Why the tear trough is my favorite treatment to perform

I would love to know who names these treatments. I mean seriously… tear trough? Tears are what you cry when you are sad. Troughs are an item pigs eat out of! The term tear trough filler is just wrong. That aside, the proper anatomical name for the tear trough is the nasojugal groove. Much better! Medical. Not scary or disgusting. But here we are.. So why do I love tear trough treatment?


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Dark circles and the tear trough

Why are the dark circles constituting the tear trough my favorite part of the face to treat? It’s simple really. The tear trough treatment with hyaluronic acid embodies everything I believe about how cosmetic treatments should be done and exemplifies several lessons that every doctor should know about performing any cosmetic procedure, and in particular facial cosmetic procedures.

4 rules for tear trough filler treatment with hyaluronic acid

  1. Less is more
  2. A little too much is way too much
  3. Filler does not wear away after 6 months
  4. Perfect is awful


Tear trough filler – Less is more?

So we all know by now less is more. Just like with all dermal filler, tear trough fillers need to be treated with caution. Volume loss in the lower eyelid, causes the dark circles that sit at the upper cheek. These tear trough hollows should be addressed very carefully to ensure natural looking results. What is noticeable immediately may not be what patients find after a few days. Just like breast surgeons overzealously treated patients in the 90s, tear trough fillers are being overzealously used by some doctors performing filler injections in this thin skin area.

Non surgical treatments are still catching up

Unfortunately, the world of tear trough fillers and Dermal fillers are still playing catchup with the lessons learned by surgeons learned many years ago.  And nowhere is this more true than in the Tear trough.  This tiny fat pad only takes an even tinier amount of filler to correct when we have lost fat in this area. But we have to be very careful

What exactly is the tear trough area anyway? How does it form?

The tear trough is a deformity you often see under your eye. With aging, and often even in young people and kids that haven’t yet aged, having less fat or a different bone structure in this under eye area can give others the impression that you are tired or perhaps even sick.

The tiny fat pad contains less than a teaspoon of fat on each side, and as you slowly lose fat with the aging process, you slowly look more tired under your eyes. Bouts of illness, lack of sleep or stress can contribute to the sunken appearance in this area.  Everyone has seen this in themselves when they are unwell, dehydrated, sick, but when it remains as you age, we call it a tear trough deformity. (I prefer nasojugal groove!)



The under eye filler is simultaneously the easiest and also hardest part of the face to correct.

So, under-eye fillers replace the tiny bit of fat missing in this part of the face; so, what’s the big deal? Put it back! Well, because the area is so small and because there are a lot of blood vessels, very thin skin and soft tissue drainage issues in this area, precision is paramount.. This is why the tear trough separates the men from the boys ( and the women from the girls!)

A little too much dermal filler injections in the dark shadows can be disastrous.

Due to the poor fluid drainage under the eye and how many important vascular structures sit in this area, the tear trough filler procedure is not as forgiving as other dermal filler treatment areas parts of the face.

If you’ve ever been up at night crying as a kid, or been allergic to something you’ll have noticed this part of the face JUST LOVES to swell up. The lymph drainage system here means that if you overshoot the amount of filler you need in this area by just 1% it can result in swelling of 20-30%. Yes, just a tiny bit too much filler here can result in a lot more fluid retained in this area and therefore worse puffiness and worse bags!

More is not more in the tear troughs

Unfortunately many clinicians are unethical and or uneducated and they do not advise patients that filler, despite what the manufacturers suggest often lasts a lot longer than advertised.  Why would an unethical doctor do that – it would affect the bottom line if they were to treat people with filler injection less often.

Well nowhere is it more true that filler accumulates and stays in the face than in the tear troughs!  So if you didn’t go over by 1% the first time you did your tear trough filler, good on you and good on your doctor! However should you go with the often given bad advice to repeat treatments every year or, god forbid, every 6 months in this area, the chances of you overshooting and ending up with puffiness and bigger bags than you started with becomes astronomically higher.

Do you really need your tear troughs treated?

Before I explain that all is not lost and the reason this is my favourite area to treat in the right face, there is one more reason people have bad results in the tear trough.

Let me take the case of Kim kardashian, one of the first women to famously get tear trough treatment. Have a look at a picture of her in her paris hilton assistant days vs now. What do we notice…

She had  tear troughs, and now she no longer has them. She looks airbrushed in real life! No tiredness…no eyebags… but look again closely.

Which picture looks better?


Tear trough fillers should be done carefully.

Did you know that monkeys, unlike humans have no nasolabial folds. This is the line from your nose to the side of your mouth. Everyone begins to form them pretty much from when we start smiling. And they get deeper as we age.  They can be corrected with filler but should never be completely removed.

Just like the nasolabial fold, the tear troughs are an area that can show aging, poor health, or even, they say poor genetics!  But is zero optimal? Do we look our best without a tear trough area at all? The answer is NO.

So what is the trick and why do I love dermal fillers under the eye?

The aging of the undereye area is something that happens to you in the 8 year period between the ages of 27 and 35. Pretty much while the other parts of the facial aging are paused, or waiting to begin the aging process. So this injection site is a very early sign of the ageing process.

The undereye hollows can be corrected with less filler than any other part of the face, a jaw might take up to 6 mls to ‘perfect’. I never use more than 1ml to correct the lower eyelids. Its such a small space, so little is needed.

The tear trough is one of the least mobile parts of the face so dermal fillers don’t get compressed as much as they do in other parts of the face. This, I believe, is why hyaluronic acid fillers in this part of the face can last for years.

What all this means is the tear trough:

  • Can be corrected with the least amount of filler making it the best value
  • Lasts longer than any other area making it even better value
  • Can singlehandedly gives a more youthful appearance than any other part of the face

Why I love this anatomical area

Now do you see why I love the tear trough?  Now, it may not be the best treatment for my business, it really doesnt pay the bills, but it really is the best of all the treatment options. This non surgical procedure changes peoples confidence hugely for the amount of work and time that it takes.  And it is almost pain free, replacing this lost volume in the ideal candidate.

Doing a good job on a tear trough is a great place to start the non surgical cosmetic journey. The only problem I find with the tear trough is nothing comes close.  There are other treatments that can have spectacular results but from a ml for ml perspective, it really is a difficult to repeat experience.

And once you see it being treated, and how easy it is to treat, you will find yourself like I did about 9 years ago after training with Raj Acquilla at a dublin masterclass and learning a cannula technique for treating the tear trough. I couldn’t stop looking for faces with this transformable deficit.

Several times I would sit on the tube daydreaming on my way to and from my london clinics. Suddenly realising I was staring at a (sometimes not impressed) face, because it would be just perfect for a 5 minute tear trough filler. XD

Tear trough filler can be done at Amara as part of one of our many treatment packages. Call us for a consultation today!


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