Tear-trough filler (under-eye filler) is one of the technically hardest HA injections. The anatomy is complex, the margin for error is small, and the wrong product placed at the wrong depth produces visible lumps that last for years.
The right tear-trough work changes a face dramatically; the wrong work creates problems that take serious effort to fix.
Who's a candidate
Patients with true structural hollowness (the bone curves down beneath the orbital rim, creating a shadow). NOT candidates: patients whose dark circles are pigmentation or vascular shadowing — filler will worsen these.
Diagnostic clarity at consultation prevents unnecessary or counterproductive treatment.
How to test
Pull skin under the eye flat. If a shadow remains, the cause is structural (good filler candidate). If the darkness is visible without the shadow, it's pigmentation (treat with picosecond instead). Diagnostic guide.
Anatomy considerations
The infraorbital artery runs through this zone. Skin is thin (~0.5 mm). Lymphatic drainage is limited. These factors mean: superficial injection = lumps and Tyndall effect (blue tint), inappropriate product = palpable bumps for years.
Operator anatomical knowledge is the primary safety factor. Not an ideal first filler procedure.
Technique
Cannula technique preferred over needle for safety. Product placed deep on the bone (preosteal). Conservative volume — 0.2–0.4 mL per side typical. Massage to settle.
Conservative dosing produces natural results. Over-correction creates puffy under-eye appearance.
Product choice
Soft, low-G' HA fillers specifically designed for the periorbital area. NOT high-G' fillers used for cheekbone enhancement.
Common appropriate choices: Restylane Eyelight, Belotero Soft, Juvederm Volbella.
Recovery
Mild swelling and possible bruising 3–7 days. Full result visible at 2–4 weeks.
Longevity and reversibility
Results last 12–24 months. Reversible at any time with hyaluronidase if patient is dissatisfied.
Cost
Elyzea: S/850 (~US$243) per syringe. Typical 1 syringe per visit. US: $700–$1,500.
Combining with other treatments
- + HIFU: structural lift + under-eye support
- + Picosecond: volume + pigmentation
- + Toxin (crow's feet): volume + dynamic line softening
- + Cheekbone filler: harmonious mid-face refresh
What can go wrong
- Tyndall effect (blue tint) from superficial injection
- Palpable lumps from wrong product
- Asymmetric volume
- Vascular events (rare but serious)
- Persistent swelling
Reversibility with hyaluronidase addresses most cosmetic concerns.
Frequently asked questions
Will it look natural?
Conservative dosing + appropriate product + correct depth = natural.
Can it be reversed?
Yes within 24-48 hours.
How long does it last?
12-24 months.
Will I bruise?
10-25% mild bruising. Hide with concealer.
Can I get this with concurrent skincare?
Yes. Continue retinoid + SPF after recovery.
What about repeated treatments over years?
Maintenance every 12-18 months. Monitor for any persistent issues.
Is the procedure painful?
Topical anesthesia minimizes discomfort. Cannula technique gentler than needle.
Bottom line
Tear-trough filler = technically demanding HA procedure for structural hollowness. Operator experience critical. Lima at ~US$243 vs US $700-$1,500. Reversible, well-tolerated when properly performed.