Is It True That Fillers Are Not for Tear Troughs?

I have very deep tear troughs that are genetic. I recently went to a dermatologist that informed me that fillers would not help my situation. She said fillers are not meant for the tear trough. Should I see a second opinion? Should I see a plastic surgeon instead of a dermatologist?

Doctor Answers 12

Injections could work, but they aren't for everyone...

It’s not unusual for patients with tear trough deformities to request plastic surgical consultation. When this situation arises, hyaluronic acid fillers are very effective for treating this problem. Under these circumstances fillers can minimize tear troughs and ultimately improve peri orbital aesthetics.
It’s extremely important to individualize the treatment of tear troughs. In some patients the lower eyelid skin is extremely thin and for this reason injectable fillers aren’t always indicated. In this situation injections may be accompanied by nodules and bluish discoloration.
It’s important to realize that lower eyelid filler injections can be very effective for treating tear trough deformities but aren’t for everyone with this condition. For this reason it’s important that patients with tear trough deformities be evaluated by a board certified plastic surgeon. This surgeon should be able to formulate an appropriate treatment plan for this problem.

Fillers can soften the tear trough

Fillers can be used to soften the tear trough area. The choice of filler is important> I prefer the hyaluronic aced fillers because of their consistency, clear nature, and reversibility. Especially in this area, the skin is very thin, lumps may occur and it is nice to be able to inject a hyaluronidase which can smooth the area in a day or two.

Autologous fat transfer is an excellent filler, however I prefer to perform this procedure in the operating room.

Brian Maloney, MD, FACS
Atlanta Facial Plastic Surgeon
4.5 out of 5 stars 21 reviews

Fillers are GOOD for tear troughs

 In a patient with the right anatomy and good skin, fillers are among the best ways to improve the tear troughs.  They work better and are more predictable than fat injections in my opinion.

Not true

This question was posted several years ago. Today, there is a Health Canada approved filler for the tear troughs: Teosyal Redensity II. It is designed for the area to fill out the undereye hollows. I’ve performed the procedure many, many times with great results.

Under Eye Fillers, Tear Trough Filler Injection

Under eye (Tear Tough) are can be improved with inj. filler or Fat grafting. 

Use of blunt Cannula can help to minimize the bruising in this area.

Good knowledge of Anatomy & minimum amount of filler in desired area gives best results.

M. Khawar Nazir, MBBS, MS(Derm)
Pakistan Dermatologist
5.0 out of 5 stars 5 reviews

Fillers for Tear Troughs

I inject a lot of fillers and see a great deal of patients in consultation for facial fillers.  The tear trough area can have excellent results when injected properly.  I prefer Restylane or Belotero for this delicate area under the eyes.  For the best cosmetic results please consult a board certified dermatologist with a great deal of experience with injecting fillers under the eyes.

Tear Troughs Can Be Injected

It may be worth your while to seek a second opinion.  The tear troughs can be injected with a dermal filler if the client is a good candidate for the procedure.  The area above the orbital rim cannon be injected.  It also would depend on which part of the tear trough has the hallowing.

Jeffrey W. Hall, MD
Austin Plastic Surgeon
4.5 out of 5 stars 15 reviews

Fillers can help tear troughs

Certain fillers can do wonders for making tear troughs less noticeable. My patients commonly tell me that even though they feel tired and sleep-deprived, their filler makes they look well rested!  However, it's very important to go to someone experienced in treating this area.  Certain people have very prominent fat pads under their eyes, and these patients are probably best suited for surgery. However, many patients who have hollows can absolutely benefit from a small amount of filler. I usually start with only a drop and then we can always add more.  Too much filler in this area can look very artificial, so be sure to go to someone who is conservative and is looking to help you achieve a natural look    

Whitney Bowe, MD
New York Dermatologic Surgeon
4.5 out of 5 stars 6 reviews

Fillers not the first choice for tear troughs

Facial fillers are not the best choice for tear troughs.  This area has inherently thin skin and can easily show the fillers underneath the skin.  They can have a lumpy or blueish appearance (tinseling).  This is probably the area most prone to unsatisfactory results or complications and for this reason fillers are generally avoided or used with extreme caution.  This is not a good solution for severe tear trough deformities.  The best option is something called a mid face lift which repositions the fat in the area and gives a more permanent soft result.

When it comes to choosing between a plastic surgeon and a dermatologist it would depend on the problem.  Problems with the skin cancer, hypo-pigmentation, crepe like appearance of the skin, fine wrinkles, superficial problems etc are all easily handled by both but as the problem gets deeper or more severe a plastic surgeon is the better choice as they are trained in surgery for at least 6 years while a dermatologist may have little to no training in cosmetic surgery.  Severe problems as described here typically need a surgical solution. 

Under eye "tear troughs"

The dark shadows beneath the eyelids, especially the inside half, can be challenging to improve. Use of the HA fillers such as Restylane and Juvederm can be successful IF performed very carefully, meticulously, and placed properly (usually deep to the slender muscle layer that is there). It is not unusual for some bruising to occur. These injections are best performed by the more experienced physician. Keep in mind that skin color and thickness, aged skin, and presence of fat all can contribute to the under eye shadows and circles.   DRC


Donn R. Chatham, MD
Louisville Facial Plastic Surgeon
5.0 out of 5 stars 51 reviews

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.