The tear trough is one of the first areas of the face to show signs of aging. Located between the lower eyelid and the upper cheek, it appears as a hollow of varying depth, often associated with a shadow or dark circle. Its formation, whether gradual or constitutional, involves complex anatomical and physiological mechanisms. In Geneva, patients concerned with aesthetics often wonder about the age at which this hollow area appears: is it linked to natural aging or to an individual predisposition ?
This article aims to provide a detailed, medically grounded, and aesthetically relevant answer to the question: at what age does the tear trough begin to form ?
The tear trough corresponds to an anatomical groove located between the lower orbital rim and the upper part of the cheek. It mainly results from a loss of subcutaneous tissue volume, ligamentous laxity, and a reduction in infraorbital bone support. This hollow creates a break in the continuity between the eyelid and the cheek, giving the eyes a tired appearance.
This area is particularly delicate, as the skin is thin, mobile, and richly vascularized. Even a slight volumetric deficit becomes quickly noticeable, making it an early indicator of facial aging.
The tear trough generally appears between 28 and 35 years of age. This age range corresponds to a slowing of cellular renewal, a gradual decrease in collagen production, and a loss of density in the supporting tissues of the face. In patients with good lifestyle habits and favorable genetics, this process can be delayed. But for others, infraorbital volume loss may become noticeable before 30, prompting them to seek an aesthetic consultation.
In some individuals, the tear trough is visible as early as adolescence or the early twenties. This early hollow is often genetic, related to particular anatomy: a retruded maxilla or a lack of fat tissue in the cheek area. In these cases, early correction with hyaluronic acid is entirely feasible. The goal here is not to correct aging, but to balance facial volumes.
Around 40 to 45 years, the infraorbital hollow tends to become more pronounced. This change is explained by a loss of overall support: bone resorption, deep fat migration, and ligamentous laxity. Aggravating factors such as menopause, andropause, rapid weight loss, or chronic stress can also contribute.
In this context, treating the tear trough alone is often not sufficient. A comprehensive approach to the mid-face is needed to restore volumes, support the tissues, and give the eyes their youthful freshness.
In many people, the tear trough, previously discreet, suddenly becomes more pronounced between 40 and 45 years of age. This change, although perceived as abrupt, actually results from a slow and progressive process.
Around the forties, several physiological phenomena combine: bone resorption at the infraorbital rim, fat loss in the cheek area, laxity of the supporting ligaments, and deterioration of skin quality. Together, these factors weaken the junction between the eyelid and the cheek, revealing a hollow previously compensated by tissue volume or firmness.
Certain factors can accentuate this shift: menopause, andropause, rapid weight loss, prolonged stress, or significant life events. It is often at this stage that an initial aesthetic intervention is considered, whether preventive or corrective.
Facial morphology and skin characteristics differ significantly between sexes, directly influencing the age of onset and clinical expression of the tear trough.
In women, the skin is generally thinner, with less prominent malar bone support. Additionally, hormonal variations affect tissue tone and fat distribution. These factors make the tear trough visible earlier, on average between 28 and 32 years. Women are also more sensitive to slight changes in infraorbital volume, making the hollow more noticeable at an early stage.
In men, bone density is higher, the orbital rim more prominent, and the skin thicker. These elements delay the appearance of the tear trough, which often appears around 35 to 40 years. However, when it becomes noticeable, it is often deeper and more pronounced. Treatment requires a specific approach, with injectable products adapted to male skin and a technique designed to preserve the masculinity of the face.
Skin phototype and ethnic characteristics strongly influence how the tear trough appears with age.
In people with fair skin (phototypes I to III), the skin is often thinner, more fragile, and more sensitive to the sun. This can lead to an earlier appearance of the tear trough, sometimes as early as the late twenties. The eyes may appear tired due to a combination of hollowness and bluish discoloration, linked to the transparency of the skin.
Conversely, darker skin types (phototypes IV to VI), such as those of Mediterranean, African, or Asian origin, have denser, more elastic skin that is more resistant to photoaging. This often delays the appearance of the tear trough. However, these skin types more frequently present pigmented dark circles, meaning a visible shadow even without actual volume loss.
For this reason, it is essential to adapt the treatment to each phototype. The tear trough does not manifest in the same way in fair-skinned and darker-skinned individuals, and it should not be corrected using the same approach.
High-level athletes or patients who are very physically active often have a face characterized by low subcutaneous fat. This can accelerate the appearance of the tear trough.
In these patients, the infraorbital hollow may appear as early as 25-30 years, not due to premature aging, but because of a natural thinning of the supporting tissues. The reduction of deep fat, extreme skin tone, and increased catabolism contribute to this mechanism.
Furthermore, intense physical effort generates chronic oxidative stress, leading to accelerated degradation of collagen and elastin. The eyes may then appear tired, out of sync with the patient’s overall physical condition.
It is recommended to consult as soon as the first signs of hollowing appear, generally between 30 and 35 years of age. This early evaluation allows differentiation between a constitutional tear trough and the beginning of age-related laxity. It also provides the opportunity to intervene at a stage where corrections can be light, subtle, and preventive.
The initial consultation includes a complete morphological analysis of the mid-face, an assessment of skin quality, and a study of bone and fat volumes. It allows the development of a personalized aesthetic strategy, which may rely on preventive measures (cosmeceuticals, Skinboosters, mesotherapy) or curative injections.
Waiting too long before consulting can make the treatment more complex. More extensive interventions may be required, with less optimal results. Additionally, correcting only the tear trough at an advanced stage can create an imbalance with the rest of the face.
Article written by Dr Romano Valeria
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