The tear trough is an often-overlooked area of the face, yet it is frequently discussed during consultations in aesthetic-oriented medicine. Its appearance, sometimes from a young age, gives the eyes a tired or even sad look, regardless of the patient’s health or lifestyle. This aesthetic concern is not pathological; it results from a combination of anatomical, physiological, and structural mechanisms that should be understood before considering any treatment, whether corrective or preventive.
The tear trough is a groove that starts at the inner corner of the eye and slopes diagonally toward the cheek. It is located at the junction between the lower eyelid and the upper part of the cheekbone. In medical terminology, this depression is often referred to as the nasojugal groove. It is not a surface defect or a simple skin issue, but rather a volumetric transition zone between two distinct anatomical structures.
In some patients, this groove is present constitutionally, sometimes from adolescence. In others, it gradually appears with age, as the deep facial fat diminishes. This hollow becomes visible, particularly under certain lighting, and alters the appearance of the eyes. The face looks more pronounced, less rested, even in the absence of actual fatigue.
The formation of the tear trough results from several combined factors. The natural evolution of the face over time is the main cause, but it can be accentuated by certain individual parameters :
There is no precise age for the appearance of the tear trough. In some patients with thin skin, the tear trough may be noticeable as early as their twenties. In other cases, it appears around 35–40 years of age, in connection with the first changes in the facial structure.
Its appearance is therefore more related to the nature of the face than to the chronological factor alone. Particular genetics, significant weight loss, or harmful lifestyle habits (smoking, stress, prolonged sun exposure) can accelerate the process. Conversely, good skin density, a well-projected bone structure, and a regular skincare routine can delay its onset.
No. It is neither a disease nor a functional disorder. It is a natural morphological variation linked to facial aging. This hollow may be more or less pronounced depending on the person, and its presence does not indicate any anomaly. However, its aesthetic impact is often poorly experienced. Many patients consult not because of pain or functional discomfort, but because they perceive themselves as tired or sad, without this actually reflecting their inner energy.
The physician’s role is above all to establish a precise diagnosis : is it truly a tear trough, or another phenomenon mimicking its appearance — dark circles, fat pads, skin laxity ? This differential diagnosis is an essential step prior to any therapeutic decision.
The tear trough is not just a detail. It is located in a part of the face directly associated with emotional expression. The gaze conveys alertness, vitality, and mood. When a hollow develops under the eye, even a subtle one, it casts a shadow that alters how the gaze is perceived. This often creates a mismatch between the patient’s actual state and their perceived image : they may feel healthy and energetic, but see themselves as “tired” or “sad” in the mirror.
This subjective dimension is important. It explains why treatment is often requested early, even when the hollow is only moderate. The patient is not seeking a dramatic change, but rather the restoration of the natural brightness of their gaze, without transformation.
The terms “tear trough,” “dark circles,” and “under-eye bags” are often used interchangeably by patients, even though they refer to very different anatomical realities. Confusing them can lead to an incorrect diagnosis and, consequently, an inappropriate treatment.
The tear trough is an anatomical hollow located at the junction between the lower eyelid and the cheekbone. It can be genetic or related to a loss of subcutaneous tissue volume. It gives a tired appearance due to shadowing, without necessarily being accompanied by a color change.
Dark circles are located under the eyes. They can be pigmentary (brown, due to melanin accumulation), vascular (bluish, due to thin skin and visible capillaries), or hollow.
Bags, finally, refer to a protrusion of the fat tissues contained within the orbit. They can be moderate or very noticeable and do not fall under the same treatment : in severe cases, only cosmetic surgery can correct them.
A thorough medical evaluation allows for the distinction between these three entities and guides toward the appropriate solution.
Yes, the tear trough can be constitutional in origin. Some patients, young and healthy, have a pronounced hollow from adolescence or their twenties, without it being related to aging. This is explained by facial structure: flat cheekbones, thin skin, or a wide orbit can accentuate the visibility of the nasojugal groove.
In these cases, patients often consult because those around them comment on a tired appearance that does not reflect their actual state. This type of tear trough, called “structural,” is generally well corrected with hyaluronic acid injection.
An experienced doctor will be able to make the correct diagnosis, distinguishing between a genuine indication for early filling and a simple need for superficial aesthetic care.
In the vast majority of cases, the tear trough worsens with age. Like any sign of facial aging, the tear trough tends to become more pronounced over time. Several mechanisms combine :
• The progressive loss of deep fat pads.
• Bone resorption of the orbital rim.
• Laxity of the supporting ligaments.
• Gradual thinning of the skin.
The hollow then becomes more visible, the shadow it casts intensifies, and it may be accompanied by other signs of aging around the eyes, such as the appearance of bags or sagging of the cheekbones. Early intervention often helps slow this progression, subtly preserving volumes and the quality of the skin in a targeted manner.
It is not always possible to completely prevent the appearance of the tear trough, especially in cases of genetic predisposition. However, several measures can delay or reduce its visibility.
A regular, measured approach, guided by an experienced doctor, often helps preserve the harmony of the eyes for longer.
It is not necessary to wait until the tear troughs are very pronounced to consult. On the contrary, results are often more natural and harmonious when treatment is initiated early, either preventively or with a light corrective approach.
During a first consultation, the doctor establishes a precise diagnosis, analyzes the facial structure, and defines a progressive intervention strategy. They then determine whether immediate treatment is indicated or if it is preferable to delay the procedure, while monitoring its evolution.
The ideal time to consult is when the eyes no longer reflect the patient’s inner energy. This dissonance between appearance and feeling often becomes the starting point of the process. It is then essential to be guided by an experienced, attentive doctor who can offer a tailored approach, respectful of the face and its natural expressiveness.
Article written by Dr Romano Valeria
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