Article Medically reviewed by Dr. Gavin Chan (MBBS, cosmetic physician, liposuctionist)
Templestowe Lower and Berwick Clinics
Dr. Gavin Chan has a background in intensive care, anaesthesia, and emergency medicine. Since 2004, Dr. Chan has provided cosmetic procedures, including anti-wrinkle injections, dermal fillers, liposuction, fat transfer, skin needling, and laser treatments. He is a doctor trainer for various dermal fillers and anti-wrinkle injections.
What are tear troughs, under eye hollows, and eye bags?
Tear troughs are the grooves that sit between the lower eyelid and the cheeks. They create a hollow at the junction between the lower eyelid and the cheek. In many cases, tear troughs are genetic rather than a result of ageing, and often arise in the early twenties. Pseudo-tear troughs appear similar in appearance to tear troughs, but the difference is they the skin is not tethered to the underlying muscles. The groove of a pseudo-tear trough can be improved by pulling the skin to one side or pressing on the upper cheek. These manoeuvres temporarily fill the tear troughs as the skin is lifted up by doing so. With true tear troughs, the skin is tethered and cannot be improved with these manoeuvres. Often pseudo-tear troughs are associated with loss of mid-cheek volume and therefore support for the eye area.
Another common concern of the lower eyelid area are eye bags. Eye bags appear as bulges of the lower eyelid, and can be fat or fluid filled. Although eye bags were previously thought to have been a result of laxity of the lower eyelid muscles allowing fat to protrude, they mostly occur due to fat in the mid-cheek falling away from the lower eyelid, causing the lower eyelid to look protruded in relation to the cheek.
The transition from the eyes to the cheeks becomes interrupted by the presence of eye bags and tear troughs, and this can be ageing or be associated with looking tired. Dermal fillers can help to smooth the transition between the lower eyelid and the cheeks and make the appearance of tear troughs or eye bags less obvious. Most commonly, 1 to 2mL of dermal fillers are used to fill the tear trough and cheek area.
For more information on prices visit the Cosmetic consultation and treatments pricing page.
How can I treat my tear troughs / eye bags non-surgically?
The appearance of eye bags and tear troughs can be reduced through the injection of temporary dermal filler.
Tear troughs can be corrected by injecting dermal filler directly under the hollow between the lower eyelid and cheek. This lifts the tear trough up to the level of the lower eyelid and cheek, thus smoothing the appearance of the area. Fillers placed in this area often last for many years. Usually one syringe or less of dermal filler is required for this area.
In the case of eye bags, often these are caused, at least in part, by the loss of volume in the mid-cheek. When the mid-cheek loses volume, eye bags appear relatively bigger, as the volume beneath it has fallen away. By replacing volume in the mid-cheek using dermal fillers, it is possible to reduce this difference and therefore the appearance of eye bags.
It is important to note however, that eye bags and tear troughs are often present in combination with each other, so that it is necessary to treat both these problems by filling the mid-cheek as well as the tear trough directly.
How can I treat my tear troughs / eye bags surgically?
As an alternative to dermal fillers, fat transfer from another part of the body can be used to fill in any hollows. This involves a minor liposuction to harvest fat from an area such as the abdomen, and then injecting this fat into the under eye area or areas of the face that require revolumising. The fat that is transferred then regenerates in its new position, and acts in a similar way to a dermal filler to revolumise and smooth the area under the eyes. Fat transfer should be considered as a permanent procedure. Therefore, it is necessary to slightly under-fill the area, as any lumps or excess fat may require further surgery to remove. Fat does have the advantage however of not being hydrophilic (attracted to water), and, once settled in, seem to have less fluctuations in volume in comparison to dermal fillers.
Surgically, a lower eyelid blepharoplasty can be performed to remove the excess skin and fat from under the eyes. In some cases, removal of the fat/skin under the eyes can cause the eyes to appear more hollow, and worsen the overall appearance of the eyes. Ironically, this may necessitate further treatment to put volume back into the area in the form of dermal fillers or fat.
What type of dermal fillers are used for the tear trough area?
The most common fillers that are used for the tear trough area are made from a substance called hyaluronic acid. Hyaluronic acid is composed of chains of sugar that are cross-linked to give it a gel consistency. Forms of hyaluronic acid are also naturally found in the skin, eyes, and joints in the body.
One of the advantages of hyaluronic acid fillers are their reversibility. A substance called hyaluronidase can be injected into the area to dissolve the filler. This does not affect your normal skin or tissues, and only affects the dermal filler. Left alone, the hyaluronic acid filler will last in the tear trough area for some years.
The difficulties of using hyaluronic acid fillers is their natural hydrophilic nature, that is, they attract water. This can cause difficulties with estimating how much filler needs to be injected into the tear troughs, as the initial appearance post-treatment may be less than the final result. Therefore, it is necessary to underfill the area and estimate the amount of hydration that will subsequently occur.
We do have dermal fillers that are specifically made for the tear trough area. These are fillers that tend to blend well into the area and are less likely to cause puffiness after treatment.
For estimate volumes and costs visit the Cosmetic consultation and treatments pricing page.
What techniques are used at VCI to treat tear troughs with dermal fillers?
Originally, when we first started treating tear troughs, we used needles to inject the filler. This can be seen in this video
The risk of bruising using this technique was extremely high. Most patients would experience a week or more of significant bruising.
This lead us to using the cannula technique. See this video for a comparison between a needle and cannula;
By using a blunt tipped cannula, it is possible to feed the filler into the tear troughs and push blood vessels aside and reduce the chances of bruising.
What are the difficulties involved with the use of dermal fillers when treating tear troughs / eye bags?
The tear trough is probably the most difficult area in the face to treat with dermal fillers. It is common for patients to become very critical of the area, especially after having treatment done – that is they often want to achieve perfection or perfect smoothness in the area. However, the search for perfection is fraught with problems. Firstly, the skin is very fine here, and any slight imperfections can be seen. Secondly, hyaluronic acid based dermal fillers tend to hydrate and increase in size few days after treatment, which makes judging the amount to inject difficult. Thirdly, placement of the filler is difficult in this area, and perceiving the location and depth of filler placement under the skin is difficult..
It is therefore natural then for practitioners to prefer to underfill rather than overfill the tear troughs. As practitioners, our goal is to make the patient happy and to improve their confidence in their appearance. We do try to advise all patients to underfill, as this is the most ‘perfect’ outcome.Puffiness or swelling from overfilling of the area can promote the appearance of tiredness or make patients appear like they have been crying. Less is best, and the most attractive outcome is a natural (slightly underfilled) one.
The use of dermal fillers in this area needs to be done by experienced practitioners, and even in the best of hands, commonly requires a touch up treatment to further improve the result.
Case Study 1
This patient presented to Victorian Cosmetic Institute with concerns about her tear troughs and eyebags. She felt that she looked tired even when she was not.
1 syringe of filler was injected into the tear troughs and this helped to smooth the transition between the eyelids and cheeks and hide the appearance of her eyebags.
Case Study 2
This female presented to Victorian Cosmetic Institute with concerns about her under eye area. She was concerned about the puffiness under her eyes in particular. Using 1 syringe of filler, her under eye tear troughs were filled, and this smoothed the transition between her under eye bags and her cheeks, effectively camouflaging her eye bags/puffiness.
Case Study 3
This female presents with concerns about her under-eye bags. She was treated with 1 syringe of dermal filler to her tear troughs (the depression just underneath the buldge). It has lifted the tear trough and decreased the apparent appearance of the eye bags by smoothing the transition from the eye to the cheeks.
Case Study 4
This patient presented to Victorian Cosmetic Institute with a strong dislike for her tear trough area, she hated looking sunken and friends and family always saying she looked tired. She like that there was only 1 injection site on each side of her face and experienced no bruising from the treatment.
1 syringe was used with a small amount left over.
Case Study 6
This patient attended for tear trough dermal filler. 2mls of dermal filler was used to significantly reduce the appearance of her eye bags.
Case Study 7
This patient has some herniated fat pads in the lower eyelid, and also hollowing just under this. A total of 1.5ml of dermal filler was used in the tear trough and mid cheek to achieve this lovely natural result.
Case study 8
This patient in her late thirties presented with concerns about looking tired. She had 2mL of dermal filler injected. A ‘base’ layer of a thicker filler was injected into her cheek, and then a finer filler designed for the eye area was injected into her tear troughs. The results show a much refreshed appearance of the eye area.
Case study - tear troughs dissolved and refilled
This patient had her tear troughs corrected many years ago. Often we see the results of filler to this area last many years. In this case, the product used a few years ago had a tendency to shift or swell after some years. The top picture shows this swelling, especially in the right lower eyelid.
We dissolved the tear trough filler from the previous treatment and performed the tear trough filler again with a better product that tends to cause less swelling.
Why should I choose Victorian Cosmetic Institute as my provider of Tear Trough and Eye Bag Treatments?
At Victorian Cosmetic Institute, our cosmetic doctors have a large range of dermal fillers for you to choose from to suit your needs and goals, and we specialise in the treatment of tear troughs and eye bags.
Making that first phone call can be a confronting task – many of our patients have preferred filling out our online enquiry form.
We can then contact you with an understanding of the results you are hopeful of achieving and ensure the treatment is appropriate.
It’s as easy as clicking either of the buttons below and completing the provided form.
Otherwise, you can phone us directly on 1300 863 824.
For estimate volumes and costs visit the Cosmetic consultation and treatments pricing page.