The tear trough corresponds to a hollow area located between the lower eyelid and the upper part of the cheek.
Its appearance gives the face an expression often perceived as melancholic, tired, or prematurely aged. This infraorbital hollow results from a combination of pathophysiological processes : resorption of the malar fat pad, loss of skin tone, and stretching of the supporting ligamentous and dermal structures. Today, validated medical solutions exist to correct this hollow progressively, safely, and adapted to each facial morphology.
The first-line treatment of the tear trough relies on the use of a specific hyaluronic acid, injected directly into the hollow to restore lost volume. This molecule, naturally present in the body, has remarkable hydrophilic properties, allowing immediate rehydration and filling of the hollow.
The hyaluronic acid used for this indication must meet strict criteria : low viscosity, high cohesion, and great flexibility to adapt to the movements of this highly mobile area. It is injected using small cannulas, deeply, either in contact with the bone or in the subcutaneous plane, depending on the patient’s anatomy. The correction is progressive, often performed in two stages to avoid overcorrection and ensure a natural result.
The advantages of this method are multiple : immediate and reversible results, no social downtime, precise injection, and visible improvement of the eyelid-cheek transition. However, this technique requires precise expertise of the periocular region to avoid complications, notably the risk of product excess, nodules, or visibility of the product under thin skin.
Rather than directly filling the groove, another approach consists of correcting the cause of the hollowing : the descent of the malar fat compartment. This technique is based on a biomechanical principle : by restoring the volumes of the midface (cheekbones, zygomatic arch), the natural support of the tissues is restored, resulting in a harmonious lifting of the sagging structures — including those responsible for the appearance of the tear trough.
Hyaluronic acid is injected using a medical lifting technique. This strategy has several advantages : reduced risk of irregularities or overcorrection in the tear trough, a more global and harmonious result, and an effect on the overall facial dynamics.
It requires a perfect knowledge of the deep anatomical planes and the logic of traction vectors. This technique is particularly suitable for patients whose infraorbital hollowing occurs in the context of overall malar laxity.
Sculptra®, based on L-polylactic acid, is not a filler that provides immediate results. Its mechanism of action relies on the progressive stimulation of collagen synthesis : after injection into the deep layers of the dermis and subcutaneous tissue, it induces a fibroblastic response that restores skin thickness, firmness, and density.
In the context of tear trough treatment, Sculptra® is used to rebuild the depleted dermal cushion, restore volume diffusely, and avoid the effect of overcorrection. It provides a long-lasting improvement in skin quality and structure, with a subtle and natural lifting effect.
The advantages of this approach are notable : progressive, adjustable results, no “filled” effect, endogenous stimulation of collagen production, and physiological restoration of skin density.
This treatment is particularly suited for patients whose tear trough is associated with diffuse dermal and fat tissue loss, often observed after 40 years of age. It can be combined with other techniques for a synergistic effect, especially in patients with thin skin.
In certain cases, particularly when the tear trough is associated with very thin, wrinkled, or lax skin, laser photorejuvenation represents an effective adjunctive treatment. Fractional non-ablative and ablative laser technologies (such as Fraxel®) stimulate collagen production, improve skin quality, and increase skin density.
Although their action is indirect, it remains essential : by improving skin quality, these treatments reduce its transparency, soften the shadows in the infraorbital groove, and strengthen the dermal support of restored volumes. Laser treatment, in particular, is highly relevant for patients with associated fine lines or mild hyperpigmentation, which visually accentuates the depth of the hollow.
The benefits are multiple and fit within a framework of therapeutic synergy. Noticeable improvements in skin quality and tone are observed. The skin becomes denser, more supple, and visibly revitalized. This enhancement reinforces the smoothing effect of injections by acting as complementary dermal support. Furthermore, the eyes gain a refreshed appearance, with a visible reduction in signs of fatigue. This treatment requires multiple sessions, and a prior assessment by an experienced physician is essential to select the appropriate protocol based on phototype and skin thickness.
The choice of aesthetic treatment to correct the tear trough depends on several factors that must be precisely evaluated during the initial consultation. There is no universal solution : the strategy depends on the main cause of the hollowing (fat loss, ptosis, skin atrophy), the patient’s age, skin thickness, muscle mobility, and the desired result.
In a young patient whose tear trough is primarily constitutional (due to low-set cheekbones or weak malar projection), hyaluronic acid injection is often sufficient. In an older patient presenting volumetric loss and overall midface laxity, a combined approach using medical lifting techniques, Sculptra®, and skin densification techniques with laser is generally more appropriate.
The clinical examination must therefore be thorough. It involves static and dynamic palpation of the orbito-malar area, assessment of volumes, inspection of skin quality, and sometimes the use of imaging tools (medical photography, polarized light, volumetric mapping). The goal is to propose a rational, coherent, and gradual therapeutic strategy to achieve a natural, stable result without overcorrection.
A combined approach, using multiple techniques, is often the most appropriate. The tear trough is never caused by a single factor ; it always results from a combination of structural deficits : loss of bony support, sagging of fat compartments, decreased dermal density, and skin laxity. Correcting only one tissue plane is often insufficient to achieve a complete aesthetic result.
Combining several techniques — in a rational sequence — allows treatment of the tear trough while respecting the anatomical layers. First, restore deep volumes with cross-linked hyaluronic acid injected deeply against the bone. Then, if necessary, complete with targeted filling using a more fluid product. Next, stimulate the tissues with Sculptra® to restore the skin’s natural thickness. Finally, reinforce the superficial skin structure with laser photorejuvenation sessions.
This approach achieves a coherent, harmonious, and long-lasting result, avoiding common errors such as excessive or isolated filling of the tear trough.
Even though remarkable results can now be achieved with aesthetic medical procedures, certain limitations must be clearly explained to the patient. The tear trough is a particularly delicate anatomical area : richly vascularized and subject to significant individual variations, it requires a precise and cautious approach. Some morphologies, particularly those with very thin skin, make treatment more technically demanding and require heightened expertise. Several factors must be considered during evaluation and treatment planning :
In all cases, realistic management of expectations is essential. It is important to prioritize subtle corrections that respect the balance of the face. When the alterations are too pronounced, a surgical alternative may be more appropriate.
Article written by Dr Romano Valeria
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