops, how to it from other concerns, and what the realistic treatment options are.

What the tear trough actually is

The tear trough is a anatomical . It’s the depression that marks the between the lower eyelid (which sits on a thin membrane over the eye) and the Cheek Filler (which sits on a substantial fat pad). In youthful faces, this is smooth — the cheek fat is full and high, and the lid blends into it. The "tear trough" exists but isn’t .

Tear trough deformity when that smooth becomes a groove or hollow. Several anatomical changes contribute:

Loss of fat volume. The cheek fat pads thin and with age. The cheek that used to sit high under the eye now sits lower, and the becomes visible as a shadowed line.

Bony rim changes. The bone around the eye socket actually changes shape with age — the lower rim resorbs slightly, a small step where the lid meets the cheek.

Skin thinning. The skin over the lower lid is around 0.5mm thick — the on the body. As it thins further with age, underlying structures (blood vessels, the underlying muscle) become visible through it, contributing to dark shadowing.

Tethering at the rim. The lower lid is firmly anchored to the bone of the orbital rim by ligaments. As the cheek tissue with age, the lid stays in place — and a visible step or groove forms at the point.

vector. Some patients are born with a bony where the eye sits forward of the cheek (rather than the cheek of the eye). This — called vector — a tear trough deformity even in young patients, and it which are appropriate.

For more on the broader context of ageing, see our guide on .

What causes it to develop or worsen

Ageing is the most common cause. Volume loss, bony changes, skin thinning, and skin laxity all progress over decades.

Genetics the . Some patients are born with prominent tear troughs that become in their twenties; others them only in their .

Significant weight loss can produce tear trough deformity at any age. Rapid loss of facial fat the cheek volume that previously concealed the junction.

Chronic stress and poor sleep contribute through mechanisms — changes, fluid patterns, and inflammation that affects skin quality.

Sun exposure accelerates and elastin breakdown, to skin and quality changes around the eye.

Smoking compounds the problem with direct collagen damage and vascular compromise.

Allergies and chronic eye conditions can to cycles that the under-eye .

Tear trough vs. under-eye bags vs. dark circles

These three findings often but they’re not the same thing, and confusing them leads to .

Tear trough deformity is a hollow or . It produces shadowing because light doesn’t reach into the groove. The area looks sunken or "in."

Under-eye bags are protrusions. They’re caused by fat through a septum (the membrane that holds the fat behind the eye in place). The area looks raised or "out." For more, see and

Dark circles are a discolouration of the skin. They can be caused by shadowing from a deep tear trough, by pigmentation from sun or genetics, by vascular show-through (blood vessels through thin skin), or by inflammation. See our guide on .

It’s possible to have all three at once — many do. But they need different treatments:

For the discussion of which patient suits which approach, see our and our companion guide on .

Treatment options for tear trough deformity

For most patients with isolated tear trough deformity, is the standard non-surgical . The is placed deep, onto the bony orbital rim, to fill the hollow from below — the smooth transition between lid and cheek.

The product choice significantly. The area requires a specific kind of HA filler — soft, with low water-binding capacity, for placement under thin skin. Standard cheek or lip fillers are too robust for this area. At Centre for Surgery the choice is Redensity 2, which is formulated specifically for the area. Read more about how long results last in our guide on .

Results are typically visible immediately and last 6 to 12 months on a first treatment. The treatment is reversible with if needed.

For patients whose tear trough is to descended cheek volume, is often more than tear trough filler. the volume above the junction lifts the descended tissue back to where it sat in youth, and the tear trough hollow indirectly — sometimes without needing any filler in the trough itself.

This is particularly true for in their 30s and early 40s where the underlying is intact but mid-face descent has begun. The cheek approach produces a more result than the hollow .

uses the patient’s own fat — from another area of the body — to fill the tear trough. Unlike HA filler, the result is for the fraction of fat that ( 50 to 70%). The transferred fat integrates fully with tissue and produces a softer, more natural-looking result than filler in cases.

Fat transfer is particularly useful for patients with significant volume loss across the mid-face, or for those wanting a long-lasting result. It’s often with blepharoplasty when both volume loss and skin or fat changes are present.

is the surgical that addresses excess lower lid skin and fat — the structural changes that filler cannot address. For patients whose under-eye concerns include true bags, significant skin laxity, or festoons, is the appropriate intervention rather than continued filler .

A specific variation — fat blepharoplasty — uses the orbital fat from the bag to fill the tear trough below, addressing both findings in a single procedure. This is a more sophisticated technique than simple fat and results in the right hands.

The procedure takes 1.5 to 2 hours and requires about a week of social downtime. Results are long-lasting and look natural when performed by experienced .

For patients also considering correction of the upper eyelid, full addresses both upper and lower lid in a single procedure.

For patients whose complaint is skin quality, pigmentation, or fine lines around the eye rather than the hollow itself, energy-based treatments may be more appropriate than filler.

stimulates and improves skin quality in the periorbital area. radiofrequency reaches deeper into the dermis for tightening. Both treatments can be combined with filler when both and skin-quality are present.

Who is a good candidate for tear trough filler?

The ideal has:

A useful self-test: pull the skin below your eye gently downward with a fingertip. If the hollow becomes less when the skin is stretched, filler is likely to help. If the hollow remains visible regardless, or if there’s clearly herniated fat sitting above the trough, filler isn’t the right answer.

for surgical (fat transfer or blepharoplasty) should additionally be and mentally healthy, or willing to stop smoking before surgery, and have realistic about and outcome.

A with our team — Dr Vlachos — which fits your anatomy and what the right intervention is.

Risks and complications

Filler complications include bruising, swelling, asymmetry, lump formation, migration, and from old undissolved product. The most serious — though rare — complication is vascular occlusion, which can cause skin necrosis or, in cases involving facial to the eye, vision changes. This is why tear trough filler should only be performed by practitioners with anatomical and immediate access to dissolving .

Filler complications worth about that develop later (over weeks rather than immediately) include bruising, worsening redness or swelling, persistent loss of sensation, severe pain, infection, or blurry vision. Any of these require urgent assessment.

complications include hematoma, infection, asymmetry, scarring, dry eyes, vision changes, and unsatisfactory aesthetic results. These risks are low in experienced hands but cannot be to zero by any technique.

Fat specific risks include overcorrection, asymmetry, lumpiness, and absorption touch-up .

A thorough consultation the realistic risk profile for the you’re considering.

What home remedies and lifestyle changes can achieve

Patients often ask about approaches. The honest answer:

Daily SPF, good sleep, hydration, and not smoking slow the progression of tear trough deformity but don’t reverse what’s already .

Topical skincare (retinoids, vitamin C, niacinamide) improves skin quality and can lighten pigmentation to dark circles, but doesn’t change the structural hollow.

Cold compresses reduce temporary puffiness but don’t change .

water for overall skin but won’t eliminate tear troughs.

Concealer and makeup can camouflage the appearance for daily use without any . For many patients, this is the right answer.

For wanting correction, the realistic remain filler, fat transfer, or surgery — on which anatomical changes are present.

Cost

Tear trough filler is priced per syringe of Teosyal 2. Most patients need 1 for the treatment with a possible top-up at 2 to 4 weeks. Surgical options vary substantially. , including 0% APR, are available.

Common questions

Most people some degree of tear trough with age, but the timing and vary enormously based on genetics, lifestyle, and bony anatomy. Some patients have visible tear in their twenties; others reach their without significant changes.

No. Once established, tear trough deformity tends to progress slowly with age rather than improving. The good news is that the change is — and the available work well for the right .

Retinol improves skin and may reduce fine lines around the eye, but doesn’t the hollow that tear trough . It’s a useful of overall skincare but not a for the deformity itself.

Patients with malar oedema (chronic lymphatic producing festoons) should not have filler — the with fluid and creates puffiness. Patients with body dysmorphic concerns about the eye area rarely achieve satisfaction with . and are to delay any . See our guide on for the full .

Look in a mirror at . Tear troughs are — the area below your lid looks darker or indented compared to your cheek. Bags are — the area below your lid looks raised or pouchy compared to your cheek. Many patients have both. The two need different treatments.

Hydration affects how the area looks day-to-day ( skin reflects light more evenly), but it doesn’t the changes that produce tear trough . water is part of good skin health, but it isn’t a .

Centre for Surgery · · GMC specialist-registered surgeons · · · ·

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Centre for Surgery is a CQC-regulated on London’s Baker Street, plastic and through GMC-registered specialist surgeons. Our expertise spans facial procedures including and , , for men, and body contouring procedures such as and . Patient safety, surgical and natural-looking results sit at the heart of everything we do.

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