Dr. Ayşegül Girgin · Aesthetic Medicine · Reading time ~12 minutes · Last updated: 26 October 2026
Short answer
Tear troughs are the grooves running from the inner corner of the eye down and outwards towards the cheek. They are shaped mainly by a ligament that tethers the skin to the bone below the eye, together with thin skin and changes in fat and support around it. Filler can help some people, but rarely those whose main concern is eye bags, puffiness or pigment.
Many people notice their tear troughs in a photograph and assume filler is the answer. Sometimes it is; often it is not. Drawing on published cadaver research, including Dr Ayşegül Girgin’s own study of the retaining ligaments around the eye, this article explains the anatomy beneath the groove and who is unlikely to benefit from filler.
What Are Tear Troughs?
A tear trough is the groove or hollow that runs from the inner corner of the eye downwards and outwards, where the lower eyelid meets the upper cheek. Medical papers call it the tear trough deformity, and its outer continuation the lid–cheek junction.
In some people the groove is visible from early adulthood because of inherited face shape; in others it appears with age. It is a shape that casts a shadow, not a disease, and does not need treatment.
What Lies Beneath: The Anatomy of the Tear Trough
The tear trough sits over a ligament that anchors the skin to the bone, with very thin skin above it and fat on either side.
- Skin: among the thinnest on the face, with very little fat beneath it in this area.
- Orbicularis oculi: the ring of muscle around the eye, with an eyelid part and an outer (orbital) part.
- Tear trough ligament: in a dissection study of 48 cadaver half-faces, Wong and colleagues described a true ligament running from the bone of the upper cheek (the maxilla) to the skin, between the eyelid and orbital parts of the muscle. It begins near the inner corner of the eye, runs to roughly the middle of the pupil, and continues outwards as the orbicularis retaining ligament.
- Orbital rim and orbital fat: the bony edge of the eye socket and the fat that cushions the eye; when this fat bulges forward, it forms an eye bag above the groove.
- Cheek fat: the fat compartments below the ligament, which support the area from beneath.
What Dr Girgin’s cadaver study adds
In a study published in Anatomy (2025), Dr Ayşegül Girgin and Oğuz Taşkınalp examined 28 adult cadaver heads. They measured the distances between the retaining ligaments around the eye, including the tear trough ligament, the zygomatic ligament and the ligaments above the eye, and fixed landmarks: the midline of the face, the orbital rim and the most prominent point of the cheekbone.
Some distances differed significantly between the right and left side, including that from the tear trough ligament to the cheekbone’s most prominent point. This is anatomical research: it describes where structures lie, not how any treatment performs.
Why Do Tear Troughs Become More Visible With Age?
Tear troughs usually become more visible with age because the ligament stays anchored while the tissues around it change.
- Above the ligament: the fat around the eye may bulge forward, so the edge of the groove looks sharper.
- Below the ligament: the cheek may lose volume and support, so there is less to soften the step down.
- Over the ligament: skin becomes thinner and less elastic, so the outline beneath shows through more.
The mix varies, so two similar-looking grooves may need entirely different advice.
Why Might One Side Look Different From the Other?
One tear trough often looks different from the other because the two sides of the face are not built identically. The right–left differences in ligament position found in the cadaver study above are one anatomical reason.
If the ligament lies in a slightly different position on each side, the groove can look different even when skin and fat are similar. Bone shape, cheek volume and previous treatment add to this, and perfect symmetry is not a realistic aim.
For treatment, each side should be assessed on its own rather than assumed to need the same amount of product. How much a living person needs remains a clinical judgement made at an in-person assessment, not something a cadaver study can answer.
Is It a Tear Trough, an Eye Bag or Something Else?
A tear trough is a hollow, whereas an eye bag is a bulge, and the two often appear together. Telling them apart matters because filler can make a bag look worse.
| Concern | What it looks like | Main cause | Is filler likely to help? |
|---|---|---|---|
| Tear trough | A groove from the inner corner of the eye towards the cheek | Ligament tethering, thin skin, reduced support below | Sometimes, if skin and fat allow |
| Eye bag | A rounded bulge under the lower lid | Orbital fat bulging forward | Usually not; surgery is often more appropriate |
| Puffiness or festoons | Soft swelling, sometimes lower on the cheek | Fluid collecting in the tissues | No; filler can make it more noticeable |
| Pigment or visible vessels | Brown, bluish or purple colour without a groove | Skin colour or blood vessels showing through thin skin | No; this is a colour issue, not a volume issue |
Swelling that comes and goes or affects one side only, or any change in how the eye sits, should be checked by your GP, who may refer you to an ophthalmologist. Loose eyelid skin is a different concern; our page on non-surgical eyelid aesthetics covers that area.
When Might Filler Be Considered, and When Is It Not the Answer?
Filler may be considered when the main problem is a hollow, with reasonable skin thickness, little bulging fat and no tendency to puffiness. A published review of periocular filler complications identifies people with prominent fat, existing swelling or very thin skin as poor candidates.
Tear trough filler is unlikely to be the answer, or may not be suitable, if:
- Your eye bags are prominent, as adding product below bulging fat can make the area look fuller.
- You tend to get puffiness, fluid or festoons under the eyes.
- Your skin is very thin or translucent, which raises the chance of visible product or a bluish tint.
- The darkness is mainly pigment or visible vessels rather than a groove.
- The main issue is loose lower-eyelid skin.
- Previous filler is still present or has not been assessed.
- You are pregnant or breastfeeding, have an infection near the eye or are under 18.
- You expect the groove to disappear completely or both sides to match exactly.
When the groove is part of a wider mid-face change, the cheek is assessed too; our page on mid-face filler explains that treatment. Treatment of the area itself is described on the under-eye filler page. In every case, suitability is decided only after an in-person assessment.
What Are the Specific Risks of Treatment Around the Eyes?
The under-eye area carries particular risks because the skin is thin, the tissues hold fluid readily and important blood vessels lie nearby. Bruising and swelling are common and usually settle; the following deserve more attention.
- Tyndall effect: a blue-grey tint when hyaluronic acid filler sits too close to the surface of thin skin.
- Prolonged or delayed swelling: some hyaluronic acid fillers draw in water, and swelling can persist or appear months later. In one retrospective series, delayed complications appeared on average about 17 months after treatment.
- Lumps and irregularities: more visible where there is little fat to cover the product.
- Blocked blood vessel: filler entering or pressing on a vessel can damage the skin and, rarely, cause irreversible loss of vision. A 2020 review counted 48 published cases of filler-related eye complications between 2015 and 2018, most involving vision loss.
Hyaluronidase, an enzyme that can break down hyaluronic acid filler, is prescription-only, used after an in-person medical assessment, and can itself cause allergic reactions.
Warning signs that need urgent attention:
- Any change in vision, eye pain or double vision during or after treatment: seek emergency care immediately (999 or A&E in the UK).
- Severe or increasing pain, or skin that turns pale, white, mottled or dusky.
- Spreading redness, heat, pus or a fever.
- Swelling that keeps increasing, or appears weeks or months after treatment.
If you are considering treatment in Istanbul
- An in-person consultation takes place before any treatment, and you can decide not to go ahead.
- You receive a written treatment plan and, afterwards, an English-language medical report naming the product, batch number, amounts and areas treated.
- Follow-up after you return is remote. There is no UK clinic or UK aftercare partner; if a problem arises in the UK, you would see your GP, call NHS 111 or go to A&E, taking the report with you.
- The NHS advises thinking in advance about where check-ups will take place, which matters here because complications can appear late.
- Speak to your GP before travelling, and read the health section of the UK government’s foreign travel advice for Türkiye, which covers medical treatment abroad.
Are There Non-Filler Options, and What Is the Evidence?
There are non-filler options, but most target skin quality, colour or bulging fat rather than the groove itself, and the evidence for each varies.
| Option | What it targets | Evidence for tear troughs |
|---|---|---|
| No treatment, sun protection, lighting and make-up | Skin health and how the shadow appears | No risk from treatment; does not change the groove |
| Polynucleotides | Skin quality: fine lines, elasticity | Limited clinical data from small, mostly uncontrolled studies |
| Peels, microneedling, platelet-rich plasma | Skin texture and colour | Not designed to fill a hollow |
| Lower eyelid surgery | Bulging fat, loose skin, the ligament itself | Surgical techniques that release the tear trough ligament have been described; a surgical decision with its own risks |
Polynucleotides under the eyes aim to improve skin quality rather than fill the groove. A 2026 review concluded that hyaluronic acid remains the better option for structural correction, noting that polynucleotide studies are small and short. No result can be promised from either.
Questions about tear troughs?
Whether any treatment is suitable for you can only be decided after an in-person assessment. If you would like to understand what is causing the shape under your eyes, you can contact the clinic.
Related pages:
Under-eye filler ·
Mid-face filler ·
Non-surgical eyelid aesthetics
Frequently asked questions
Can tear troughs be improved without filler?
Sometimes, depending on the cause. If bulging fat is the main problem, eyelid surgery may be more appropriate than any injection; if colour is the issue, skin-focused care may help. A groove created mainly by the ligament and reduced support is harder to change without adding volume.
How long does tear trough filler last?
Figures of 6 to 12 months are often quoted, but a retrospective photographic study of 155 patients found results persisting beyond 18 months. Longevity varies with the product, its depth and the individual, and product that stays longer can also cause late swelling or discolouration, so follow-up matters.
Why do my under-eyes look worse in overhead lighting?
Light from above casts a shadow beneath any ridge or hollow. The groove created by the ligament sits just below the softer tissue of the lower lid, so overhead light, as in lifts and bathrooms, deepens the shadow. Even, front-facing light makes the same groove look shallower.
Are polynucleotides an option for tear troughs?
They are sometimes used under the eyes to improve the skin rather than fill the groove. The clinical data are limited: one study around the eyes followed 42 people without a control group, and another reviewed records of 23 patients. They cannot be expected to change a ligament-defined hollow.
Can tear trough filler make eye bags look worse?
Yes. If fat is already bulging above the ligament, adding product below may make the whole area look fuller rather than smoother, and some hyaluronic acid fillers draw in water, making puffiness and festoons more noticeable. This is why people with prominent bags are generally not good candidates.
What is the Tyndall effect?
It is a blue-grey tint seen when hyaluronic acid filler lies too close to the surface, caused by the way light scatters through the gel. It is most associated with the tear trough because the skin there is thin. Correcting it may require the filler to be dissolved after an in-person assessment.
About the author
Dr Ayşegül Girgin is a medical doctor practising in Istanbul, Türkiye (registered in Türkiye). She graduated from Ege University Faculty of Medicine in 1992 and has worked in aesthetic medicine since 1997. She carries out academic work on facial anatomy at the Department of Anatomy, Trakya University Institute of Health Sciences; her cadaver study of the periorbital retaining ligaments was published in the journal Anatomy (2025). She is a co-author of a Turkish handbook on aesthetic botulinum toxin use and a co-translator of Turkish editions of textbooks on dermal fillers and mesotherapy. She sees patients at Smileest Clinic in Nişantaşı and Koşuyolu, Istanbul.
Medical sources
- Girgin A, Taşkınalp O. Anatomy, 2025;19(3):77-85 — Morphology and locations of infraorbital and supraorbital retaining ligaments in adult cadaver heads
- Wong CH, Hsieh MKH, Mendelson B. Plastic and Reconstructive Surgery, 2012 — The tear trough ligament: anatomical basis for the tear trough deformity
- Zein M et al. Plastic and Aesthetic Research, 2020 — Complications after cosmetic periocular filler: prevention and management
- Puyana C, Montes JR. The Journal of Clinical and Aesthetic Dermatology, 2025 — Long-Term Effects of Tear Trough Hyaluronic Acid Filler: A Retrospective Study
- Khan RS, Hafeez K. Journal of Clinical Medicine, 2026 — Hyaluronic Acid Fillers Versus Polynucleotides for Under-Eye Rejuvenation
- NHS — Cosmetic surgery abroad