What the tear trough actually is
The tear trough, also known anatomically as the nasojugal groove or palpebromalar groove, is the depression that runs along the junction of the lower eyelid and the cheek, extending from the inner corner of the eye along the lower orbital rim. When this depression deepens or becomes more visible, it is often referred to as tear trough deformity. It is one of the earliest visible signs of age-related volume change in the face, although it can also appear in younger patients with the right underlying anatomy.
This page is about the structures involved and why technique and anatomical knowledge matter when treating the area. For the treatment itself, see tear trough filler.
Structures involved
The appearance of the tear trough is shaped by several layered structures, including:
- The orbicularis oculi muscle
- The orbicularis retaining ligament and the tear trough ligament
- The arcus marginalis along the orbital rim
- The orbital fat compartments, infraorbital fat pads and sub-orbicularis oculi fat
- The shape of the bone along the orbital rim, including any natural hollow at the zygomatic and malar region
With age, fat compartments shift, ligaments weaken, collagen reduces, and the bony rim itself remodels slightly. The result is that the tear trough often becomes more pronounced even when the skin surface above it has not changed.
Skin and support
The skin of the lower eyelid is among the thinnest on the body, with very little soft tissue cushioning between it and the structures beneath. That is why small changes in volume show up so quickly in this area, and why incorrect product choice, incorrect plane of injection, or too much volume can produce visible filler, contour irregularities or persistent swelling.
Fat herniation versus volume loss
Not every visible hollow under the eye is caused by volume loss. In some patients, the appearance is driven by fat compartments bulging forward through a weakened orbital septum, producing eye bags rather than true hollowing. In these cases adding filler often makes the area worse, not better.
Identifying which pattern is in front of you is one of the most important parts of the consultation. If the underlying issue is excess tissue rather than missing volume, the appropriate options may be surgical (lower blepharoplasty, arcus marginalis release, fat repositioning or fat grafting). PHI Clinic is non-surgical, so where these are the right answer we will say so and refer.
Vascular anatomy and risk
The infraorbital artery and its branches run close to the planes commonly used for injection in this area, and the veins that accompany them are similarly placed. Vascular complications in the periorbital region are uncommon, but they are well documented in the medical literature and are taken seriously. That is why this area calls for particular care, conservative use of product, and the use of a cannula rather than a needle where appropriate.
Dr Tapan Patel on treating the tear trough
As Dr Tapan Patel, Founder of PHI Clinic, explains:
- Treating the area around the eyes is challenging as it is a high risk area.
- The blood supply is complex and a detailed knowledge of the anatomy is essential to avoid serious complications.
- In addition, poor technique can result in an unsightly appearance. This may be evident soon after treatment or manifest many months or even years later.
- A strategic approach however can transform the area and give a completely different message.
Tear trough outcomes are rarely decided by the immediate result alone. The periorbital area continues to change over time, and the choices made at the first treatment influence how the area looks years later.
How anatomy informs treatment decisions
A working knowledge of these structures shapes every part of the treatment plan:
- Whether the patient is suitable for filler at all
- The choice between hyaluronic acid filler, support from other treatments, or surgical referral
- The product chosen (different hyaluronic acid gels behave very differently in thin skin)
- Depth, plane and technique of injection
- When to dissolve previous filler with hyaluronidase rather than add more
Restraint is part of this work. Knowing when not to treat, or to treat lightly and review, is as important as knowing how to inject.
Why individual variation matters
Bone shape, ligament strength, fat pad position and skin quality vary considerably between patients. A standardised tear trough protocol does not exist for this reason. Assessment looks not only at the tear trough itself but at the cheek, the malar support behind it, and the wider mid-face, since these structures support (or fail to support) the lower eyelid above them.
Book a consultation
To discuss whether tear trough filler, another treatment, or referral is the right answer for you, contact our team at PHI Clinic or book a consultation at our Harley Street clinic.
