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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 and outward toward the cheek. It’s one of the most common cosmetic we see at Centre for Surgery — and one of the most misunderstood, because patients often it with under-eye bags, dark circles, or general "tired eyes." These are related but anatomically distinct findings, and each one requires a different .

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

What the tear trough actually is

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

Tear trough deformity when that smooth becomes a visible groove or hollow. Several 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 visible as a shadowed line.

Bony orbital rim changes. The bone around the eye socket actually changes shape with age — the lower rim slightly, creating 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 muscle) become visible through it, contributing to dark .

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 point.

Negative orbital vector. Some are born with a bony anatomy where the eye sits forward of the cheek (rather than the cheek 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 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 determine the . Some are born with tear troughs that become in their twenties; others them only in their fifties.

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

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

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

Smoking the problem with direct damage and compromise.

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

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

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

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

Under-eye bags are . They’re caused by orbital fat herniating forward 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 shadowing from a deep tear trough, by pigmentation from sun exposure or genetics, by vascular (blood vessels through thin skin), or by chronic inflammation. See our guide on .

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

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

Treatment options for tear trough deformity

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

The product choice matters significantly. The under-eye area requires a 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 the standard choice is 2, which is formulated specifically for the periorbital 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 . The treatment is reversible with if needed.

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

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

uses the patient’s own fat — harvested from another area of the body — to fill the tear trough. Unlike HA filler, the result is for the of fat that survives (typically 50 to 70%). The fat integrates fully with surrounding tissue and produces a softer, more natural-looking result than filler in selected 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 that excess lower lid skin and herniated orbital fat — the structural changes that filler cannot address. For whose concerns include true bags, significant skin laxity, or festoons, blepharoplasty is the appropriate rather than continued filler treatment.

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

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

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

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

and improves skin in the periorbital area. reaches deeper into the dermis for stronger tightening. Both can be combined with filler when both and concerns are present.

Who is a good candidate for tear trough filler?

The ideal candidate has:

A useful self-test: pull the skin below your eye gently with a . 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 above the trough, filler isn’t the right answer.

Candidates for correction (fat or blepharoplasty) should additionally be and healthy, non-smokers or willing to stop smoking before surgery, and have expectations about recovery and outcome.

A with our specialist team — Dr Spyridon — establishes which category fits your anatomy and what the right intervention is.

Risks and complications

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

Filler complications worth knowing about that develop later (over weeks rather than immediately) include bruising, worsening 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 hands but cannot be reduced to zero by any technique.

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

A thorough explains the risk for the procedure you’re considering.

What home remedies and lifestyle changes can achieve

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 .

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

Cold compresses reduce puffiness but don’t change underlying anatomy.

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

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

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

Cost

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

Common questions

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

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

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

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

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

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

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Centre for Surgery is a CQC-regulated private hospital on London’s Baker Street, delivering and cosmetic through surgeons. Our spans facial including and , , for men, and body procedures such as and . Patient safety, surgical excellence and results sit at the heart of everything we do.

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

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