The tear trough refers to an anatomical hollow that extends from the lower eyelid to the upper cheek, whose presence can make the eyes look tired and darkened. It appears gradually with age, following volume loss and tissue laxity in the mid-face. Hyaluronic acid injections are currently the most commonly used treatment to correct this hollow. However, some patients, either out of caution or due to contraindications, seek alternatives to injections. Are there other effective solutions to reduce the tear trough ?
Dr. Romano proposes a personalized approach, integrating several therapeutic tools, adapted to the anatomical profile and expectations of each patient. This page objectively examines the available alternatives, specifying their indications, limitations, and role within a global medico-aesthetic strategy.
To consider alternatives to injections, it is essential to understand the structural causes of the tear trough’s appearance. This hollow is not superficial but deep, and results from a combination of factors :
Injections help compensate for these losses, but some alternatives aim to naturally stimulate tissue metabolic activity, improve skin quality, or indirectly act on the hollow.
Although Skinboosters are composed of lightly cross-linked hyaluronic acid, they are not considered filler injections. Their goal is to restore deep hydration, stimulate collagen production, and sustainably improve skin quality.
Skinboosters are particularly effective in patients presenting :
Mesotherapy is based on a similar principle but uses a targeted cocktail of vitamins, minerals, and antioxidants. It acts on local microcirculation, promotes cellular regeneration, and provides a true “fresh-looking eyes” effect.
Although they do not directly fill the tear trough, these treatments strengthen the skin structure and visually reduce its impact, particularly for prevention or in young patients.
Laser photorejuvenation is an interesting alternative for treating certain visible signs in the peri-orbital area, particularly when they are related to skin laxity or impaired skin quality. Although it is not a volumizing treatment, the laser works by stimulating fibroblasts and boosting the natural production of collagen and elastin, key elements for skin support.
Depending on the skin characteristics and the type of hollow observed, several technologies can be proposed.
The non-ablative fractional laser acts in depth, helping to redensify the dermis, improve skin quality, and smooth fine lines under the eyes.
This treatment is particularly indicated for patients with thin, wrinkled, or lax skin, mild to moderate loss of firmness, or dark circles of vascular or pigmentary origin, sometimes associated with the beginning of infraorbital hollowing.
Laser photorejuvenation fits perfectly into a non-invasive overall aesthetic approach, complementing targeted topical care and light medical procedures such as Skinboosters, mesotherapy, or certain superficial peels. It does not replace injections in cases of marked volume loss but can prepare the skin, improve skin quality, and extend the results of injections.
The personalized treatment plan often includes several sessions spaced over time to gently stimulate dermal tissue regeneration.
Given the thinness of the skin and fragility of the peri-orbital area, this type of intervention must be performed by an experienced physician who perfectly controls the energy parameters.
uperficial peels based on fruit acids (AHAs) or trichloroacetic acid (light TCA) can be used to improve the skin quality of the orbital and malar regions, reduce residual pigmentation, and gently stimulate cellular renewal.
Combined with cosmetics formulated for the peri-orbital area, these treatments help reduce the visibility of pigmented dark circles, strengthen the skin barrier, and combat tissue oxidation.
Although they do not have a volumizing effect, these treatments help maintain skin quality, a fundamental parameter in any sustainable and coherent aesthetic strategy.
In some patients, particularly those with severe malar hypoplasia, a very long lower eyelid, or prominent fat pads, surgery can be considered.
Surgical procedures, being more invasive, are reserved for specific cases. They should be discussed during a specialized consultation, after clinical evaluation and benefit/risk analysis. They do not constitute a direct alternative to injections, but rather a structural treatment in complex contexts.
Although hyaluronic acid injections are widely used to correct the tear trough, some patients wish to avoid them entirely or use them only as a last resort. The motivations are varied and must be respected within the framework of responsible medical care.
Among the most common reasons :
In all these cases, the medical consultation aims to assess the patient’s expectations, explore realistic alternative solutions, and build a coherent aesthetic strategy, without inducing guilt.
Patients seeking an alternative to injections often question the real effectiveness of these approaches. It is essential to remember that the tear trough is a structurally hollow area, linked to a loss of bony, fatty, or ligamentous support. No technique, apart from injections, can on its own restore missing volume.
However, alternatives can have visible effects on skin quality (density, tone, texture), pigmentation (brown or bluish dark circles), and tissue firmness, by stimulating collagen synthesis and local vascularization, and improving microcirculation.
The result is therefore often indirect but significant : a less tired look, a brighter peri-orbital area, firmer skin. In certain profiles — young patients, early hollowing, or still firm skin — these results can delay, or even avoid, the need for injections for several years.
When it comes to avoiding injections, it is often necessary to combine several complementary approaches to achieve a visible and lasting effect. Among the most effective combinations, laser photorejuvenation, integrated into a targeted dermocosmetic routine and periodic in-office treatments, constitutes a coherent and scientifically based strategy.
Non-ablative fractional laser acts deeply on the dermis, inducing stimulation of collagen and elastin synthesis without damaging the skin surface. This treatment improves tissue density, softens fine lines, and restores slight support to the under-eye area.
Combined with the application of cosmeceuticals containing hyaluronic acid, peptides, or vitamin C, with light mesotherapy sessions to reinforce hydration, and with daily photoprotection, photorejuvenation fits perfectly into a non-invasive eye care pathway. This synergistic approach progressively improves skin quality and eye brightness, with often very satisfactory results in patients reluctant to injections.
In light of the rise of natural methods promoted on social media, it is essential to recall the limits, and even the risks, of unsupervised practices. Many patients, wishing to avoid injections, turn to “homemade” techniques supposedly aimed at preventing or correcting the tear trough. However, the vast majority of these solutions have no proven scientific basis, and some may even be harmful.
Among the practices to avoid :
These methods in no way replace supervised medical care. However, certain gentle drainage techniques, performed by trained professionals, can prove beneficial as a complement to medical treatment.
Article written by Dr Romano Valeria
SHARE THIS ARTICLE ON
