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What Is Tear Trough Deformity?

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Tear trough is the term for a hollow, groove that runs from the inner corner of the eye and outward 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 distinct findings, and each one requires a different treatment.

This guide what tear trough deformity actually is, why it develops, how to distinguish it from other under-eye concerns, and what the realistic treatment options are.

What the tear trough actually is

The tear trough is a anatomical . It’s the that marks the transition between the lower eyelid (which sits on a thin membrane over the eye) and the cheek (which sits on a fat pad). In faces, this transition 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 visible 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 lid-cheek junction becomes as a shadowed line.

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

Skin . 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 muscle) become visible through it, contributing to dark shadowing.

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

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

For more on the broader of under-eye 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 determine the baseline anatomy. Some are born with prominent tear troughs that become visible in their twenties; others them only in their .

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

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

Sun exposure and breakdown, contributing to skin thinning and quality changes around the eye.

Smoking compounds the problem with direct damage and compromise.

Allergies and chronic eye conditions can contribute to swelling cycles that exaggerate the .

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

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

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

bags are protrusions. They’re caused by fat herniating 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 of the under-eye skin. They can be caused by from a deep tear trough, by pigmentation from sun exposure or genetics, by vascular show-through (blood vessels visible through thin skin), or by inflammation. See our guide on .

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

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

Treatment options for tear trough deformity

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

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

Results are 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 cheek volume, is often more effective than tear trough filler. Restoring the volume above the lifts the tissue back to where it sat in youth, and the tear trough hollow softens indirectly — sometimes without needing any filler in the trough itself.

This is particularly true for patients in their 30s and early 40s where the is intact but has begun. The cheek a more natural-looking result than the hollow .

uses the patient’s own fat — harvested from another area of the body — to fill the tear trough. Unlike HA filler, the result is permanent for the fraction of fat that survives transfer ( 50 to 70%). The transferred fat integrates fully with surrounding tissue and produces a softer, more result than synthetic 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 herniated fat — the structural changes that filler cannot address. For whose under-eye concerns include true bags, significant skin laxity, or festoons, is the appropriate rather than continued filler treatment.

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

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

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

For patients whose primary 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 collagen and improves skin quality in the periorbital area. radiofrequency microneedling reaches deeper into the dermis for . Both treatments can be with filler when both structural and concerns 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 with a . If the hollow becomes less visible when the skin is stretched, filler is likely to help. If the hollow remains visible regardless, or if there’s clearly fat sitting above the trough, filler isn’t the right answer.

Candidates for (fat transfer or blepharoplasty) should additionally be physically and mentally healthy, non-smokers or willing to stop smoking before surgery, and have realistic expectations about and .

A consultation with our specialist team — including Dr — establishes which category fits your and what the right is.

Risks and complications

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

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

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

Fat specific risks include overcorrection, asymmetry, lumpiness, and partial requiring touch-up treatment.

A thorough consultation explains the 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 what’s already established.

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

Cold compresses reduce but don’t change underlying .

Drinking water matters for overall skin but won’t established tear .

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

For patients wanting correction, the options remain filler, fat transfer, or surgery — depending on which changes are present.

Cost

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

Common questions

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

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

skin quality and may reduce fine lines around the eye, but doesn’t address the hollow that Tear Trough Fillers trough deformity. It’s a useful component of overall but not a treatment for the deformity itself.

Patients with malar oedema ( puffiness producing festoons) should not have filler — the accumulates with fluid and creates puffiness. with body about the eye area rarely achieve with . Pregnancy and breastfeeding are to delay any elective . See our guide on for the full discussion.

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

Hydration affects how the area looks (well-hydrated skin light more evenly), but it doesn’t reverse the changes that tear trough deformity. Sufficient water is part of good skin health, but it isn’t a treatment.

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Centre for is a hospital on London’s Baker Street, delivering plastic and cosmetic surgery through . Our spans facial and , , for men, and body contouring procedures such as and . Patient safety, excellence and results sit at the heart of everything we do.

Centre for is a CQC-regulated hospital on London’s iconic , plastic and cosmetic led by GMC-registered surgeons.

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