The tear trough is a delicate area of the face, located between the lower eyelid and the upper cheek. Its hollowing, often related to age or genetics, gives a tired appearance. Hyaluronic acid injections can correct this hollow, restore softness to the gaze, and rejuvenate the mid-face without surgery.
However, this area, where the skin is very thin and mobile, remains one of the most technically challenging to treat. It is therefore essential to be aware of the potential risks associated with this procedure, even if they are rare and generally reversible. This article clearly and precisely explains the possible side effects, the real complications to avoid, and the conditions to respect for a safe treatment.
Beneath the skin of the tear trough, which is very thin and transparent, lie blood vessels, nerves, ligaments, and fat compartments. An excess of product, an overly superficial or poorly executed injection can lead to unesthetic results or discomfort.
For this reason, this treatment should be entrusted exclusively to an experienced physician trained in this area, with a thorough knowledge of the anatomy of the eye region. In skilled hands, the injection is safe and properly performed.
After an injection in the tear trough, certain signs may appear in the hours or days following the procedure. They are common and disappear spontaneously :
These effects are normal and temporary. They usually last between 2 and 7 days. Good lifestyle habits, the application of cold (cold compresses) after the injection, and following pre- and post-injection instructions help minimize them.
Prolonged swelling is the most common complication of tear trough treatment, but also the least understood by patients. It is a swelling that persists for several weeks, sometimes several months, under the eye, without signs of infection, but gives the eyes a “puffy” or “swollen” appearance.
This type of swelling can result from several factors :
Prolonged swelling is not medically dangerous, but it can affect the aesthetic result and disappoint the patient. It is therefore essential to prevent it by adapting the product, technique, and treatment strategy to the patient’s anatomy.
If it persists, two options are available:
The physician’s role is central here : to carefully assess the patient’s condition before injecting, choose the appropriate product, and know how to promptly correct any side effect that occurs.
The Tyndall effect is a well-known optical phenomenon in aesthetic medicine. It appears as a bluish or grayish tint under the skin, usually in the tear trough area. This coloration is caused by an overly superficial injection of hyaluronic acid in an area where the skin is thin and transparent.
Ambient light refracts through the injected gel, altering the perceived color under the skin. It is neither a bruise nor an inflammatory reaction, but a problem related to a superficial injection, sometimes worsened by using an inappropriate product.
The Tyndall effect is purely aesthetic, but it can persist for a long time if the gel does not naturally resorb. In most cases, the solution is to inject a specific enzyme, hyaluronidase, which dissolves the hyaluronic acid. A new injection can be considered later, provided it is performed in a deeper tissue plane, with a less hydrophilic hyaluronic acid and an injection technique adapted to the peri-orbital anatomy.
This complication underscores the importance of an expert approach to tear trough treatment. The eye area is sensitive, where even the slightest technical inaccuracy becomes visible. An experienced physician knows the risks of the Tyndall effect and can prevent them with precise gestures, measured volumes, and perfect control of the injection depth.
As with any filler injection, it is possible in some cases to observe slight asymmetry or an excess of product after tear trough treatment. In this area, where the skin is thin and constantly mobile, even a minor imbalance becomes visible, especially in natural light.
The most common causes of these imbalances are :
Fortunately, these irregularities are usually mild, temporary, and easily correctable. If a touch-up is necessary, it is generally performed after a few weeks, once the product has fully integrated into the tissues.
The best strategy remains initial caution: it is always preferable to slightly under-correct during the first session, in order to assess tolerance, skin reaction, and overall harmony of the gaze. A second adjustment session can then refine the result in a targeted and safe manner.
This two-step approach ensures a natural, symmetrical, and durable result, respectful of the facial expression.
Although very rare, some serious complications can occur during tear trough injections. They are vascular in origin and occur when a blood vessel is accidentally affected by the injected product. In exceptional cases, this can lead to localized skin necrosis — if blood flow is interrupted — or, in extremely rare instances, visual impairment if the product reaches a vessel connected to the ocular circulation.
These complications do not occur when an experienced physician, trained in orbital anatomy and safety protocols, performs the injection in a controlled medical setting. They are mainly associated with high-risk situations: injections outside a medical environment, untrained practitioners, or lack of in-depth knowledge of the treated area.
To avoid any incident, an experienced physician takes strict precautions :
Finally, the physician must be trained to manage a vascular incident immediately, having the necessary antidotes on hand (notably hyaluronidase), as well as a responsive medical organization.
These complications, although exceptional, remain serious. They fully justify that the tear trough should only be treated by an experienced physician, specifically trained for this delicate area, and with thorough knowledge of orbital anatomy.
The choice of hyaluronic acid is a crucial step for successful tear trough treatment. This area of the face is particularly challenging to treat, requiring precise product selection. An ill-suited gel can turn a simple procedure into a source of discomfort or even cause side effects.
Today, many hyaluronic acids are available on the market, differing in their degree of cross-linking (ability to maintain volume over time), viscosity, concentration, and especially hydrophilicity (ability to attract water). These properties are essential: a gel perfectly suited for the cheeks may be inappropriate for the under-eye area.
For tear trough treatment, hyaluronic acid must meet several very specific criteria :
A gel that is too dense or too volumizing can create an artificial bulge, or even accentuate a pre-existing under-eye bag. Conversely, a product that is too fluid may be absorbed too quickly and fail to provide adequate correction.
It is also crucial to respect the injection depth. Some gels are not designed for the superficial layers of the skin. Injecting a gel that is too thick at a shallow depth increases the risk of the Tyndall effect — the bluish hue visible through the skin.
Finally, the product’s longevity must be well understood. An ill-chosen gel may remain visible for too long, migrate, or make future corrections difficult.
An experienced physician always selects the product taking into account the patient’s anatomy, injection depth, and desired outcome. This technical rigor is the key to a result that is natural, safe, and harmonious.
The injection technique plays a fundamental role in preventing side effects. Even with the best product, a poorly executed procedure can lead to an unaesthetic result, prolonged discomfort, or, in rare cases, a real complication.
Tear trough injection requires millimetric precision. A poorly performed injection can disrupt local microcirculation, cause edema, or result in visible irregularities.
Here are the most common technical errors observed in this area:
A trained physician adheres to certain fundamental rules :
In summary, even an excellent hyaluronic acid can produce a poor result if the technique is not appropriate. Conversely, a rigorous, structure-respecting, and progressive technique allows for natural, elegant, and safe results.
Tear trough injection is a technical and precise procedure that, when performed correctly, delivers a natural, subtle, and elegant result. However, to ensure the safety and effectiveness of the treatment, several elements must be strictly respected. Each step, from the initial consultation to post-injection follow-up, plays a fundamental role in preventing adverse effects.
Post-injection follow-up : follow-up is an essential component of treatment safety. A control consultation, approximately 10 to 15 days after the injection, allows verification of product integration, detection of persistent edema or asymmetry, and adjustment or correction if necessary. Rigorous follow-up also reassures the patient, addresses their questions, and maintains transparent communication throughout the process.
Article written by Dr Romano Valeria
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