Ageing : the main cause of tear trough development
With age, gradual loss of deep facial fat compartments is one of the first causes of tear trough development. More specifically, malar fat — located around the cheekbones — diminishes and migrates, reducing under-eye support. This fat loss is often accompanied by tissue ptosis (sagging), deepening the hollow between the orbit and cheek. Volume loss is not limited to superficial tissues : deeper areas are also affected, altering the overall facial architecture.
Bone ageing also contributes to tear trough formation. 3D imaging studies have shown that the malar bone (cheekbone) gradually resorbs with age, particularly in its medial portion. This resorption reduces structural support for soft tissues, causing them to descend and accentuating under-eye hollows. Often subtle but progressive, this phenomenon makes the eyes look increasingly tired over time.
Genetic and morphological causes of tear troughs
- Individual anatomical constitution : some people have visible tear troughs from a very young age. This constitutional feature is often associated with naturally low cheekbones, a hollow lower eyelid or a pronounced lid-cheek junction. In these cases, tear troughs have an anatomical origin rather than being caused by ageing, although they may deepen over time. Medical diagnosis distinguishes congenital causes from acquired changes and allows treatment to be adapted accordingly.
- Heredity : a genetic predisposition to early skeletonisation of the eye area can be inherited independently of chronological age or lifestyle. This hereditary component is particularly evident in patients from ethnic or phenotypic groups with slender facial features.
Including this history in clinical assessment is essential when developing a personalised treatment protocol.
Collagen loss and skin ageing : why tear troughs deepen
- Intrinsic skin ageing : skin quality plays a fundamental role. With age, skin gradually loses elasticity and thickness as collagen, elastin and hyaluronic acid production slows. This skin atrophy makes underlying structures (bones, muscles and ligaments) more visible and accentuates hollows. Thinning of the infraorbital skin intensifies natural shadows, contributing to formation of the groove.
- Extrinsic skin ageing : environmental factors — particularly chronic sun exposure (photoageing), smoking, pollution, oxidative stress and an unhealthy lifestyle — also contribute to dermal deterioration. These stressors accelerate loss of skin firmness, reduce local microcirculation and weaken dermal structure, worsening hollows around the eyes.
Ligament and muscle laxity : a cause of tear troughs
- Orbital and malar ligaments : the face is supported by a complex ligament network that stabilises soft tissues. Over time, these ligaments — particularly the orbital and zygomatic ligaments — lose tension and allow tissues to sag. Ligament laxity is particularly visible in the infraorbital area, encouraging folds and hollows in the tear trough.
- Reduced muscle tone : the orbicularis oculi muscle surrounding the eye can also lose tone with age. This muscle laxity causes an uneven redistribution of volume and may extend the tear trough towards the cheek. It is often accompanied by compensatory muscle overactivity, creating excessive contractions and encouraging static and dynamic wrinkles around the eye.
Weight loss, lifestyle and tear trough development
- Significant weight changes : substantial weight loss or gain directly affects facial fat volume. Yo-yo dieting or rapid fat loss associated with certain conditions or drug treatments can deepen infraorbital hollows. The face, particularly its middle third, is sensitive to these changes, which can accelerate tear trough development even in younger patients.
- Lifestyle habits : lack of sleep, an unbalanced diet, chronic dehydration and stress can all make the eyes look more tired. Although not directly responsible for tear trough development, they may worsen its clinical appearance or bring it forward. Comprehensive care combining aesthetic medical procedures with healthier lifestyle habits is therefore essential for a lasting, harmonious result.
Medical and traumatic causes of tear troughs
- After-effects of surgery or trauma : certain operations (lower blepharoplasty, rhinoplasty or malar lifting) or facial injuries can cause retraction or secondary hollowing in the tear trough. Poor healing, excessive fat resorption or postoperative fibrosis may alter the natural volumes of the lid-cheek area.
- Underlying conditions : endocrine disorders, severe nutritional deficiencies (particularly protein, iron or vitamin deficiencies) or chronic skin conditions may indirectly affect skin firmness and facial volume balance. In these cases, tear troughs are just one of many signs of a wider imbalance.
How does facial anatomy contribute to tear trough formation ?
The infraorbital region is anatomically complex, with several overlapping tissue layers of distinct functions and characteristics : the epidermis, dermis, orbicularis muscle, superficial and deep fat pads, supporting ligaments, zygomatic bone and orbital rim. This fine, dense, multilayer arrangement allows both considerable mobility and expressive movement of the eyes.
Over time, these tissue layers lose their functional cohesion. The fibrous septal network anchoring superficial fat to deeper fat becomes looser, causing fat volumes to migrate and diminish. At the same time, the skin thins, making underlying anatomical discontinuities more visible. This microanatomical disruption creates a clear boundary between the periorbital area and cheek, accentuating the hollow that forms the tear trough.
This subtle, gradual process explains why tear troughs may develop from the thirties even without illness or tiredness. It also underlines the importance of considering every tissue plane when aesthetically assessing the middle third of the face.
Does orbicularis oculi muscle overactivity contribute to tear troughs ?
The orbicularis oculi, a ring-shaped muscle around the eyelid, plays an essential role in eyelid closure and eye expression. It contracts constantly, either reflexively (blinking) or voluntarily (facial expressions). In some patients, this muscle activity is excessive.
Overactivity of the orbicularis muscle places chronic traction on underlying tissues. Over time, this mechanical action contributes to wear of ligament attachments and compression of superficial fat, encouraging atrophy. Repeated orbicularis contractions also create a kind of "pleating" effect on the skin, accentuating the lacrimal groove.
This functional factor is particularly important because it is often present from a young age, contributing to early tear trough development in younger patients. It also explains why some patients have prematurely hollow-looking eyes despite good skin quality.
Lymphatic drainage and circulation : their role in tear trough development
The lymphatic system plays a key role in removing cellular waste and maintaining tissue fluid balance. However, the infraorbital area has a poorly developed lymphatic network and relatively slow vascular circulation. This anatomical characteristic makes it susceptible to stagnation, particularly with tiredness, stress or prolonged lying down.
Insufficient lymphatic drainage may cause swelling — often slight, but enough to accentuate natural shadows around the eyes. This congestion makes the eyes look tired and heavy while visually emphasising the lacrimal hollow. Although secondary, this cause acts as an aggravating factor, making tear troughs more apparent, particularly on waking or in patients prone to water retention.
Vascular congestion may also influence perception of the infraorbital hollow. Venous stasis, particularly in the under-eye plexuses, can darken the area, emphasising the groove's depth through contrast. This mechanism is often temporary but may become chronic if its causes are not identified and corrected.
Do hormonal factors contribute to tear trough development ?
Hormones play an essential role in tissue regeneration, collagen production and water retention in skin and subcutaneous tissues. Oestrogens directly affect skin hydration, dermal thickness and the density of supporting fibres. In women, the sharp fall in oestrogen at menopause causes rapid deterioration of skin tone and tissue firmness, including in the infraorbital region.
More generally, hormonal ageing — whether age-related or associated with certain endocrine conditions — reduces hyaluronic acid synthesis, dermal elasticity and vascularisation. These changes diminish the tissues' natural fullness, making underlying structures more apparent. In men, a gradual decline in androgens can also reduce bone and muscle density, contributing to laxity of facial support.
This hormonal factor is often underestimated despite being a major systemic cause of accelerated facial ageing. It must be considered in overall facial analysis, particularly for women approaching menopause or patients showing signs of endocrine imbalance.
Pollution, sun and smoking : factors that worsen tear troughs
Skin ageing and signs such as tear troughs are strongly influenced by the living environment. Among the most damaging extrinsic factors are chronic exposure to ultraviolet radiation, urban pollution, smoking and blue light from digital screens. These often unnoticed stressors cause cellular oxidative stress that gradually damages collagen fibres, weakens cell membranes and reduces elastin production.
The skin around the eyes, naturally thinner than elsewhere on the face, is particularly vulnerable to these attacks. It ages faster, with reduced dermal density and deeper hollows such as tear troughs. Air pollution has also been identified as an aggravating factor in periorbital pigmentation, visually increasing contrast between the hollow and adjacent areas.
In Geneva, where pollution levels are moderate but real, these factors must be considered during aesthetic assessment, particularly for patients exposed daily to an urban environment. Preventing these stressors is an integral part of a comprehensive, considered approach to ageing around the eyes.
