Tear Trough Fillers for Under-Eye Hollows

The tear trough is the most technically demanding area of the face to treat with filler. The skin is thin, the anatomy is unforgiving and the margin for error is small. It is also the area where the difference between a good and a poor result is most visible.

What the tear trough is

The tear troughs are the grooves between the lower eyelids and the cheeks. They become more pronounced with age, fatigue or as a result of individual anatomy. The area can appear darker or hollow, producing a tired appearance independent of how rested you actually are.

The skin around the eyes is thin and loses elasticity over time, while the underlying fat and muscle structures shift or reduce.

Several factors contribute. Age reduces collagen and elastin, which provide structure and firmness, leading to volume loss. Repeated facial expression deepens the grooves over time.

Anatomy matters. Prominent tear troughs often run in families. Skin tone and thickness also affect how noticeable they are — thinner or lighter skin makes the grooves more visible because of how light interacts with the skin.

Fatigue exacerbates the appearance. Fluid accumulates, causing puffiness and deepening shadows, and poor circulation from lack of sleep intensifies the darkness.

What filler does here

Filler adds volume and smooths the area beneath the eyes, reducing the shadowing that produces the appearance of dark circles.

Tear trough fillers are usually hyaluronic acid based. Hyaluronic acid occurs naturally in skin, where it retains moisture and contributes volume. When injected it fills the hollow, producing a smoother transition between lid and cheek.

An important distinction: filler addresses hollowness and the shadow it casts. It does not address pigmentation in the skin itself, and it does not address significant lower-lid fat prolapse — that is a surgical problem. Establishing which of these is the actual cause determines whether filler is the right treatment at all.

The procedure

Consultation comes first — assessment of the facial structure and skin type, and whether you are a suitable candidate. Pre-treatment photographs are usually taken.

On the day, the under-eye area is cleansed. A topical anaesthetic is applied, or a filler containing lidocaine is used. The filler is injected using a fine needle or cannula. The choice between the two depends on technique and the individual anatomy; a cannula is often preferred in this area because it reduces the risk of vessel injury.

The injection process typically takes 15 to 30 minutes. The area is gently massaged to ensure even distribution.

Minor swelling or bruising afterwards is common and usually settles within a few days. Results are visible almost immediately but continue to improve over the following weeks as the filler settles.

Choosing the filler

The consistency of the product matters more here than elsewhere. Thinner consistency fillers blend better with the delicate under-eye skin and reduce the risk of visible lumps and irregularity.

Hyaluronic acid fillers are the appropriate choice for this area. They integrate smoothly and, critically, they are reversible — if the result is uneven or the product is placed too superficially, it can be dissolved. In an area this unforgiving, reversibility is not a convenience, it is a safety feature.

Most hyaluronic acid fillers here last six months to a year.

If you have thin skin, a filler that minimises the risk of visibility through the skin is required — the Tyndall effect, a bluish discolouration from superficially placed product, is a recognised problem in this area.

Risks

Bruising or swelling at the injection site is common and usually temporary. Redness or tenderness typically settles within a few days.

Lumps or unevenness beneath the skin can occur if the filler is not evenly distributed, and may require correction. Allergic reaction is rare but possible, which is why medical history is discussed beforehand.

Filler migration — movement away from the intended area — can produce an unnatural appearance, and is more of a problem in this region than elsewhere.

Vascular occlusion is the serious risk. Injection into a blood vessel can cause significant complications including, in this region, visual disturbance. Practitioner experience and knowledge of periorbital vascular anatomy is the principal safeguard.

Aftercare

Apply a cold compress gently over the treated area to reduce immediate puffiness — gentle pressure only.

Avoid vigorous exercise, excessive sun exposure and alcohol for at least 24 to 48 hours. These increase blood flow and can worsen swelling and bruising. Keep the head elevated, including when sleeping.

Avoid touching or massaging the treated area unless specifically instructed otherwise, as this can displace the filler.

Improvement is visible almost immediately, but the full effect becomes apparent after the initial swelling settles, usually within a week or two.

How we quote

Fees depend on the product and volume used, and are set out in writing after assessment.