Tear troughs are the hollows or grooves that run from the inner corner of your eye down toward your cheek. Getting rid of them, or at least making them significantly less noticeable, is possible through several approaches ranging from injectable fillers to surgery. The right option depends on how deep your troughs are, what’s causing them, and how long you want the results to last.
Why Tear Troughs Form
The under-eye area has some of the thinnest skin on your body, and it sits over a complex structure of muscle, fat, and ligaments. Tear troughs appear when the support system beneath this skin weakens or shifts. Several things drive this process, often at the same time.
As you age, the ligament that holds the lower eyelid tissue in place loosens. This creates a visible V-shaped groove along the lid-cheek junction. At the same time, the skin itself loses elasticity and thickness, making the hollow beneath it more obvious. Fat pads that once filled the area shrink, and the membrane holding orbital fat in place weakens. This is why many people develop both a hollow trough and puffy bags: fat bulges outward in some spots while disappearing from others.
Genetics play a major role too. Some people develop visible tear troughs in their twenties simply because of their bone structure or naturally thin under-eye skin. Dark circles and tear troughs often go together, since the shadow cast by the groove deepens the appearance of discoloration.
What Eye Creams Can Actually Do
No cream will fill in a structural hollow. That said, certain ingredients can improve the skin quality around the trough and reduce the shadowing effect that makes it look worse. Caffeine is one of the better-supported options: it reduces fluid retention, strengthens small blood vessels, and has been shown to improve lower eyelid puffiness by stimulating fat breakdown in the area. If puffiness above or around your trough is making the hollow look deeper, caffeine-based eye creams can help.
Vitamin C increases under-eye brightness, which partially offsets the dark shadow a tear trough creates. Niacinamide and vitamin E have been shown to decrease the hyperpigmentation that often accompanies hollowing. Retinol and peptides help with fine lines and skin texture but won’t change the depth of the groove itself. Hyaluronic acid in a cream form hydrates the surface and can temporarily plump the skin, though the effect is subtle compared to injectable treatments.
Think of topical products as a way to improve the appearance of mild tear troughs or maintain results from other treatments. For moderate to deep hollows, they won’t be enough on their own.
Hyaluronic Acid Fillers
Injectable filler is the most popular non-surgical treatment for tear troughs. A practitioner uses a fine needle or cannula to place hyaluronic acid gel beneath the skin, filling the hollow and smoothing the transition between your lower eyelid and cheek. The procedure typically takes 15 to 30 minutes, and results are visible immediately.
Most people need one to two syringes for both eyes, putting the total cost between $1,000 and $2,000. The duration of effect has traditionally been cited as 8 to 12 months, but a retrospective study published in the Journal of Clinical and Aesthetic Dermatology found significant results lasting up to 18 months.
Risks to Know About
The under-eye area is one of the trickiest spots to inject, and complications here tend to be more visible and harder to fix than in other parts of the face. The Tyndall effect is a well-known risk: if filler is placed too close to the skin’s surface, it creates a bluish discoloration that can look like a bruise that never goes away. Because the skin over the tear trough is so thin, this area is especially prone to the problem. Without correction, the Tyndall effect can persist for months or even years. Proper technique requires placing filler deep, at or near the bone.
Lumps and unevenness are possible, particularly with thicker filler products. More serious but rare complications include vascular occlusion, where filler inadvertently blocks a blood vessel. This is a medical emergency that requires immediate treatment.
Some people should avoid under-eye filler entirely. If you have malar bags (puffiness on the upper cheeks) or a history of facial swelling after salt or alcohol intake, filler in this zone can make things worse. Injected product can block lymphatic drainage, leading to persistent edema that is disfiguring, lasts for months, and responds poorly to treatment. A skilled injector will evaluate you for these signs before proceeding.
Laser and Radiofrequency Treatments
These treatments don’t fill the hollow directly. Instead, they tighten skin and stimulate collagen production, which can reduce the appearance of mild tear troughs by improving skin thickness and elasticity around the groove.
Radiofrequency devices deliver controlled heat into deeper skin layers to trigger new collagen and elastin growth. Monopolar systems like Thermage typically work in a single session, while bipolar or multipolar systems distribute energy more evenly but may require multiple treatments. RF microneedling devices like Morpheus8 combine tiny needles with radiofrequency energy for deeper tissue remodeling and can be customized for the delicate eye area.
Laser resurfacing is another option. Ablative lasers (fractional CO2 and erbium types) remove thin layers of damaged skin to reveal smoother tissue underneath, while non-ablative lasers heat deeper layers without breaking the surface. Fractional lasers treat only a portion of the skin at a time, which speeds healing. Recovery from ablative treatments typically involves several days of redness and peeling, while non-ablative options have less downtime.
These approaches work best for people whose tear troughs are primarily a skin-quality issue: thin, crepey skin that’s making a mild groove look worse. If you have a deep structural hollow, lasers and RF alone won’t be enough. They’re often combined with filler or surgery for a more complete result.
Surgical Options
For deeper tear troughs or people who want a permanent solution, lower blepharoplasty is the most definitive treatment. This surgery addresses the structural causes of the hollow rather than masking them.
One well-studied technique involves transconjunctival lower blepharoplasty, where the surgeon works through an incision inside the lower eyelid (leaving no visible scar) and uses the patient’s own orbital fat to fill the tear trough. In a study of this approach using minced orbital fat grafts, the average tear trough depression grade dropped from 3.11 to 0.87 on a standardized scale. Nearly 79% of patients rated their outcome as excellent or good, about 20% as fair, and only one patient out of the group reported no improvement. No major complications were observed.
Surgery costs significantly more than filler, typically $4,000 to $7,000. Recovery involves swelling and bruising for one to two weeks, with final results becoming clear over the following months. The trade-off is longevity: surgical correction generally lasts years rather than months, and you avoid the ongoing cost of repeated filler appointments.
Choosing the Right Approach
The best treatment depends on the severity of your tear troughs and what you’re comfortable with. For mild hollowing with some discoloration, quality eye creams containing caffeine and vitamin C can make a noticeable difference. For moderate troughs where you want visible correction without surgery, hyaluronic acid filler is the most predictable option, with results lasting a year or longer. Laser and RF treatments complement either approach by improving skin quality.
For deep, structural tear troughs, especially those accompanied by under-eye bags, lower blepharoplasty offers the most dramatic and lasting improvement. Many people start with filler to see how correction looks on their face before committing to surgery. Since hyaluronic acid filler can be dissolved with an enzyme if you don’t like the result, it’s a relatively low-risk way to preview the change.