Tear trough deformities became one of the most frequent concerns among patients seeking facial rejuvenation. This condition causes a tired or aged appearance, even if patients otherwise have youthful skin. The underlying causes range from genetics and natural aging to sleep deprivation and dehydration.

Dermal fillers can restore lost volume and improve the transition between the lower eyelid and cheek. Probably the biggest obstacle is the sensitivity of the tear trough region. Because of that, a deep understanding of facial anatomy and the choice of filler are even more important than otherwise.

Today, we aim to explore tear trough correction, from anatomical considerations to selecting the most suitable dermal fillers. We will also cover many other different, but related topics.

Tear Troughs and Their Aesthetic Impact

The tear trough is a prominent anatomical region that extends from the inner corner of the eye, running obliquely downward and outward across the cheek. It forms a natural groove that can become more visible over time due to a variety of factors. It makes people look old and tired.

Several factors can contribute to the development and exacerbation of tear trough deformities:

• Aging: As the skin ages, it loses collagen and elasticity, while fat pads under the eyes begin to shift downward. This natural loss of volume in the orbital rim leads to the formation of visible hollowing along the tear trough.
• Genetics: Some individuals are genetically predisposed to deeper tear troughs, even at a younger age. Lifestyle factors such as poor sleep and excessive sun exposure can make it even worse.
• Lifestyle Choices: Poor nutrition and smoking accelerate skin aging, making the tear troughs more pronounced. Dehydration and excessive alcohol consumption can also contribute.

Since the eyes are one of the most expressive features of the face, the tear trough plays a big role in how others perceive an individual’s overall vitality and age.

Suitable Types of Dermal Fillers

When used for tear trough correction, dermal fillers have the power to reduce hollowness and make a smoother transition between the lower eyelid and cheek. But because the under-eye area is so delicate, choosing the right filler is often very tricky, because issues like swelling, lumpiness, or vascular complications are not rare.

Unique properties of these fillers influence their suitability for tear trough treatments.

Hyaluronic Acid (HA) Fillers

Hyaluronic acid is a naturally occurring substance in the skin. HA fillers are the preferred choice for tear trough treatments due to their biocompatibility, softness, and reversibility with hyaluronidase if needed. These fillers integrate well into the tissue. Brands such as Restylane Eyelight, Juvederm Volbella, and Belotero Balance are frequently used for under-eye rejuvenation, as they have a lower viscosity and reduced risk of Tyndall effect (a bluish discoloration that can occur when fillers are placed too superficially).

Calcium Hydroxylapatite (CaHA) Fillers

CaHA fillers, such as Radiesse, are composed of microscopic calcium-based spheres suspended in a gel carrier. These fillers provide both immediate volume and long-term collagen stimulation. However, due to their thicker consistency and stronger lifting capacity, CaHA fillers are rarely used in the tear trough region. When applied incorrectly in this area, they may cause excessive fullness or a palpable texture.

Poly-L-lactic Acid (PLLA) Fillers

PLLA-based fillers, such as Sculptra, work by stimulating collagen production over time rather than providing immediate volume. While highly effective for deep volume loss in areas like the cheeks and temples, they are generally not recommended for tear trough treatments. The risk of delayed nodules, excessive firmness, and unpredictable collagen deposition makes them less desirable for such a thin, mobile region.

Injection Techniques for Tear Troughs

We have to start with precision in product placement, instrument choice, and volume control. Those three together are guarantees of success or, on the other hand, failure.

You need to follow these steps:

• Patient Assessment and Marking: A thorough pre-treatment evaluation is used for determining the depth, extent, and severity of tear trough hollowing. Skin thickness, presence of malar fat descent, and venous congestion should be assessed. You need to properly mark the infraorbital rim, orbital retaining ligament, and lateral extent of the tear trough.
• Choice of Instruments: Cannula or needle? While sharp needles (25G-30G) allow for precise bolus placement, they pose a higher risk of vascular occlusion, bruising, and irregular distribution. Blunt-tipped cannulas (22G-25G) are usually better as they navigate the delicate vascular network more safely.
• Injection Depth and Placement: Just above the orbital bone is the optimal depth for structural support while maintaining a natural contour. Depositing small, linear threads of filler along the tear trough ligament is a way to distribute.
• Volume Control: The tear trough requires minimal filler, and overcorrection can lead to persistent swelling and unnatural fullness. Gradual, micro-aliquot injections (0.05-0.1 mL per pass) maintain precision and allow for adjustments. Typically, 0.3-0.5 mL per side is sufficient, with reassessment after two weeks to determine if correction is needed.
• Post-Injection Molding and Massage: After injection, gentle molding with a cotton swab or gloved fingers helps evenly distribute the filler and smooth out irregularities. Excessive pressure should be avoided to prevent displacement or vascular compression.

Safety Considerations and Risk Management

While generally safe, tear trough filler treatments can present complications:

• Bruising and Swelling: Common but typically transient, these can be minimized with proper injection placement and post-procedure care.
• Tyndall Effect: Discoloration resulting from superficial placement of HA fillers; preventable by appropriate injection depth.
• Vascular Compromise: Although rare, inadvertent intravascular injection can lead to tissue necrosis or vision loss.

Trends and Innovations in Tear Trough Fillers

Current Trends and Innovations in Tear Trough Filler Treatments

The field of tear trough rejuvenation is continuously evolving with the goal of improving appearance and safety.

AI Integration in Treatment Planning

Artificial Intelligence (AI) is making its mark in dermal filler treatments, with algorithms now being used to assess patient anatomy and predict the most suitable filler types and injection patterns. AI-driven tools analyze facial structures and create highly personalized treatment plans that aim to optimize both safety and aesthetic outcomes.

Advanced Injection Techniques

Refinements in injection techniques aim to enhance precision and longevity while reducing downtime. The Three-Point Tangent Technique, for example, targets key anatomical landmarks to achieve a balanced and natural under-eye contour with minimal trauma. Additionally, ultrasound-guided injections help practitioners visualize vascular structures in real time, significantly lowering the risk of complications.

Patient-Centric Treatments

Aesthetic medicine is shifting towards personalized, patient-focused treatment plans that prioritize subtlety and natural improvements. Rather than overfilling the tear trough, clinicians are focusing on facial balancing, integrating cheek support and skin quality improvements into treatment plans.

Combination Therapies

Standalone dermal fillers are now frequently paired with other fillers and complementary treatments to optimize results. Procedures like microneedling with platelet-rich plasma (PRP), radiofrequency skin tightening, or laser resurfacing can improve skin texture, elasticity, and pigmentation in the tear trough area. Even with revolutionary products that are derived from human adipose tissue.

Longer-Lasting and Biodegradable Fillers

Research into next-generation filler materials is ongoing. Newer formulations contain crosslinked hyaluronic acid with longevity boosters, while others incorporate biodegradable scaffolds that stimulate collagen renewal over time.

In Conclusion

Correcting tear trough deformities with dermal fillers is an amazing method, which has helped many people. Whether using Hyaluronic Acid (HA) fillers, Calcium Hydroxylapatite (CaHA), or Poly-L-lactic Acid (PLLA), each product has its place in tear trough rejuvenation based on its ability to restore volume, smoothen contours, and improve the under-eye area naturally.

Beyond the product itself, we have to keep in mind that this is a highly specialized procedure, which must be done perfectly so that the results are desired and the side effects are minimal.

Always follow new trends and use the best fillers and cannulas/needles to maximize patient satisfaction.

Frequently Asked Questions (FAQs)

How do dermal fillers compare to surgical options for tear trough correction?

Dermal fillers are a non-invasive alternative to surgery for tear trough correction, giving immediate results with minimal downtime. Unlike lower blepharoplasty, which removes excess skin and fat, fillers restore lost volume and improve under-eye hollowing without permanent alterations. However, fillers require periodic maintenance, while the results of surgery last longer, so it can be necessary for severe cases.

Can tear trough fillers be combined with other treatments like lasers or microneedling?

Yes, tear-trough fillers can complement treatments like lasers or microneedling to maximize under-eye rejuvenation. Fillers restore lost volume, while lasers target pigmentation and skin texture. On top of that, microneedling boosts collagen production. So, they are very complementary, but treatments should be spaced to avoid excessive swelling or irritation.

What factors determine the longevity of tear trough fillers in different patients?

The durability of tear trough fillers depends on metabolism, filler type, injection technique, sun exposure, smoking, etc. Patients with a fast metabolism may break down fillers faster. Yet, highly cross-linked fillers tend to last longer. Proper hydration and skin care can also prolong results.

Are there specific pre-treatment preparations that improve filler outcomes in the tear trough area?

Avoiding blood thinners (like aspirin or NSAIDs), alcohol, and excessive salt intake before treatment can minimize bruising and swelling. Staying hydrated and using gentle skincare can also help create an optimal injection environment. Some practitioners recommend arnica or bromelain supplements to further reduce bruising.

Which age groups benefit the most from tear trough fillers?

Younger patients (late 20s to early 40s) with mild volume loss tend to see the best results, as their skin retains good elasticity. Older patients can still benefit, but they require a combination of fillers and skin-tightening treatments for optimal results due to collagen and elasticity loss. Volume loss in surrounding areas, such as the cheeks, can also affect how fillers settle.

References

Trinh LN, Grond SE, Gupta A. Dermal Fillers for Tear Trough Rejuvenation: A Systematic Review. Facial Plast Surg. 2022 Jun;38(3):228-239. doi: 10.1055/s-0041-1731348. Epub 2021 Jun 30. PMID: 34192769.

Sharad J. Dermal Fillers for the Treatment of Tear Trough Deformity: A Review of Anatomy, Treatment Techniques, and their Outcomes. J Cutan Aesthet Surg. 2012 Oct;5(4):229-38. doi: 10.4103/0974-2077.104910. PMID: 23378704; PMCID: PMC3560162.

Trinh LN, McGuigan KC, Gupta A. Delayed Complications following Dermal Filler for Tear Trough Augmentation: A Systematic Review. Facial Plast Surg. 2022 Jun;38(3):250-259. doi: 10.1055/s-0041-1736390. Epub 2021 Oct 19. PMID: 34666405.

Atiyeh B, Hakim CR, Oneisi A, Ghieh F, Chahine F. Surgical Correction of Tear Trough Deformity (TTD) with Orbicularis Retaining Ligament Release and Volume Augmentation for Periorbital Rejuvenation: Review of the Literature. Aesthetic Plast Surg. 2023 Feb;47(1):199-214. doi: 10.1007/s00266-022-03183-0. Epub 2022 Dec 1. PMID: 36456652.