Tear trough filler — also called under-eye filler — is one of the most requested non-surgical treatments at Centre for Surgery, and one of the most easily done badly. The under-eye area is anatomically high-risk, the skin is the thinnest on the face, and the difference between a result that makes a patient look rested and one that makes them look worse is often a fraction of a millilitre of product placed slightly wrong.
This is the comprehensive guide: what tear trough filler actually is, who it suits, who it doesn’t, which product we use and why, the risks worth understanding, what to expect on the day, and when the right answer is lower blepharoplasty instead.
What the tear trough actually is
The tear trough is the natural groove that runs from the inner corner of the eye downward and outward, separating the lower eyelid from the upper cheek. In youth it’s barely visible — the cheek fat sits high and full, the lower lid blends smoothly into the cheek, and the transition is invisible.
With age — or in patients who are simply born with prominent tear troughs — the groove deepens. Several anatomical changes contribute:
Loss of mid-face fat volume. The cheek fat pad descends and thins. The cheek that used to sit high under the eye now sits lower, and the lid-cheek junction becomes visible as a shadowed line.
Bony changes. The orbital rim — the bone around the eye socket — actually changes shape with age. The lower rim resorbs slightly, creating a small step where the lid meets the cheek.
Skin thinning. The skin over the lower lid is around 0.5mm thick — the thinnest on the body. As it thins further with age, underlying structures (including small blood vessels) show through, contributing to the dark circle appearance that often accompanies a deep tear trough.
Loss of skin elasticity. The lower lid skin loses its ability to retract neatly over the underlying tissue, contributing to a hollow or shadowed look.
For the dedicated anatomical breakdown, see our guide on what is tear trough deformity.
What tear trough filler actually does
The treatment uses small volumes of hyaluronic acid filler placed precisely onto the orbital rim — the bony shelf below the eye — to physically fill the hollow. By restoring volume below the lid-cheek junction, the shadowed groove becomes a smooth surface and the under-eye area reads as rested rather than tired.
What it doesn’t do:
It doesn’t remove eye bags. Under-eye bags are pockets of orbital fat that herniate forward through a weakening septum (the membrane behind the eye that holds the fat in place). Filler can soften the visual transition between a bag and the cheek, but it doesn’t remove the bag itself. For patients with significant herniated fat, surgical lower blepharoplasty is the appropriate intervention.
It doesn’t eliminate dark circles caused by pigmentation. Dark circles have multiple causes — the most common is shadowing from a deep tear trough (which filler does address) but pigmentation, vascular show-through, and skin texture also contribute. Filler addresses shadowing only.
It doesn’t fix lower-lid skin laxity. Crepey, lax under-eye skin needs either energy-based skin treatment (SmoothEye, Morpheus8) or surgical correction. Trying to mask laxity with filler often makes the area look heavier.
The product we use and why it matters
The under-eye area requires a specific kind of hyaluronic acid filler — not the same product used for cheeks, lips, or jawline contouring. At Centre for Surgery, the standard choice for this area is Teosyal Puresense Redensity 2.
Why a specialised product is essential:
Low water-binding capacity. Standard HA fillers bind significant volumes of water, which is useful in areas like the cheek where you want volume. In the tear trough, excessive water-binding produces the puffy, swollen appearance patients see in poorly-treated under-eye work. Redensity 2 is formulated with reduced water-binding for this reason.
Low G’ (softness). The lower lid skin is too thin to hide a robust, structural filler. Soft, finely-tuned HA blends smoothly into the tissue without visible lumps or ridges. Robust fillers used here often produce the bluish “Tyndall effect” — a slight blue tint visible through the thin skin.
Specific design for the periorbital area. Redensity 2 contains a dermo-restructuring complex (amino acids, antioxidants, minerals) intended to improve skin quality alongside volumetric correction.
The choice of product matters more in this area than almost anywhere else on the face. Patients seeing other clinics should ask what filler is being used — if the answer is a robust cheek or lip filler, that’s a warning sign.
For more on duration and what affects it, see our guide on how long do tear trough fillers last.
Who is a good candidate
The ideal candidate has:
- A genuine hollow — visible shadowing or indentation along the tear trough that’s bothering them
- Good skin quality — relatively firm, not significantly crepey or thin
- Minimal or no fat herniation — no visible “eye bags” that protrude above the trough
- Good general health — no active periorbital skin disease, no recent eye surgery, no chronic eye conditions affecting the area
- Realistic expectations — understanding that filler softens shadowing rather than eliminating all signs of facial ageing
A useful self-test: pull the skin below the eye gently downward with a fingertip. If the hollow becomes less visible when the skin is stretched, filler is likely to help — the volume restoration mimics what the stretching does. If the hollow remains visible regardless, or if there’s clearly herniated fat sitting above the trough, filler will not produce the result the patient wants.
Who is not a good candidate
Tear trough filler is the wrong tool for:
Patients with significant under-eye bags. Trying to “fill around” prominent bags makes the under-eye area look heavier rather than smoother. The right answer for these patients is lower blepharoplasty — the surgical procedure that addresses the herniated fat directly.
Patients with significant skin laxity. Loose, crepey under-eye skin doesn’t hold filler well — the product often looks lumpy or migrates. Skin-tightening treatment (or surgery) needs to come first.
Patients with malar oedema (festoons). Some patients have impaired lymphatic drainage in the lower lid and cheek area, producing chronic puffiness that often gets worse with filler placement. This is a definite contraindication.
Patients with very thin or pigmented skin. The Tyndall effect (bluish discolouration from filler showing through) is more likely in patients with very thin skin. Pigmented skin requires extra caution and product selection.
Patients with previous tear trough filler that hasn’t been assessed. Old filler in the area can sit for years, often migrated or lumpy. New treatment without first assessing (and often dissolving) old filler typically makes things worse.
Pregnancy and breastfeeding.
Patients with body dysmorphic concerns about the eye area. Repeat treatment in this group rarely produces satisfaction.
For more detail on candidacy and the patients who shouldn’t have this treatment, see our guide on why under-eye filler is not for everyone.
What the procedure involves
A typical session takes about 30 minutes, including the wait for topical numbing cream.
Pre-treatment. Topical anaesthetic is applied for 15 to 20 minutes. The filler itself contains lidocaine for additional comfort during injection. Photographs are taken in standard lighting for the medical record.
Injection technique. Either a fine needle or a blunt cannula is used depending on the area and the practitioner’s assessment. Cannula technique is often preferred for the under-eye area because it reduces the risk of vascular injury — the blunt tip pushes vessels aside rather than penetrating them.
The product is placed deep, onto the periosteum (the layer covering the bone of the orbital rim). Superficial placement causes lumps and Tyndall effect. Deep placement integrates smoothly with surrounding tissue.
Volumes are small. Most patients need 0.5 to 1ml total across both sides for the first treatment. We deliberately under-correct on the first session — the result is assessed at 2 to 4 weeks, and a small top-up is added if needed. This conservative approach is what prevents over-correction.
Recovery. Mild redness for a few hours. Possible bruising at injection points — the under-eye area is well-vascularised, so small bruises are common and resolve over a few days. Patients can return to normal activities immediately but should avoid:
- Strenuous exercise for 24 hours
- Lying flat for 4 hours
- Pressure or massage on the treated area for 48 hours
- Saunas, steam rooms, and hot environments for a week
See our full injectables aftercare guide for the complete post-treatment protocol.
Risks worth understanding
The tear trough is one of the highest-risk areas of the face for filler. Two complications warrant a separate conversation:
Vascular occlusion. The under-eye area has blood vessels that connect, via the angular artery and supratrochlear branches, to the ophthalmic artery — and from there to the central retinal artery supplying the eye. Filler accidentally injected into one of these vessels can travel back toward the eye and cause skin necrosis or, in the most extreme cases, vision loss.
This is rare — the published incidence of vision-affecting events from facial filler is very low — but it cannot be reduced to zero by any technique. What reduces the risk:
- Detailed anatomical knowledge of the periorbital vasculature
- Cannula technique where appropriate
- Slow injection with low pressure
- Frequent aspiration before depositing product
- Immediate access to hyaluronidase (hyalase) if a vascular event is suspected
This is the main reason this area should never be treated by a non-medical injector or in a setting without immediate access to dissolving treatment.
Migration and chronic puffiness. Even when nothing acute goes wrong, filler placed too superficially or in the wrong tissue plane can sit visibly under the skin for years. Patients sometimes present months or years after another clinic’s treatment with persistent under-eye puffiness they assumed was their own swelling — but is actually old filler.
This is fixable with hyalase dissolving, but it’s worth knowing the risk exists before treatment.
Other side effects. Mild swelling and possible bruising for a few days. Asymmetry that can be corrected at the follow-up. Occasionally, lumps that can be massaged out or dissolved if persistent. Allergic reactions to HA are extremely rare.
The two-stage protocol
At Centre for Surgery the standard approach is a deliberately conservative two-stage treatment:
Stage 1. A small volume is placed at the initial session. The patient leaves under-corrected — the hollow is reduced but not fully filled.
Stage 2. Two to four weeks later, the patient returns for assessment. Any residual hollowing is corrected with a precise top-up. Often, the top-up is much smaller than the patient expected — the initial filler has settled and integrated, and the eye area is closer to the target result than it looked immediately after stage 1.
This protocol is more time-intensive than single-session treatment but produces a more natural, more durable result. Patients who insist on a one-session “finished” result are at higher risk of over-correction, which is far harder to fix than under-correction.
How long it lasts
Tear trough filler typically lasts 6 to 12 months on a first treatment, and often longer on subsequent maintenance treatments as the appropriate volume for the patient is established. Some patients experience much longer duration in this area — occasionally 2 to 3 years — though this isn’t necessarily positive, as it can indicate filler that has migrated or accumulated in the wrong plane rather than dispersing normally.
For the full discussion of duration and the factors affecting it, see our dedicated guide on how long do tear trough fillers last.
When surgery is the right answer
For patients with significant herniated orbital fat (true under-eye bags) or with skin laxity beyond what filler can address, lower blepharoplasty is the appropriate intervention.
The procedure repositions or removes the herniated fat, addresses excess skin if present, and produces a cleaner long-term result than repeated filler treatment that can’t address the underlying anatomy. Recovery is around a week of social downtime, with full resolution over several weeks.
This is a transformative procedure for the right patient. The honest assessment in some cases is that years of filler treatment have been an expensive workaround for what surgery would have addressed cleanly in one intervention.
Other related surgical options include:
Canthoplasty for patients with significant lateral lid laxity.
Fat transfer for patients with significant volume loss in the lateral cheek and lid-cheek junction. Often combined with blepharoplasty for the most complete result.
How to decide
A simple guide based on what you see:
Genuine hollow with good skin quality, no significant bags: filler is the right first step. Two-stage protocol, conservative volume.
Hollow plus mild eye bags: consider whether filler can reasonably camouflage, or whether you’d be better served by addressing the bags surgically. Often a consultation will recommend surgery if the bags are the more prominent feature.
Significant bags, skin laxity, or festoons: surgical assessment. Continued filler treatment at this stage rarely produces a satisfying result.
Tired-looking eyes without an obvious hollow: the issue may be skin quality, pigmentation, or shadowing from descended cheek volume rather than the tear trough itself. Cheek filler, SmoothEye laser, or Morpheus8 may be more appropriate than tear trough filler.
A consultation with our specialist team — including Dr Spyridon Vlachos — establishes which category fits your actual anatomy and recommends the right approach.
Cost
Tear trough filler at Centre for Surgery is priced per syringe of Teosyal Redensity 2. Most patients need 1 syringe for the initial treatment, sometimes with a small additional volume at the 2-4 week top-up. Subsequent maintenance treatments often use less. Finance options through Chrysalis Finance, including 0% APR, are available.
Common questions
How quickly will I see the result?
The volumetric change is visible immediately, though the final result emerges at 2 to 4 weeks once initial swelling has settled and the filler has integrated.
Will I need to take time off work?
No — most patients return to normal activities the same day. Bruising is possible and can be covered with makeup after 24 hours, but there’s no surgical downtime.
Can I have my tear trough filler dissolved?
Yes. Hyaluronic acid filler can be dissolved with hyalase if the result isn’t what was wanted, if filler has migrated, or if a vascular complication is suspected. The dissolving treatment is quick and effective, with re-treatment possible about 2 weeks later if appropriate.
Is tear trough filler safe during pregnancy?
No — we don’t perform any elective injectable treatment during pregnancy or breastfeeding. Treatment can resume after.
Will my eye bags get worse without treatment?
The tear trough hollow tends to deepen gradually with age as cheek volume continues to descend. Filler doesn’t slow this process — it addresses how the area looks at the time of treatment. Maintenance is usually needed annually.
Can I have tear trough filler if I’ve had blepharoplasty?
Often yes, particularly if there’s residual hollowing after the surgery. The timing and product choice need careful assessment by an experienced injector, but filler can be a useful complement to surgical correction.
What if I’ve had filler at another clinic that I’m not happy with?
Don’t have more filler placed on top. Book a consultation to assess the existing product — many patients in this situation benefit from dissolving the old filler first, waiting a few weeks, then having properly-placed fresh treatment. Adding new filler to badly-placed old filler usually compounds the problem rather than fixing it.
Centre for Surgery · CQC-regulated · GMC specialist-registered surgeons · 95–97 Baker Street, Marylebone, London W1U 6RN · 0207 993 4849 · Book a consultation · Finance from 0% APR
