Tear Trough Deformity

Tear trough deformity is a hollow or groove that forms between the lower eyelid and the upper cheek. It can make the eyes look tired, sunken, or older than a person’s age. The groove runs from the inner corner of the eye toward the mid‑cheek. It happens when the thin lower‑eyelid skin and the soft tissues under it lose support or volume, or when the cheek fat pad sits lower than before. Some people are born with a deeper groove because of their bone shape and family traits. In others, it becomes more visible with age due to thinning skin, less collagen, weaker ligaments, and small shifts in fat pads. Shadows collect in this groove and create a dark line even when the skin color is normal. In many people there is also real skin darkening from pigment or from tiny blood vessels showing through thin skin. Swelling from allergies, salt, or poor sleep can make the hollow look worse.

Tear trough deformity is not dangerous, but it affects appearance and self‑confidence. It can be improved with lifestyle steps, skin care, office procedures (like fillers, lasers, and microneedling), and in some cases surgery (like lower blepharoplasty with fat repositioning). The best plan depends on the cause in each person: bone shape, skin thinness, volume loss, extra fat pads, skin pigment, blood vessel show‑through (called “vascularity”), or swelling.

The tear trough is a natural groove that runs from the inner corner of the eye down and out along the upper cheek. In many people this groove looks deeper with age, with genetics, or with certain health and lifestyle factors. When the groove becomes deep, it casts a shadow and makes the under-eye look hollow or dark even when the skin is healthy. Doctors call this look a tear trough deformity. It is not a disease by itself. It is a shape change of the lower eyelid and upper cheek that creates a hollow line and a shadow. The shadow can make a face look tired or older even when the person feels well. The deformity appears because of a mix of issues: the skin gets thinner, the small supportive ligaments tether the skin more clearly, the cheek fat pads shift or shrink, and the bone of the midface can sit a little back relative to the eyeball. These small changes add up to a visible groove and a darker curve under the eye. Research shows that key supporting structures such as the orbicularis retaining ligament and the tear-trough ligament create a sharp border that can become more obvious with aging and volume loss, producing the classic hollow line. PMC+1

Doctors often grade the deformity by how long and how deep the groove is and whether it blends into the cheek. One widely used method is the Hirmand classification, which describes mild, moderate, and more extensive tear troughs by how far they extend and how much shadow they create. This helps the clinician describe what they see and plan treatment if needed. Lippincott Journals

Types

1. Type 1 (mild, medial): The hollow is only near the inner corner of the eye. The line is short and the shadow is small, but makeup still collects in it. This is common in younger people or in early aging. Lippincott Journals

2. Type 2 (moderate, extends laterally): The hollow stretches from the inner corner toward the mid-pupil line. The shadow is obvious under overhead light. It blends with a small drop in the upper cheek.

3. Type 3 (long, blends into mid-cheek): The hollow extends across the lower lid and may join a second groove lower on the cheek. The shadow is strong and the under-eye looks flat or sunken.

4. Skin-dominant tear trough: The skin is thin and wrinkled and shows fine vessels. Even small volume loss looks big because the skin is delicate.

5. Ligament-dominant tear trough: The problem is mostly due to firm attachments from the retaining ligaments, which hold the skin tight in one line and make a nearby hollow look deeper. PMCOxford Academic

6. Volume-loss tear trough: The cheek fat pads have thinned or shifted, and the area right under the ligament has less fill, so the border looks sharp and casts a shadow. Oxford Academic

7. Bone-structure tear trough: The midface bone sits a little back compared with the eyeball (a “negative vector”). This anatomy makes a deeper natural hollow even in younger faces.

8. Pigment-mixed tear trough: The hollow is mixed with skin darkening from melanin or visible small veins, so the area looks dark even where volume is normal. PMCLippincott Journals

9. Edema-mixed tear trough: There is mild morning puffiness or fluid, but the groove remains below the puff, so you see both a bag and a hollow line.

10. Asymmetric tear trough: One side is deeper than the other due to natural facial asymmetry, prior sinus or dental issues, prior surgery, or sleeping position habits.

Causes

1. Natural aging of skin: The skin gets thinner and less elastic. Thin skin shows tiny vessels and shadows more easily. Oxford Academic

2. Ligament “tethering”: Firm attachments like the orbicularis retaining ligament and tear-trough ligament hold the skin in a line, so the area next to the line looks more hollow as tissues change with age. PMC+1

3. Loss or shift of cheek fat pads: The sub-orbicularis fat and other mid-cheek pads descend or deflate, making the lid-cheek junction look sharp. Oxford Academic

4. Midface bone shape: A slight backward position of the maxilla makes the lower lid look longer and the trough deeper.

5. Genetics and family traits: Some people have a natural groove from youth because of their inherited bone and soft tissue pattern. Oxford Academic

6. Sun exposure: Sun thins collagen and increases pigment and vessel visibility, which deepens the look of the groove. PMC

7. Periorbital hyperpigmentation: Extra melanin, post-inflammatory darkening from eczema or rubbing, or increased blood vessel show can make the area look darker. Lippincott Journals

8. Allergies and eye rubbing: Itching leads to chronic rubbing, which inflames skin and can darken it over time. Lippincott Journals

9. Nasal congestion or sinus issues: Venous pooling under the eyes can add a bluish hue and highlight the trough.

10. Sleep patterns: Poor sleep or sleeping face-down can cause temporary swelling above a permanent hollow, making the groove look deeper in contrast.

11. Fluid and salt retention: Morning puffiness accentuates the step between a bag and a hollow.

12. Smoking: Smoking breaks down collagen and elastin faster, so the skin thins and sags more.

13. Rapid weight loss: Fat volume drops quickly in the face, so the under-eye hollow looks deeper.

14. Anemia or low iron: Pallor and vascular changes can make under-eye darkness worse, which visually deepens the groove. PMC

15. Thyroid imbalance: Thyroid disease can change skin texture and facial soft tissue tone, which can worsen under-eye appearance.

16. Kidney or systemic fluid issues: Systemic edema can cause repeated swelling and deflation that emphasizes the groove.

17. Atopic or contact dermatitis: Chronic eyelid dermatitis leads to pigmentation and texture changes that make hollows look darker. Lippincott Journals

18. Medications that thin skin: Long-term topical steroids on the eyelids can thin the skin.

19. Prior surgery or trauma: Scars, septal tightening, or fat removal can sharpen the lid-cheek border.

20. Ethnic and anatomical variation: Some groups have deeper set eyes or stronger ligament definition, which can make the trough more prominent even at a young age. Wiley Online Library

Symptoms

1. A hollow line under the inner corner of the eye that looks like a small valley.

2. A dark curve or shadow under the eye that stays even after good sleep.

3. A “tired” look even when you feel fine, because the shadow reads as fatigue.

4. Makeup settling in the groove and showing a crease or line.

5. The hollow looks deeper under overhead light, because top light throws a stronger shadow.

6. Color changes like brown, gray, or blue—brown from melanin, blue from visible veins, and gray from combined shadow and thin skin. PMC

7. Fine lines and crepey skin right over the hollow because the skin is thin.

8. Morning puffiness above the hollow, which makes the step between bag and trough look sharper.

9. Asymmetry, where one side looks deeper, often due to natural anatomy.

10. Worse look with dehydration or high-salt meals, because fluid shifts change how the area sits.

11. Photos emphasize the hollow, especially with direct flash or overhead light.

12. The hollow extends outward with time, moving from the inner corner toward the outer third.

13. The lid-cheek junction looks like a hard border, not a smooth blend.

14. Mild tenderness after rubbing if there is dermatitis or allergy.

15. Low confidence about appearance, which is common and understandable because the under-eye is central on the face.

Diagnostic tests and assessments

Important note: Tear trough deformity is mainly a clinical and visual diagnosis. Doctors diagnose it by looking, touching, and moving the tissues. Imaging is rarely required unless another problem is suspected. Lab tests help when the doctor wants to rule out health issues that worsen under-eye darkening or swelling. Electrodiagnostic tests are not part of standard tear trough assessment. The lists below explain what clinicians may use and why.

A) Physical exam tests

1. Standard light inspection: The clinician looks at the under-eye in bright, even light to map where hollow, shadow, pigment, and puffiness sit relative to each other. This defines whether the problem is volume, pigment, swelling, or a mix. Oxford Academic

2. Overhead and side-light test: The same area is examined with overhead light and with side light. If the area darkens mainly with overhead light, the darkness is mostly shadow from a hollow, not pigment.

3. Hirmand grading: The deformity is graded by extent (inner corner only, to mid-pupil, or across the lid) and by depth. This creates a common language for severity. Lippincott Journals

4. Skin quality check: The clinician gently stretches the skin to see if color lightens (pigment in the top layer) or stays (deeper pigment or vessels). This helps separate pigment from shadow. PMC

5. Vessel visibility check: The area is examined for a bluish show of veins through thin skin. Visible vessels point to vascular contributors to darkness. PMC

6. Cheek-lid junction continuity: The doctor looks for a smooth curve or a sharp step at the lid-cheek border. A sharp step suggests volume loss or ligament tether. Oxford Academic

7. Puffiness vs hollow mapping: The clinician marks where any “bag” sits compared to the hollow beneath it. A bag over a trough is a common mixed picture.

8. Bony support and vector check: From the side, the doctor checks whether the eyeball sits forward compared with the cheekbone. A negative vector often makes the trough look deeper.

B) Manual tests

9. Two-finger malar lift: The clinician lifts the upper cheek gently. If the hollow fills and the border softens, cheek volume loss plays a large role.

10. Skin stretch test: The skin is pulled gently. If color lightens, there is superficial pigment. If the shadow stays, the hollow is the main issue. PMC

11. Blanching pressure test: Gentle pressure is used to blanch small vessels. If the blue color fades, visible veins are contributing.

12. Snap-back and laxity test: The lower lid is pulled down and released to gauge laxity and tone. Lax skin makes shadows worse.

13. Cheek support test with smile: The patient smiles while the doctor supports the malar area. If the trough improves with support, mid-face ptosis or fat shift is likely.

14. Position change test: The patient sits up and lies down. If swelling improves when upright but the hollow remains, the deformity is structural, not only fluid.

15. Cold compress response: Brief cooling can reduce vascular congestion. If the color improves but the groove shape stays, vessels are a contributor but the hollow is primary.

16. Transillumination for edema vs pigment: A penlight behind the skin can help the examiner sense fluid or very thin skin. (This is a simple office aid, not a formal imaging test.)

C) Lab and pathological tests

These tests are not for diagnosing the groove itself. They help find health issues that can worsen under-eye darkness or puffiness.

17. Complete blood count (CBC) and ferritin: Looks for anemia or low iron, which can deepen the look of darkness. PMC

18. Thyroid function tests (TSH, free T4): Checks for thyroid imbalance that can change skin and soft tissue tone.

19. Renal function tests (creatinine, electrolytes): Screens for systemic fluid balance issues that can cause puffiness.

20. Liver panel: Looks for liver disease that may contribute to fluid changes or skin color changes.

21. Allergy assessment (total IgE, eosinophils) as indicated: Supports a history of atopy or allergic eyelid dermatitis, which can cause rubbing and pigment. Lippincott Journals

22. Patch testing for contact dermatitis when suspected: Identifies allergens in cosmetics or skincare that inflame and darken thin eyelid skin. Lippincott Journals

D) Electrodiagnostic tests (clarification)

23. Electrodiagnostic studies are generally not used for tear trough deformity. The condition is structural and cosmetic, and testing nerve or muscle electrical activity does not change the diagnosis or the plan. Such tests would only be considered if a separate nerve disorder of the face or eyelid was suspected, which is uncommon in typical tear trough cases.

E) Imaging tests

24. High-frequency ultrasound of the lower eyelid: Can visualize the lower lid retractors, fat pads, and septum with fine detail. It is sometimes used for complex cases or pre-procedure planning. PMC

25. MRI of the orbit and eyelid: Shows soft tissues very clearly, including fat pads and septum; used when other orbital disease is suspected or for complex surgical planning, not for routine cases. MDPI

26. CT scan of the midface and orbit: Shows bones and can help in planning surgery when bony shape is the key factor or when trauma is involved. It is not routine for simple cosmetic evaluation. MDPI

27. Wood’s lamp or dermoscopy for pigment: Helps separate epidermal (more superficial) from dermal pigment and from vessels. This is useful when darkness is a large part of the complaint. PMC

Non‑Pharmacological Treatments (Therapies and Others)

1) Sleep, Position, and Routine
Description: Aim for 7–9 hours of quality sleep; sleep on your back with head slightly elevated.
Purpose: Reduce morning swelling and tired look.
Mechanism: Better fluid drainage and reduced venous pooling around the eyes.

2) Hydration and Sodium Control
Description: Drink water regularly; keep daily salt moderate; limit alcohol at night.
Purpose: Reduce fluid shifts that cause puffiness and deepen shadows.
Mechanism: Balanced body fluids prevent periorbital edema.

3) Allergy Control and No Rubbing
Description: Manage allergies with physician guidance; avoid rubbing eyes.
Purpose: Less swelling and pigment from irritation.
Mechanism: Lower histamine response and mechanical trauma to thin skin.

4) Sun Protection
Description: Daily broad‑spectrum SPF 30+, sunglasses, hats.
Purpose: Prevent pigment and collagen breakdown.
Mechanism: Blocks UV/visible light that triggers melanocytes and damages collagen.

5) Cold Compress (Short‑Term)
Description: Apply a cool pack 5–10 minutes in the morning.
Purpose: Reduce swelling and constrict vessels.
Mechanism: Vasoconstriction reduces redness and puffiness.

6) Cosmetic Camouflage and Color Correction
Description: Use peach/orange correctors under concealer matched to skin.
Purpose: Neutralize blue/purple tones and soften the hollow’s look.
Mechanism: Color theory cancels unwanted hues; light‑reflecting pigments reduce shadow.

7) Gentle Under‑Eye Skin Care
Description: Fragrance‑free moisturizers with hyaluronic acid, ceramides, and peptides.
Purpose: Improve skin hydration and barrier.
Mechanism: Water retention in the stratum corneum and support for skin proteins.

8) Topical Retinoids (Cosmeceutical strength)
Description: Low‑strength retinol or retinaldehyde, applied carefully a few nights per week.
Purpose: Thicken dermis over time and smooth fine lines that emphasize the groove.
Mechanism: Boosts collagen turnover and dermal matrix.

9) Lymphatic Massage (Light)
Description: Very gentle strokes from inner eye area toward temples/ears.
Purpose: Encourage fluid movement.
Mechanism: Assists superficial lymph drainage to reduce morning puffiness.

10) Microneedling (Office Procedure)
Description: Controlled micro‑injuries stimulate repair.
Purpose: Improve skin texture and mild crepiness.
Mechanism: Wound‑healing cascade increases collagen/elastin.

11) Chemical Peels (Very Light, Physician‑Directed)
Description: Superficial peels (e.g., lactic, glycolic) tailored to under‑eye skin.
Purpose: Brighten pigment and improve texture.
Mechanism: Exfoliation promotes even tone and new collagen.

12) Non‑Ablative Lasers/Light (Professional)
Description: Devices such as gentle fractional lasers or IPL when indicated.
Purpose: Reduce pigment/vascular show‑through and stimulate collagen.
Mechanism: Target chromophores (hemoglobin/melanin) and dermal remodeling.

13) Radiofrequency (RF) or RF Microneedling
Description: Heat in the dermis with or without needles.
Purpose: Tighten and thicken under‑eye skin over sessions.
Mechanism: Thermal collagen remodeling and neocollagenesis.

14) Platelet‑Rich Plasma (PRP) Injections
Description: Concentrated platelets from your blood injected under the eye.
Purpose: Improve texture and mild pigmentation over time.
Mechanism: Growth factors signal collagen and vascular normalization.

15) Hyaluronic Acid (HA) Filler (Expert Injector)
Description: Small amounts of soft HA filler placed deeply at the trough.
Purpose: Replace lost volume and soften the shadow.
Mechanism: Adds scaffold support; hydrates by binding water.

16) Biostimulatory Fillers (Selected Cases)
Description: Agents like calcium hydroxylapatite (diluted) or poly‑L‑lactic acid in the cheek support area.
Purpose: Lift and support the midface to reduce the step‑off.
Mechanism: Stimulates collagen over months.

17) Midface Volumization
Description: Filler placed in the lateral/medial cheek by an expert.
Purpose: Indirectly softens the trough by supporting the lid‑cheek junction.
Mechanism: Restores vector and reduces contrast.

18) Lifestyle: Stop Smoking and Limit Alcohol
Description: Quit smoking; keep alcohol low.
Purpose: Preserve collagen and reduce swelling.
Mechanism: Less oxidative stress and vasodilation.

19) Weight Stability and Nutrition
Description: Avoid crash diets; maintain steady, healthy weight.
Purpose: Prevent sudden facial fat loss that deepens hollows.
Mechanism: Stable adipose support in the midface.

20) Professional Skin‑Care Plan
Description: Tailored regimen by dermatologist/oculoplastic surgeon.
Purpose: Combine safe actives and device care for your skin type.
Mechanism: Stepwise improvements add up across several pathways.

Safety note: Procedures near the eye must be done by trained clinicians. Poor technique can cause lumps, bluish hue (Tyndall effect), persistent swelling, or rare vascular injury.

Drug Treatments

Important: Tear trough deformity is mainly structural and often treated with procedures, not long‑term drugs. Some medicines or medically supervised topicals can help skin quality, pigment, swelling, or associated conditions. Always use as directed by a clinician.

1. Topical Retinoid (retinol/retinaldehyde; prescription tretinoin when appropriate)
   Class: Vitamin A derivative.
   Dosage/Time: Pea‑size amount for both eyes, 2–3 nights/week, build slowly.
   Purpose: Thicken dermis, smooth fine lines.
   Mechanism: Increases collagen and cell turnover.
   Side Effects: Irritation, dryness, sensitivity to sun.
2. Topical Vitamin C (ascorbic acid or stable derivatives)
   Class: Antioxidant/brightener.
   Dosage/Time: Thin layer each morning.
   Purpose: Brighten darkness and protect collagen.
   Mechanism: Scavenges free radicals; supports collagen cross‑linking.
   Side Effects: Stinging in sensitive skin.
3. Caffeine Eye Serum
   Class: Vasoconstrictive cosmeceutical.
   Dosage/Time: Morning application.
   Purpose: Short‑term reduction in puffiness and vessel show.
   Mechanism: Constricts superficial vessels; reduces fluid.
   Side Effects: Irritation if overused.
4. Niacinamide (Topical 2–5%)
   Class: Barrier‑support vitamin B3.
   Dosage/Time: Once daily.
   Purpose: Improve tone, reduce redness, support barrier.
   Mechanism: Boosts ceramides; reduces inflammation.
   Side Effects: Mild tingling.
5. Topical Tranexamic Acid (TXA) 2–5%
   Class: Anti‑pigment agent.
   Dosage/Time: Nightly or per label.
   Purpose: Reduce brownish pigment in mixed dark circles.
   Mechanism: Blocks plasmin pathway that triggers melanocytes.
   Side Effects: Irritation; systemic use is not typical for this area without medical oversight.
6. Topical Hydroquinone (Short‑Term, Physician‑Directed)
   Class: Skin‑lightening agent.
   Dosage/Time: Nightly for limited cycles (e.g., 8–12 weeks) with medical guidance.
   Purpose: Reduce excess melanin when pigment is a major factor.
   Mechanism: Inhibits tyrosinase.
   Side Effects: Irritation, rebound hyperpigmentation if misused; not for long‑term continuous use.
7. Low‑Dose Oral Iron (When Iron Deficiency Confirmed)
   Class: Mineral supplement/medication.
   Dosage/Time: As prescribed based on labs (e.g., 30–60 mg elemental iron/day).
   Purpose: Correct anemia that worsens periorbital darkness.
   Mechanism: Restores hemoglobin and skin tone.
   Side Effects: GI upset, constipation; only if deficient.
8. Oral/Intranasal Antihistamine (Allergy‑Related Swelling)
   Class: H1 blocker.
   Dosage/Time: Per label or prescription.
   Purpose: Reduce puffiness and rubbing from allergies.
   Mechanism: Lowers histamine‑driven edema and itch.
   Side Effects: Dry mouth, drowsiness (varies by agent).
9. Topical Hyaluronic Acid (Non‑invasive Hydrator)
   Class: Humectant.
   Dosage/Time: Twice daily as serum/cream.
   Purpose: Plumps superficial skin to soften fine lines.
   Mechanism: Binds water in the stratum corneum.
   Side Effects: Minimal; may need occlusive layer to prevent transepidermal water loss.
10. Topical Peptides (e.g., Matrixyl‑type, Copper peptides)
    Class: Signal/repair peptides.
    Dosage/Time: Once or twice daily.
    Purpose: Support collagen and skin firmness.
    Mechanism: Peptide signaling for matrix production.
    Side Effects: Rare irritation.

Note: Filler injections and energy devices are procedures, not “drugs,” but they often deliver the largest improvement for structural hollows.

Dietary Molecular Supplements

Always discuss supplements with a clinician, especially if pregnant, nursing, or on medications.

1. Vitamin C (500–1000 mg/day)
   Function: Antioxidant; supports collagen synthesis.
   Mechanism: Cofactor for prolyl/lysyl hydroxylase in collagen formation.
2. Collagen Peptides (2.5–10 g/day)
   Function: Improves skin elasticity and hydration over months.
   Mechanism: Bioactive peptides stimulate fibroblasts and dermal matrix.
3. Hyaluronic Acid Oral (120–240 mg/day)
   Function: Skin hydration and elasticity.
   Mechanism: Increases skin water content via HA metabolism.
4. Grape Seed Extract (OPC 100–300 mg/day)
   Function: Antioxidant; supports capillary strength.
   Mechanism: Proanthocyanidins stabilize collagen and vessels.
5. Green Tea Extract (EGCG 200–300 mg/day)
   Function: Anti‑inflammatory/antioxidant; may reduce pigment pathways.
   Mechanism: Inhibits tyrosinase; reduces oxidative stress.
6. Astaxanthin (4–12 mg/day)
   Function: Potent antioxidant; photoprotection.
   Mechanism: Quenches singlet oxygen; protects membranes.
7. Coenzyme Q10 (100–200 mg/day)
   Function: Mitochondrial support; reduces oxidative stress.
   Mechanism: Electron transport cofactor; antioxidant activity.
8. Omega‑3 Fatty Acids (EPA/DHA 1–2 g/day)
   Function: Anti‑inflammatory; supports skin barrier.
   Mechanism: Shifts eicosanoid profile toward less inflammatory mediators.
9. Zinc (10–15 mg/day) with Copper (1–2 mg/day)
   Function: Collagen cross‑linking and antioxidant enzymes.
   Mechanism: Cofactors for matrix and superoxide dismutase.
10. Niacinamide (Oral 250–500 mg/day, if used)
    Function: Supports barrier and pigment control.
    Mechanism: Modulates melanosome transfer; supports cellular NAD+.

Drugs for “Hard Immunity Booster / Regenerative / Stem Cell”

There are no approved systemic “immunity booster” or stem‑cell drugs for tear trough deformity. This condition is structural and cosmetic. Below are regenerative‑style, clinic‑based options or supportive agents sometimes discussed. They should be performed by experts and are not substitutes for surgery when surgery is indicated.

1. Platelet‑Rich Plasma (PRP) Injections
   Dosage: Series of 2–4 sessions spaced 4–6 weeks.
   Function: Improve texture and color modestly.
   Mechanism: Growth factors (PDGF, TGF‑β, VEGF) stimulate collagen and vascular remodeling.
2. Exosome‑Rich Preparations (Investigational)
   Dosage: Protocols vary; limited evidence; discuss risks/benefits.
   Function: Potential signaling for repair.
   Mechanism: Vesicle‑mediated delivery of microRNAs/proteins to fibroblasts.
3. Polynucleotide (PN)/PDRN Injectables (Regional Use; off‑label)
   Dosage: Series based on product; physician‑directed.
   Function: Skin quality support.
   Mechanism: Purine salvage and fibroblast stimulation.
4. Poly‑L‑Lactic Acid (PLLA) in Cheek Support (Procedure)
   Dosage: 1–3 sessions months apart.
   Function: Biostimulation to thicken support tissues.
   Mechanism: Stimulates neocollagenesis gradually.
5. Calcium Hydroxylapatite (Hyper‑Diluted, Cheek Support)
   Dosage: 1–2 sessions.
   Function: Framework and collagen stimulation.
   Mechanism: Microspheres act as scaffold, prompting collagen.
6. Topical Growth‑Factor Serums (Cosmeceuticals)
   Dosage: Once daily.
   Function: Modest texture support over time.
   Mechanism: Biomimetic peptides/growth factors signal dermal repair.

Important: Avoid unregulated “stem cell” injections or IVs. Choose licensed clinics that use evidence‑based protocols and informed consent.

Surgeries

1. Lower Blepharoplasty with Fat Repositioning
   Procedure: Through a hidden incision (often inside the lower lid), surgeon releases the eyelid‑cheek tether and moves bulging fat to fill the hollow.
   Why: Treats both eye bags and the trough by redistributing your own fat for a smooth contour.
2. Lower Blepharoplasty with Conservative Fat Removal
   Procedure: Removes only the extra, bulging fat pads while preserving support.
   Why: Reduces bags that exaggerate the adjacent hollow.
3. Arcus Marginalis Release
   Procedure: Carefully releases the ligament at the lid‑cheek junction.
   Why: Softens the sharp step‑off that forms the groove.
4. Midface Lift (with or without Endoscopic Approach)
   Procedure: Elevates the cheek fat pad to its youthful position.
   Why: Restores support under the lower eyelid and reduces the trough depth.
5. Fat Grafting/Micro‑ or Nanofat Transfer
   Procedure: Your own processed fat is injected into the trough and upper cheek.
   Why: Replaces lost volume using autologous tissue and can improve skin quality.

Risks for all surgeries: Bruising, swelling, asymmetry, under‑ or over‑correction, scarring, dry eye, and rare but serious complications. Choose an experienced oculoplastic or facial plastic surgeon.

Preventions (Daily Habits to Reduce Progression)

1. Daily sunscreen and sunglasses.
2. Consistent, adequate sleep with head elevation.
3. Manage allergies; no eye rubbing.
4. Moderate salt and alcohol.
5. Stay hydrated.
6. Do not smoke; avoid secondhand smoke.
7. Gentle, regular under‑eye skin care.
8. Maintain stable, healthy weight.
9. Treat anemia or thyroid issues if present.
10. Schedule professional reviews before procedures; choose qualified experts.

When to See a Doctor

See a dermatologist or oculoplastic surgeon if the hollow is severe, fast‑changing, asymmetric, or comes with other eye symptoms (pain, vision changes, sudden swelling). Seek care if you consider fillers or surgery, have allergies that do not respond to over‑the‑counter care, or if darkness is new and unexplained. Get urgent attention for sudden, painful swelling, vision loss, or signs of infection after any procedure.

What to Eat and What to Avoid

What to Eat

1. Colorful fruits and vegetables rich in vitamin C and polyphenols (citrus, berries, peppers).
2. Protein with collagen‑building amino acids (fish, eggs, legumes).
3. Omega‑3 sources (fatty fish, flax, walnuts).
4. Hydrating foods (cucumber, watermelon, soups).
5. Whole grains and nuts for minerals (zinc, copper, selenium).

What to Avoid/Limit
6. Excess salt, especially late evening meals.
7. Heavy alcohol, especially before sleep.
8. Ultra‑processed, high‑sugar snacks that inflame skin.
9. Smoking and vaping (collagen breakdown).
10. Habitual late‑night caffeine that disrupts sleep.

Frequently Asked Questions

1) Can creams alone fix tear troughs?
Creams can brighten skin and reduce swelling, but they cannot fully correct a true structural hollow. They work best as support to procedures.

2) Are fillers safe under the eyes?
In expert hands, yes, but risks exist: swelling, lumps, bluish hue (Tyndall effect), asymmetry, and very rare vessel blockage. Choose experienced injectors.

3) How long do HA fillers last here?
Commonly 6–18 months, depending on product, placement, and your metabolism. Maintenance is often needed.

4) What if I have bags and hollows?
Fat repositioning surgery can smooth both by moving extra fat into the hollow. In milder cases, fillers plus cheek support can help.

5) Will losing weight help or hurt?
Large, fast weight loss may deepen hollows. Aim for stable, healthy weight and good nutrition.

6) Are lasers or microneedling better?
They do different jobs. Lasers/IPL target pigment and vessels;

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members

Last Updated: August 27, 2025.