Tear trough treatment with hyaluronic acid is intended for patients who have a visible hollow between the lower eyelid and the cheekbone. This area, called the “tear trough,” often gives the eyes a tired appearance, even in young or healthy individuals. When properly indicated, filling this hollow restores a natural transition between the eye and the cheek, without a frozen look or excessive transformation.
Contrary to some misconceptions, this is not solely an age-related aesthetic issue. While skin aging can accentuate the hollowing of this area, the tear trough may also be present constitutionally, sometimes as early as the twenties or thirties. Bone structure, cheekbone position, skin quality, and genetics all play a decisive role in the appearance of this under-eye shadow.
The treatment is therefore suitable for anyone, male or female, who is bothered by a sagging or hollow in this region, associated with a real aesthetic concern. The goal is not necessarily to “look younger,” but rather to achieve a more open and luminous gaze by correcting a volume discontinuity that disrupts facial expression.
It is essential to remember that the appearance of the tear trough is not exclusively age-related. Although skin laxity, loss of subcutaneous fat, and bone resorption are factors that worsen over time, some young patients have a pronounced tear trough for purely anatomical reasons. In these cases, hyaluronic acid filling can be offered early, with a focus on subtle and natural correction.
In women, this hollowing is often accentuated after prolonged periods of fatigue, stress, or following hormonal variations. In men, it may appear earlier, particularly in cases of flat cheekbones or volume loss in the midface. The treatment is entirely suitable for both profiles, provided that the anatomical specificities of each patient are respected and the injection is precisely adapted.
Patients consulting for this indication often share the same complaint: eyes that appear tired or sad, regardless of their actual condition. This gap between internal perception and the image reflected by the face is at the heart of the motivation to treat the tear trough. It is also what makes the correction particularly rewarding, as the change, although subtle, can profoundly transform the expression of the eyes.
Before any injection, a thorough medical evaluation is essential. The physician must examine several parameters: the depth of the hollow, skin quality, and the possible presence of dark circles, under-eye bags, or asymmetries. All these factors guide the therapeutic decision, as hyaluronic acid injection is not systematically indicated.
When malar bags are present, filling may be contraindicated; in any case, the procedure must be performed by an experienced physician.
In certain cases, other options such as lasers, chemical peels, or regenerative medicine may be proposed as complementary or alternative treatments.
The physician’s role is therefore to identify patients for whom the treatment is truly beneficial and to guide them toward the most appropriate solution. This rigorous evaluation ensures a result that is consistent with expectations, natural, and long-lasting.
Tear trough filling appeals to many patients seeking a discreet, non-surgical treatment, without social downtime, and with visible yet natural results. It is a particularly interesting option for individuals who do not wish to alter their face, but simply to “refresh” their gaze.
Patient expectations are often very precise: no visible transformation, no swelling. Injection of a firm, minimally hydrophilic hyaluronic acid, placed in the correct anatomical plane, allows for subtle correction and perfect integration. The eyes appear more rested and softer, without the exact cause of the change being identifiable.
This discretion makes it a preferred solution for executives, exposed professionals, artists, or anyone concerned with preserving the authenticity of their face. The effect is gradual, stabilizes after a few days, and can last between 9 and 15 months depending on the product used, the patient’s metabolism, and skin quality.
As with any treatment, tear trough filling relies on a personalized approach. It is not about applying a standard protocol, but adapting the injection to the facial morphology, skin thickness, and the patient’s specific expectations. Some faces require very subtle, almost imperceptible correction, while others demand a more complex and thoughtful approach.
The quality of the result largely depends on the precision of the assessment and the physician’s skill. Injecting too much product or in the wrong plane can weigh down the gaze or create an unsightly contour. Conversely, injecting the appropriate amount at the correct level allows for a very natural effect, difficult to detect yet immediately noticeable in the facial expression.
It is this level of precision, attention to detail, and technical mastery that makes all the difference in such a delicate area. The eyes are at the center of emotion, attention, and interpersonal connection. This is why any intervention in this region must meet a dual requirement: aesthetic effectiveness and absolute respect for the patient’s uniqueness.
Even though tear trough treatment is minimally invasive and generally well tolerated, it is not suitable for all profiles. There are situations where hyaluronic acid injection may be ineffective, aesthetically unsatisfactory, or even contraindicated. This is particularly the case when pronounced fat pads are present under the eyes: filling an adjacent hollow may then accentuate them. Similarly, failing to consider edema or chronic water retention in this area can lead to persistent swelling after injection.
Some patients also present with very pronounced under-eye pigmentation, of vascular or genetic origin. In these cases, the injection does not correct the discoloration, which can lead to disappointment if not properly explained to the patient. Other factors, such as very thin skin, medical history, weight fluctuations, or inflammatory conditions, require particular caution. A prior consultation with a clinical examination is therefore essential to establish an appropriate indication. It is this rigor in patient selection that ensures natural, consistent, and long-lasting results.
After a certain age, many patients wonder about the relevance of a treatment as localized as tear trough correction. However, there is no strict age limit. What matters is the condition of the skin, facial structure, and overall eye dynamics. After 60, the tear trough may be more pronounced due to fat loss, tissue laxity, and bone resorption. These changes can make correction more complex, but no less relevant.
In these patients, the treatment should be considered as part of a comprehensive approach to the midface. It is no longer simply about filling an isolated hollow, but about restoring volumes while considering all structural losses. The injection can then be part of a more complete protocol, combining, for example, dermal fillers, work on skin quality, and possibly enhancement of bony contours. The goal remains the same: to refresh the gaze and soften the features without overloading. A measured approach ensures a natural and elegant result, respecting the balance of the face.
Long associated with a feminine approach, aesthetic medical procedures now appeal to a growing number of men. Tear trough treatment fits perfectly within this trend. It addresses a specific need: to reduce signs of fatigue and restore freshness to the gaze without altering the identity of the face. In men, the under-eye hollow can appear early, sometimes as soon as 30 or 35 years old, even in the absence of laxity in other areas of the face. This area plays an important role in facial expression: it can harden features, prematurely age the appearance, or give a stern look, inconsistent with the patient’s actual energy.
The major advantage of this treatment for male patients lies in its discretion. The injection leaves no visible mark, does not alter contours, and preserves a natural expression. The result is not dramatic, but subtle: a clearer, more rested gaze, without those around being able to pinpoint exactly what has changed. This type of targeted and controlled intervention appeals to discerning men, keen to maintain their image while taking care of themselves with restraint.
Sometimes, the hollow may be visible, and the patient may express discomfort, yet injection is not the best option at that time. This can be due to a borderline indication, a temporary imbalance (transient fatigue, inflammation, hormonal instability), or simply unclear or unrealistic aesthetic expectations. In these cases, choosing not to intervene is not a refusal, but a mark of precision. The physician should never act according to a systematic or commercial logic. The technical procedure relies on a thorough clinical analysis, understanding the patient’s expectations, and the ability to wait when necessary.
Offering monitoring over time, a targeted cosmetic routine, or a superficial treatment such as mesotherapy or a chemical peel. This conservative approach can sometimes prevent a premature intervention or guide the patient toward a more considered decision. It is also a way to build a relationship of trust, based on respecting each individual’s pace and seeking a result that is truly appropriate.
For patients wondering about the origin of their tired-looking eyes, certain signs may point to the involvement of the tear trough. The first is visual: a hollow forms between the lower eyelid and the cheekbone, noticeable even at rest. This contour often becomes more pronounced under certain lighting, particularly lateral natural light, creating a shadow that gives a sad or aged expression, sometimes inconsistent with the patient’s actual vitality.
Another common indicator is the progressive loss of the natural continuity between the lower eyelid and the cheek. What was once a smooth and fluid line becomes more marked, like a break in the gaze. The face may then appear more hollowed or severe, even without other obvious signs of aging. This evolution, often subtle, goes unnoticed until comments such as “You look tired” or “Are you sleeping badly?” are made by others, revealing a gap between personal perception and outward appearance.
These signs alone do not constitute a systematic indication for treatment, but they may justify a consultation. The physician’s role is to objectively assess the situation, analyze the patient’s request, and, if appropriate, propose an adapted response—whether immediate or deferred—depending on the clinical context and the patient’s expectations.
Article written by Dr Romano Valeria
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