The eyes are among the first areas of the face to reveal signs of fatigue or skin laxity. The tear trough, an anatomical hollow located between the inner corner of the eye and the cheekbone, gradually becomes more pronounced with age. Tear trough correction with hyaluronic acid is a targeted and effective response to this common concern.
But how does this technique actually work ? On which mechanisms is its effectiveness based ? What is the medical rationale behind this treatment ? This page provides clear and detailed explanations.
The tear trough corresponds to a natural groove that begins at the inner corner of the eye and extends slightly diagonally toward the cheek. In some individuals, it is present from a very young age. In others, it develops progressively over time.
The hollowing is caused by several factors :
The result is a permanent shadow under the eye, giving the gaze a sad or tired appearance, even when the person is in good health. It is precisely this hollow that hyaluronic acid aims to correct.
Tear trough correction is based on a simple principle : restoring lost volume by injecting a small amount of hyaluronic acid into the hollow, a substance naturally present in the human body.
The hyaluronic acid used is a viscoelastic gel, specifically formulated for this delicate area of the face. Its role is to gently fill the depression, smooth the transition between the eye and the cheek, and reduce the shadow caused by the tear trough.
Unlike other areas of the face, the goal here is not to add volume, but rather to softly rebalance with a light, discreet, and natural correction.
The injection is performed in the clinic following a medical consultation. The physician carefully assesses the facial anatomy, the depth of the hollow, the skin quality, and the possible presence of dark circles, asymmetries, or under-eye bags.
The injection itself takes between 15 and 30 minutes. It can be performed either with a very fine needle or a micro-cannula, depending on the physician’s technique and the specific characteristics of the area being treated. The goal is to deposit the product deeply, at the bone level or in contact with the ligaments, with great precision, to avoid excess and achieve a natural result. The injected volume is always small and applied in tiny amounts to respect the natural expression of the eyes.
The procedure is generally minimally painful, does not require special anesthesia, and does not cause social downtime. In some cases, slight swelling or minor bruising may occur, but these side effects are temporary and disappear within a few days.
The choice of the injected product plays a crucial role. The tear trough is a particularly delicate area: the skin is thin, highly vascularized, and sensitive to changes in hydration as well as pressure. The hyaluronic acid used must therefore meet very specific criteria. It should be lightly cross-linked to integrate smoothly into the tissues, minimally hydrophilic to avoid swelling or a bluish reflection (known as the Tyndall effect), and sufficiently malleable to provide a uniform result without irregularities. In addition, there is of course the requirement for safety, with traceable, certified products that comply with Swiss standards.
Among the most commonly used references for this area are Teosyal Redensity II®, Juvéderm Volbella®, Restylane Lyft®, and Restylane Volyme®. These gels have been specifically formulated for the infra-orbital region and offer a good balance between finesse, tolerance, and long-lasting results.
Hyaluronic acid has become the reference product for treating the tear trough, and for several obvious reasons. Naturally present in the body — particularly in the skin — it plays a key role in tissue hydration and structure. When used in injections, it subtly restores lost volume without weighing down or freezing facial expressions.
In the tear trough, the goal is not to “fill,” but to recreate a smooth and natural transition between the lower eyelid and the cheek. Hyaluronic acid is ideal for this purpose due to its flexibility, modulating capacity, and the ability to use it in very precise amounts.
Another major advantage is its reversibility. In the case of an unsatisfactory result, a simple injection of hyaluronidase can dissolve it, providing a high level of safety for both the patient and the physician. These qualities explain why, when used with precision and discernment, this product has become an essential tool in the aesthetic management of this facial area.
Hyaluronic acid injection in the tear trough provides excellent results when the indication is properly established. It helps reduce a visible hollow, often responsible for a sad or tired appearance, even in patients who are not actually fatigued. By restoring slight support under the lower eyelid, the eyes gain softness and brightness. The goal is not to transform the face, but to restore balance by correcting this small collapse between the eye and the cheekbone.It is also important to understand what this treatment does not do. It does not treat fat pads, which usually require a surgical approach. It also does not correct pigmented or vascular dark circles, nor skin laxity. In these cases, a combined protocol is often necessary, for example including skin care, lasers, or other techniques.
The term “filling” is often used, but it can be misleading. In the case of the tear trough, the goal is not to swell or fill an area as one would do for a cheek or a nasolabial fold. What is primarily being corrected is a shadow. This facial area is marked by a break in light: the hollow creates a dark line that immediately gives a tired appearance, even if the lost volume is sometimes minimal. The visual effect is far more significant than the actual depth of the hollow. The role of hyaluronic acid is therefore to soften this transition, to “break the shadow” without altering apparent volumes. The aim is not to transform features, but to blur a discontinuity. It is this work with light, rather than substance, that restores radiance and freshness to the eyes. This also explains why this area requires such technical skill and experience: one must neither overcorrect nor inject into the wrong plane, as this could result in an unnatural outcome.
One might think that a good product alone is enough to guarantee a successful result. However, in the treatment of the tear trough, success relies primarily on mastery of the injection technique. This is an anatomically complex area: shallow, narrow, and traversed by numerous blood vessels and nerves. An injection that is too superficial or poorly performed can cause unsightly swelling, irregularities, or even a persistent bluish effect. The physician must therefore adapt the technique for each patient: choice of needle or cannula, injection plane depth, and the quantity injected. In most cases, small doses are carefully distributed to allow the product to blend naturally into the tissues. This gradual, tailor-made approach is often the key to a more open and luminous gaze. The physician’s experience is recognized in their ability to dose accurately, observe carefully, and respect the natural dynamics of the face.
Article written by Dr Romano Valeria
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