Tear trough filler question

My surgeon says that the dermal filler in the tear trough area is placed under the skin along the bone. When i look at a picture of a skull, it seems to me there is no bone in that area, just two large hollows. Can somebody clear this up for me...

Doctor Answers 8

Tear trough

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Please find a better anatomy poster to look at and trust a doctor who actually went to medical school and not just looked at a picture of the skull to find out where the tear troughs are.

Cambridge Facial Plastic Surgeon

Tear trough hollows

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There is a bone around the eye, it is called the orbital bone. It is safe to inject deep on this bone, with an experienced practitioner, which can yield some excellent and natural looking results. There are also deep skin resurfacing options, and surgical (blepharoplasty) options with equally satisfactory results, it depends entirely on your under eyes' anatomy and the skin texture. Good luck!

Thomas Buonassisi, MD
Vancouver Facial Plastic Surgeon
4.9 out of 5 stars 114 reviews

Tear trough

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My preferred technique is also injections of a soft hyaluronic filler such as Belotero directly onto the orbital bone.  The skin under the eyes is thin and unforgiving.  Lumps and bumps can be visible if the product is not placed deeply in this region.  I also educate my patients that tear troughs deformities sometimes can not properly be fully addressed without injecting the mid face and cheeks with filler as well.  Patients may come in pointing to their under eye area, however a small amount of product in the cheeks will allow for a more natural enhancement.

Claire Wolinsky, MD
New York Dermatologist

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Proceed with caution!

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It is true! The fillers around the eyes must be placed deep on the bone. The bone (orbital bone) extends around the eyes and then goes into the nasal area. You are right there are parts that are not covered by bone. Those parts are most dangerous because if fillers are placed there there is a chance they can get into the vasculature and cause blindness!

I always evaluate to see if someone is a good candidate for getting under eye circles treated based on their unique anatomy. Tip: you might combine this with Botox to create better and longer lasting results. The circular muscle around the eyes can move the fillers with movement and cause more of a bump there.

Best of luck!

Tanya Kormeili, MD
Los Angeles Dermatologist

Where to place fillers for tear trough correction

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Thank you for your question. In my opinion, fillers should be placed directly on top of the bone when correcting tear trough deformity. The skin is very thin in that area and superficial placement of the filler might lead to filler visibility. I hope this helps. Best wishes!

Filler and location.

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I am on the same page as your surgeon. It is interesting you reviewed a skull because that will help understand this. So there is a nasojugular ligament that is attached at the medial towards the nose part of the eye socket and that becomes joined with a band of the circular orbicularis muscle. These together cause this demarcation that separates the eye from the cheek. It becomes a valley at this point. So this is the area we need to lift. To lift an area there must be support to build. Like building a house on a foundation. So we use he bones orbit to push up the soft tissues of this area which helps camoflauge the eye bag demarcation.  

Hope this helps. 

Best of luck,


Benjamin Caughlin, MD
Chicago Facial Plastic Surgeon
5.0 out of 5 stars 13 reviews

Tear trough

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heygoodlooking, your surgeon is correct and a trans-oral route is the best one to take for this procedure. There is a risk of going blind but it is rare. I prefer a "SOOF lift blepharoplasty" to correct this problem but that would require surgery and anaesthesia. Good luck!

M. Sean Freeman, MD
Charlotte Facial Plastic Surgeon
4.7 out of 5 stars 55 reviews

Tear trough filler placement

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Thanks for your question.  Your surgeon is correct.  The filler is often injected on top of the bone just below the hollow of the eye.  This is an advanced injection technique given the important structures in the area, so make sure you select a physician injector with the proper training and experience.  Best of luck!

Alix J. Charles, MD
Hinsdale Dermatologic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.