Tear-trough filler is a delicate treatment with a narrow window between good and puffy.
The tear trough is one of the most requested filler areas, and one of the most technically unforgiving. Poorly placed under-eye filler can create puffiness, discolouration (Tyndall effect), and lymphatic obstruction that lasts months. Here is how we approach it and where we set the limit.
Who under-eye filler suits. Clients with a genuine volume deficit under the eye, a hollow that reads as tired even when they are rested. Clients with good skin quality and thick lower-eyelid tissue. Clients whose dark circles are shadow-based (from the hollow) rather than pigmentation-based.
Who it does not suit. Clients whose dark circles are pigmentation, not hollow. Clients with very thin lower-eyelid skin where any filler visible through the skin creates a bluish cast (Tyndall). Clients with fat prolapse in the lower lid, which needs a surgical or non-surgical approach different from filler. Clients with active fluid retention or a history of lymphatic issues in the face.
The product we use. A soft, low-hydrophilic hyaluronic acid designed specifically for delicate periorbital tissue. Firm structural fillers do not belong in the tear trough. The product must be soft enough to integrate without ridging and low-hydrophilic enough not to draw water and swell for weeks after.
The technique. Small quantities placed deep, on the periosteum, using a blunt cannula (which reduces bruising and vascular risk). We typically use 0.3 to 0.5ml per side for a first-time treatment, sometimes even less. Almost never more than 0.7ml per side. Filler placed superficially in this area is the most common source of the puffy, treated look clients want to avoid.
Why less is more here. This is one of the areas where under-treating and reviewing at four weeks is far better than over-treating. We would rather do a second small placement at follow-up than over-fill on day one, because dissolving under-eye filler is more disruptive than the treatment itself.
What to expect immediately after. Some swelling for 24 to 72 hours, occasional bruising. The final result reads at 10 to 14 days. Longevity typically 9 to 18 months, sometimes longer, this area metabolises HA slowly.
Complementary treatments we often prefer or combine. Eye Booster (a specific micro-injection of stabilised HA to hydrate and improve skin quality without adding structural volume). Salmon DNA (PDRN) for skin quality and elasticity. Thermage FLX Eye for skin laxity.
The honest read. Under-eye filler is one of the treatments where saying no, or saying not yet, is often the right clinical answer. When it is the right answer, less product placed carefully outperforms more product placed generously.