Where Exactly is Tear Trough Filler Injected?

You are very astute in your observations and reading. There is great variation in the techniques used for placement of fillers in the tear trough. However, the overwhelming majority of surgeons prefer deep injections porbably just above the orbital rim in order to minimize the possibility of visibility beneath the thin lower eyelid skin when placed too superficially.

Hi @sunshine26! This is an excellent questions. Most facial filler products that are injected into this area should ideally be placed in the tissue plane directly on top of the bone, or at least underneath the eyelid muscle layer. If a facial filler product is placed too superficial in the skin, or on top of the muscle layer, the product may settle in with an abnormal appearance and can look to be lumpy, swollen, or irregular. Best of luck, Dr. Nima!

The lower eyelid groove (tear trough) is the indentation that forms between the lower eyelid fat-bulge and cheek. Filling this groove can lead to satisfying, youthful results with no downtime.
The level of injection depends on the filler, and the experience of your doctor. You should find a board-certified physician experienced in the art of filling lower eyelid grooves. This area is delicate and requires expertise.
I've attached a link demonstrating this technique.
I hope this helps, and best regards.

The tear trough deformity is a result ot the combined loss of fat in the deep medial fat pad that occupies the space between the nose and the cheek, and loss of bone in the maxillary bone that makes up the structure of the lower orbit of the eye and cheek. The injection is deep, into the medial fat pad, and under the muscle surrounding the eye, the orbicularis oculi. Caution is essential not to over correct or blockage of the lymph drainage in the area can result in long term swelling of the lower eyelid.

Tear trough injections are placed in the area bordering the medial lower eye and the side wall of the nose and upper cheek. This is a natural depression that gets more depressed with age. I prefer to inject under the skin in the soft tissue. I do not like to inject it on the periostium of the bone.

As we age, our cheeks begin to droop. While in the young, the lower lid is hardly distinct and is just part of the cheek, as the cheek begins sliding down in not only unveils the base of the lower lid BUT the rim of the lower ledge of the eye socket.
We inject fillers along that gravitational deformity to mask it and recreate the cheek-lower lid-lashes continuum seen in the young. The best way to do it is to carefully inject very close to the bone to fill up the V-shaped deformity of the tear trough. Only if needed, would THE DOCTOR choose to go slightly more superficial to achieve a fuller look. Placing some Restylane in the upper cheek and massaging it towards the rim of the orbit further helps blend and join the cheek-lower lid complex.
Good Luck.

Hi Sunshine26,
The skin of the eyelids is extremely thin. For this reason, filler in the tear troughs is usually placed deep to prevent any bumps from being visible and to give a nice, uniform, smooth correction. As one ages and volume is lost from the midface, the distinction between the eyelids and upper cheek becomes more obvious and injecting along the tear trough (nasojugal fold) helps to restore a more continuous appearance from the midface to the lower eyelid. Injections are usually placed deep and just above the bony rim to give the most smooth natural result.
Hope this helps!

The answer to your question is that it depends on each patient's anatomy. In general, the best candidates are younger with reasonable skin cover. The older patient with thin skin does not do as well with fillers and has more lumps and bumps. The majority of the material is placed along the bony rim and then more superficially if needed. Again, the treatment is customized to each patient. Only allow a doctor to do this, not a nurse or aesthetician because the structures near the eye are too important to trust to a non-physician.