The tear trough is the depression between the lower eyelid and cheek. It's the area I get the most inquiries about—and the one I most often advise against. Not out of caution for the sake of caution, but because dark circles under the eyes have several very different causes, and only one of them is easily treatable with fillers.
Four causes that look the same
- Volume loss. The fat pad in the mid-face sags, creating a distinct groove with shadows. This is a shape that responds very well to hyaluronic acid treatments.
- Thin skin with translucent blood vessels. The bluish tint doesn't come from a shadow, but from the tissue underneath. Fillers will do little here and can even make the area appear thicker and bluer.
- Pigmentation. Brownish discoloration of the skin, often genetic. Not solvable with volume alone — this requires skincare, sun protection, and possibly other treatments.
- Protruding fat or eyelid swelling. The classic case of under-eye bags. This is a surgical issue, not a filler issue. Adding volume usually makes it look fuller, not better.
Often, a combination of factors is present. In the initial consultation, we will examine which factor predominates in your case — also using simple tests such as changes while lying down or under different lighting.
If filler is appropriate
In cases of genuine volume loss, the procedure is very conservative: small amounts are placed deep and close to the bone, usually with a blunt cannula, and with a preparation that binds little water. Often, less than half a milliliter per side is sufficient. In this area, too little is always better than too much—more can be added, removing it is more complicated.
The process
- Analysis of the cause and clarification of what proportion is actually treatable.
- If appropriate: Treatment with numbing cream, usually 20 to 30 minutes.
- Swelling in the first few days and bruising are not uncommon in this area.
- Follow-up examination after two to four weeks. I assess the tear trough later than elsewhere because the swelling takes longer to subside.
durability
The tear trough is a relatively immobile area, so the material lasts a long time: often twelve to eighteen months, sometimes even longer.
Risks — particularly relevant here
- Persistent swelling in the lower eyelid and cheek area, which can last for weeks.
- Bluish tint when material lies too superficially.
- Tangible or visible irregularities
- Bruises are more common here than in other areas.
- Rarely, infection or delayed inflammatory response
- Vascular occlusion is very rare. Near the eye socket, this is the most serious conceivable complication. Therefore, the procedure is performed close to the bone, slowly, and with a cannula; and therefore, hyaluronidase is kept in stock at the practice.
Treatment is contraindicated during pregnancy and breastfeeding, in cases of inflammation in the treatment area, pronounced eyelid swelling or tendency to water retention, and in cases of known hypersensitivity.
Aftercare — what to keep in mind
- Keep your head slightly elevated for the first few nights.
- No sports or sauna for 24 hours
- Do not rub, do not massage
- A low-salt diet in the first few days can reduce swelling.
Cost
Treatment of the tear trough with hyaluronic acid: 380 € Each appointment lasts approximately 30 minutes. A later appointment Dissolving with hyaluronidase It costs €100.
If I conclude that treatment is not advisable for you, we will proceed with the initial consultation. All prices can be found at [website address]. Prices; The cost estimate provided during the initial consultation is decisive. The initial consultation lasts approximately 25 minutes.
Frequently Asked Questions
Will this completely make my dark circles disappear?
If the shadow is caused by a true groove: largely. If pigment or translucent vessels are the cause: no. Therefore, determining the cause is the first step, not the treatment.
I look swollen after the treatment. Is that normal?
Yes, for the first one to two weeks. If it persists longer, please contact us – persistent swelling in this area is a known and treatable condition, including dissolving the material.
Can it be removed again?
Yes, with hyaluronidase. Especially in this area, solubility is a crucial safety factor.
Why are you working with such small quantities?
Because the skin here is thin and every millimeter is visible. A full lower eyelid makes the face look older instead of fresher.
Does the treatment hurt?
The treatment is well tolerated when using numbing cream. A blunt cannula is usually used, which protects the tissue.
Want to know where your dark circles under your eyes come from? We'll find that out first.
Medically responsible: Dr. Jan Gumilar, General Practitioner — Private Practice for Aesthetic Medicine, Brandstätte 3, 1010 Vienna. Member of the German Society for Aesthetic Botulinum and Filler Therapy (DGBT).