Where Exactly is Tear Trough Filler Injected?

Question

When correcting a Tear Trough deformity, where is the actual filler placed? I've read some surgeons inject directly under the eye muscle, some along the bony rim, and others on the uppermost cheek, depending on where the hollowness is in the midface.

Otto Joseph Placik, MD · Answer

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.

Nima Shemirani, MD · Answer

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!

Eric M. Joseph, MD · Answer

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.

Stephen Mandy, MD · Answer

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.

Steven Wallach, MD · Answer

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.

Where Exactly is Tear Trough Filler Injected?

Answers (5)