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What is the tear trough?

I have had a few enquiries lately about the tear trough and I thought I would provide some information to make it easier to understand.

Where is the tear trough?

It’s the small depression underneath the eye and above the cheek.

Why is it called a tear trough deformity?

Because not everyone has the depression, it was described as a deformity, and named a ‘trough’ because it was the route the tears would run down when they leaked from the eye.

The area can become more depressed as we age but there are small children that have this depression, usually as a result of genetics.

Why would you treat it?

The depression can cause the eye to look tired, hollowed out, filled with shadows and make you look like you have dark circles. Tear troughs can also vary in grade.

How do we treat it?

The best treatment for this area starts by identifying the real problem – is it volume loss? Or Skin laxity? Or excess tissue? Or Pigmentation? Or loss of mid-facial support due to ageing. (Midface – the area between the eye and the cheek, from ear to the nose)

If it is true volume loss of the midface, then firstly supporting the area by adding volume to the deep fat pads and scaffolding the cheek bones, can minimise the appearance of the deformity. Treating the mid face also carries less side effects and can result in less filler use in the tear trough itself. Once the midface has been supported, then only would I move on to the actual tear trough to address any further hollowing.

What are the risks?

The simple risks are bruising, swelling and over treatment (with bulging of filler). Often the result is subtle and not as ‘wow’ as you imagined it would be.

The big risks are permanent eye swelling, the risk of blindness from filler getting into the eye and similarly strokes as the filler can migrate to the brain. These are very rarely occurring risks but that is why it is important to choose your injector carefully. Someone who knows their anatomy, has experience injecting (3-5 years at least), uses high quality filler preferably FDA approved and who knows how that filler will react in that area. Injectors should also know how to diagnose and treat emergencies.

How do I minimise risks?

I select only FDA approved fillers designed for treating these areas. I use a cannula to minimise bruising and complete the treatment over 2-3 sessions, 2 weeks apart. This area is prone to bruising and swelling so best to plan this treatment when you don’t have a big event on.

I always undercorrect the area. This means I inject the area but stop before the skin is flush with the surrounding skin. This is because the tear trough is prone to swelling and will swell due to the filler drawing water. We need to leave some space for this to happen so that the area doesn’t bulge out. This is also why I treat this area over 2 sessions to allow for extra filler to be placed if necessary.

Other options for treatment?

Sometimes filler in this area is not the answer...if you have:

Skin laxity – a consult to discuss medicated skincare or collagen inducing treatments to thicken the skin and build support.

Pigmentation issues – a consult to discuss pigment reducing creams.

Excess tissue around the eye – a consult with a surgeon for surgical repair.


If you are interested, please book in for a consult to see me so that we can assess your eye area and determine what is causing your concern. I will then be able to give you a better idea of what will work and what wont.

Please call 075 5319 2744 to book or email Online booking can be done at

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