Tear troughs are the shallow grooves that run from the inner corner of your eye downward and outward along the border of your lower eyelid and upper cheek. They’re a normal part of facial anatomy, typically 2 to 3 centimeters long, but when they become deep or shadowed, they can make you look tired, older, or unwell even when you feel fine. Some people notice them in their early twenties, while others don’t see them until well into middle age.
The Anatomy Behind the Hollow
The tear trough sits within the boundary of the circular muscle that surrounds your eye (the same muscle you use to blink and squint). What creates the visible groove is a ligament that anchors the skin and muscle to the bone beneath. This ligament pulls the tissue inward at that specific line, creating a V-shaped depression along the junction where your lower eyelid meets your cheek.
Underneath this groove, there’s a notable absence of fat. The central and inner fat pads that cushion other parts of your lower eyelid simply thin out or disappear in this zone, which is why the area looks darker or more hollow than the surrounding skin. The skin here is also among the thinnest on the entire body, making the underlying structures, blood vessels, and shadows far more visible.
Why Tear Troughs Get Worse With Age
Lower eyelid aging begins as early as your twenties and progresses through distinct phases. In the earlier stages, the changes are mostly about volume: the fat pads behind your lower eyelid start pushing forward (creating under-eye bags), while the tissue below them loses volume, making the trough more obvious by contrast. This combination of puffiness above and hollowness below is what gives the classic “tired” look.
As you move past your forties and fifties, the picture shifts. The ligament that creates the trough loosens, the muscles around your eye lose tone, and the bone of your upper jaw gradually resorbs, meaning the structural shelf that supports your cheek actually shrinks. All of this deepens the hollow and extends it further across the cheek. Genetics play a significant role in how early and how severely this happens. People with naturally thin skin, minimal under-eye fat, or deep-set eyes often notice prominent tear troughs much younger than average.
How Fillers Work for Tear Troughs
The most common non-surgical treatment is injecting hyaluronic acid filler directly into the hollow to restore lost volume. Hyaluronic acid is a sugar molecule that naturally occurs in your skin, and when formulated into a gel, it can plump the depression and smooth the transition between your lower eyelid and cheek. The fillers used in this area are specifically chosen for low density and low water retention, because a filler that absorbs too much fluid in this thin-skinned zone will look puffy or unnatural.
Most people need one to two syringes for a complete treatment, putting the cost between $1,000 and $2,000. The filler is placed deep, right against the bone or beneath the eye muscle, to avoid visible lumps or discoloration. Results are often described as lasting 9 to 18 months depending on the specific product used, but MRI research tells a more complicated story. A review of 33 patients who underwent mid-face MRI scans found that hyaluronic acid filler was still physically present in every single patient scanned, even those who hadn’t been re-injected for over five years. In one case, filler was detectable 15 years after injection. This doesn’t necessarily mean the cosmetic effect lasts that long, since the filler can migrate or lose its shape, but it does mean the material sticks around far longer than most patients realize.
Recovery After Filler Injections
Swelling and bruising peak on days one and two after treatment. Your under-eye area will look puffier than the final result during this window. By the end of the first week, bruising typically fades and the area starts looking more natural, though you may still feel small bumps under the skin. Most swelling resolves within two to four weeks, and any minor lumps or irregularities generally smooth out by the end of week four. Many people feel comfortable returning to normal activities within a few days, though the area can remain tender.
Risks Specific to This Area
The tear trough is one of the trickiest spots on the face to inject, largely because the skin is so thin. The most distinctive complication is a bluish tint that appears when filler is placed too close to the skin’s surface. Known as the Tyndall effect, it looks like a bruise that never fades. Unlike actual bruising, which resolves in a week or two, this discoloration can persist for months or even years if left untreated. It happens because the transparent filler gel scatters light differently than your natural tissue, producing a blue or grayish hue visible through the skin.
The fix is relatively straightforward (the filler can be dissolved with an enzyme injection), but prevention matters more. Proper depth of placement, at the level of the bone or deep within the muscle, is critical. This is one reason tear trough injections are considered an advanced procedure best handled by experienced practitioners.
Edema, or persistent puffiness from fluid retention, is another concern. Some people’s under-eye tissue holds onto water after filler is placed, creating a swollen look that defeats the purpose of treatment. During a consultation, a practitioner should check whether your under-eye fullness is caused by actual fat prolapse or by fluid retention, because the two require completely different approaches.
Who Is Not a Good Candidate for Fillers
Not every tear trough responds well to filler. Before treatment, practitioners typically evaluate skin elasticity using a snap-back test, where the lower eyelid skin is gently pulled down and observed to see how quickly it returns to position. Loose, lax skin is harder to treat with filler alone because the added volume can look unnatural or worsen puffiness. Significant fat pad bulging (visible bags that push forward when you look up) also complicates filler treatment, since adding volume below a prominent bag can make the bag look even more pronounced.
People with chronic under-eye swelling from allergies, sinus issues, or fluid retention are also poor filler candidates. The filler can trap additional fluid and create a perpetually puffy appearance. These situations often call for addressing the underlying cause first or considering surgical options instead.
Surgical Correction
For deeper tear troughs or those accompanied by significant under-eye bags, surgery offers more lasting results. The most effective approach is fat repositioning (also called fat transposition), where the bulging fat pads that create under-eye bags are moved downward to fill the hollow of the tear trough. This solves two problems at once: it reduces the bags and fills the groove with your own tissue.
The procedure is performed through one of two routes. A transconjunctival approach goes through the inside of the lower eyelid, leaving no visible scar, and works best when there’s fat bulging but minimal loose skin. A transcutaneous approach makes a tiny incision just below the lash line, allowing the surgeon to remove excess skin at the same time. Recovery involves swelling and bruising that can take several weeks to fully resolve, along with a small risk of asymmetry or contour irregularities as everything settles.
Simply removing the fat pads (rather than repositioning them) is an older technique that has fallen out of favor because it can actually worsen the hollow appearance over time. Autologous fat grafting, where fat is harvested from another part of your body and injected under the eyes, is another option, though results can be less predictable because the body reabsorbs some of the transferred fat. Lower blepharoplasty surgery generally costs between $4,000 and $7,000, making it a larger upfront investment than fillers, but the results are typically permanent.