Tear Trough Filler Technique

Tear trough filling

Hyaluronic Acid (HA) fillers provide a minimally invasive way to augment several areas of the face including the lips and cheeks. It is more commonly now being used around the eyes, and more specifically in the tear trough area where many patients exhibit depressions or circles.

Filling in this area is different from other more forgiving areas due to the anatomic characteristics involved. The following guidelines ensure reproducible results in rejuvenating this area of the face.

  1. The use of blunt fine cannulas reduces the risk of bruising in this area and also protects against possible intravascular injection of product that can lead to more serious complications
  2. The use of less viscous HA fillers like Belotero, or Volbella, which are thin HA products, are preferred for this area to prevent nodule formation. Since the skin and subcutaneous tissue in this area is thin, thicker products may lead to visible deformities that are then difficult to correct.
  3. Injection deep to the skin and orbicularis muscle is the preferred plane of injection. If the injection is done too superficially, there is not only the risk of nodules, but also the risk of the Tyndall effect occurring the in the area of injection. This is when a bluish hue occurs in the area of injection due to light refraction through the skin and into an area of filler accumulation.
  4. Injecting in a retrograde fashion helps limit the risk of complications like nodule formation and intravascular injection.
  5. Serious injection complications can occur like intravascular injection and skin necrosis. If signs of this complication do occur, the use of hyaluronidase injection can help reverse these complications. It is important to have this available when doing injections in this area.

By following these principles when doing tear trough filler injections, a safe and successful filler session in the lower eyelids can be obtained. Please visit us at Thomassen Plastic Surgery to see how tear trough filler rejuvenation can improve your lower eyelid aesthetics.

Tear Trough filler with Belotero HA filler


Rao BK, Berger LE, Reilly C, Alamgir M, Galadari H. Tear trough filler technique utilizing hyaluronic acid: A systematic Review. Plas Reconstr Surg. 2022;149;1079-1087

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