What is Tear Trough Treatment?


In recent years, complaints about the eye area have increased among patients visiting aesthetic clinics. This has led to a higher frequency of diagnosis of the under-eye hollowness and dark circles known as tear trough deformity, and an increase in the use of filler treatments. Hyaluronic acid fillers are widely preferred in this area as a non-surgical, fast, and effective solution.

What is Tear Trough Deformity and How Is It Recognized?
A tear trough is a depression that begins on the medial (inner) side of the lower eyelid and extends lateral to the lacrimal ridge. As the depth of this trough increases, it can make a person appear tired, older, or sad. Loss of subcutaneous tissue, muscle laxity, or decreased bone support are important causes of the deformity.

What Factors Affect Tear Trough Classification and Treatment Decisions?
The main anatomical and aesthetic factors to consider during clinical evaluation are as follows:

Pretarsal orbicularis oculi hypertrophy: Located just below the eyelashes. It is not an indication for filler alone and treatment can be risky.

Skin hyperpigmentation: HA filler is only beneficial if accompanied by depression.

Skin laxity: Assessed using the Glogau scale. Fillers are not recommended for excessive laxity.

Fat pad prolapse: In moderate to severe cases, filler success may be limited.

Periocular edema: HA may be contraindicated because its hygroscopic effect can increase edema.

How to Use the Clinical Rating Scale for Tear Trough Deformity Treatment? Evaluation is based on a total score obtained from five criteria (muscle hypertrophy, hyperpigmentation, laxity, prolapse, fluid accumulation), scored from 0 to 4:

0–2: Ideal filler candidate

3–7: Applicable with careful evaluation

8 and above: HA filler is not recommended

In Which Situations Should Tear Trough Filler Be Avoided?

Hypersensitivity to HA

Active skin conditions (herpes, acne, rosacea)

Breastfeeding or pregnancy

Previous permanent filler application

Immune system diseases

How Should a Clinical Examination Affect Treatment Decisions Be Conducted?

Evaluation in a semi-upright position

Elasticity of the eyelid with the snap-back test

Distinguishing edema/prolapse with light pressure

Assessing the depth by looking up

It is crucial to accurately distinguish between fat prolapse and edema.

How Should the Patient Be Communicated?
Treatment success begins with open and honest communication with the patient and managing expectations effectively. It is important for the patient to comply with pre- and post-treatment care.

What Preparations Should Be Made Before HA Filler?
Discontinuing blood-thinning medications and supplements

Reducing substances such as vitamin A, vitamin C, and vitamin E

Using vitamin K cream

Avoiding strenuous exercise

What Products and Techniques Are Preferred During Application?
Low-viscosity, low-hygroscopic HA products are recommended.

The only product approved in Europe: Redensity II

It can be administered with a cannula or needle; a cannula is preferred for safety.

The entry point is the specific anatomical point where two reference lines intersect. It is mathematically defined to ensure a safe injection site.

Who is Suitable for This Procedure?
Patients with mild to moderate volume loss, adequate skin thickness, good lymphatic drainage, and no associated severe fatty hernia or edema can achieve good results with HA filler.

With proper evaluation, appropriate technique, and high-quality products, tear trough filler is an effective aesthetic procedure that gives the face a bright and youthful appearance.

This article was prepared by Dermatologist Dr. Fatma Yıldız. For more information and consultation, please contact Ankara Life Polyclinic.