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 5

Tear trough

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
4.4 out of 5 stars 20 reviews

Where to place fillers for tear trough correction

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!

Bernard S. Salameh, MD
Bowling Green Physician
5.0 out of 5 stars 17 reviews

Filler and location.

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 10 reviews

Tear trough

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 48 reviews

Tear trough filler placement

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
5.0 out of 5 stars 6 reviews

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