Nasojugal fat pads are the small, layered pockets of fat sitting between the lower eyelid and the upper cheek, running diagonally from the inner corner of the eye toward the midface. When these fat compartments lose volume, shift downward, or become more visible with age, the result is the familiar hollowing, dark circles, and groove formation that sends many people looking for answers. The anatomy of this region is more complex than most people realize, involving layered fat compartments, ligaments anchored directly to bone, and a network of arteries that make the area both cosmetically significant and tricky to treat.
The Anatomy Behind the Groove
The nasojugal groove is one of several creases in the infraorbital region, and it is worth distinguishing it from its neighbors. Grooves in this area are classified as the nasojugal groove (running from the inner eye corner toward the nose and cheek), the tear trough deformity (a closely related but slightly different depression along the lower orbital rim), and the palpebromalar groove (extending more laterally toward the outer cheek).1Archives of Plastic Surgery. Definitions of groove and hollowness of the infraorbital region and clinical treatment using soft-tissue filler In casual conversation, people tend to lump all of these together as “under-eye hollows” or “tear troughs,” but they arise from different anatomical structures and sometimes call for different treatments.
The fat in this region is not one uniform pad. It exists in both superficial and deep layers, each partitioned into separate compartments by thin sheets of connective tissue. A landmark series of anatomical studies established that these compartments behave as independent units, gaining or losing volume on their own schedules rather than deflating uniformly.2Plastic & Reconstructive Surgery. Newer Understanding of Specific Anatomic Targets in the Aging Face as Applied to Injectables The deep medial cheek fat, the suborbicularis oculi fat (SOOF), and the superficial malar fat pad all sit in this neighborhood, and their boundaries matter because volume loss in one compartment can create a visible groove even if the adjacent compartment is intact.
What anchors the groove in place is a system of ligaments. Along the tear trough itself, the orbicularis oculi muscle attaches directly to the bone of the orbital rim. Farther along the lid-cheek junction, a structure called the orbicularis retaining ligament provides the attachment instead.3Plastic and Reconstructive Surgery. The Tear Trough and Lid/Cheek Junction: Anatomy and Implications for Surgical Correction This tethering effect is the reason the groove stays put while the surrounding soft tissue sags or deflates. When the ligament holds the skin tightly against bone, any loss of fat above or below that attachment line shows up as a visible crease.
Why the Area Hollows Out With Age
Several processes conspire to deepen the nasojugal groove over time, and fat loss is only one of them. The herniation of fat from inside the orbit (the puffy, forward-bulging fat pads behind the lower eyelid), atrophy of subcutaneous fat in the cheek, contraction of the orbicularis oculi muscle, and gradual resorption of the cheekbone all contribute.4Archives of Plastic Surgery. Definitions of groove and hollowness of the infraorbital region and clinical treatment using soft-tissue filler The visual effect is a double hit: the lower eyelid may look puffy from orbital fat pushing forward, while the cheek immediately below looks sunken because its fat pad has shrunk.
Computed tomographic imaging has shown that midfacial fat compartments migrate downward with age, and that this downward slide is accompanied by a shift in volume within the compartments themselves. The deep medial cheek fat pad, which sits right behind the nasojugal groove, loses volume in a particularly noticeable way.5Plastic & Reconstructive Surgery. Aging Changes of the Midfacial Fat Compartments: A Computed Tomographic Study Because the overlying ligament holds the skin in place while the fat behind it deflates, the groove deepens like a valley between two ridges. Progressive fat atrophy in this specific zone is what many people recognize as worsening “dark circles” under the eyes.6Aesthetic Surgery Journal. Volume Correction for Nasojugal Groove With Blepharoplasty
The shift away from older surgical thinking, which treated facial aging mainly as a gravity problem, toward a volumetric understanding has changed treatment significantly. Researchers now view the face as a mosaic of fat compartments that inflate and deflate at different rates, rather than as a single sheet of tissue sliding downward.7PubMed Central. The clinical importance of the fat compartments in midfacial aging This reframing explains why a facelift alone often fails to correct under-eye hollowing: you can tighten the skin all you want, but if the fat compartment behind the groove is empty, the groove remains.
How Ethnicity Shapes What You See
The nasojugal groove does not present the same way in everyone, and some of the most clinically relevant differences track with ethnicity and underlying bone structure. A large study of over 4,000 participants found that increasing midface volume deficit correlated strongly with increasing tear trough and nasolabial fold severity in both sexes.8Dermatologic Surgery. Relationship Between Midface Volume Deficits and the Appearance of Tear Troughs and Nasolabial Folds But the type of volume loss and the resulting appearance vary.
Tear trough severity with aging is significantly greater in Caucasian women and men compared to African American, Asian, and Latino/Hispanic counterparts.9Aesthetic Surgery Journal. The Facial Aging Process From the “Inside Out” In people of African and Afro-Caribbean descent, the cheekbone tends to be less prominent, and the combination of this bone shape with sagging superficial malar fat produces nasojugal and nasolabial folds that look different from the hollowed-out tear trough more common in people of European descent. In Japanese patients, conspicuous tear troughs can flatten the midface appearance even without dramatic fat bulging. Meanwhile, in South Asian populations (Indian, Pakistani, Bangladeshi, Nepalese patients), under-eye bags tend to result from a combination of fat descent and deep volume loss rather than the forward bulging of orbital fat seen in other groups.10Dermatologic Surgery. Assessing the Midface: Nose and Cheeks
These differences matter practically because a treatment plan designed around the classic Caucasian tear trough presentation (deep hollowing, thin skin, prominent orbital rim) can miss the mark for someone whose groove is driven more by fat descent or bone shape. A provider who ignores these variations risks either overtreating or undertreating the area.
Filler Injections and Why This Area Is Risky
Hyaluronic acid fillers have become the most common non-surgical treatment for the nasojugal groove, and the results can be impressive when done well. But the infraorbital region is one of the riskiest areas on the face for injection because of the dense network of blood vessels running through it. The infraorbital artery and nerve, the angular artery, the facial vein, and a variable detoured branch of the facial artery all pass through a small zone.11Archives of Plastic Surgery. Definitions of groove and hollowness of the infraorbital region and clinical treatment using soft-tissue filler – Section: TREATMENT USING SOFT-TISSUE FILLER Hitting one of these vessels with filler can cause bruising at best and tissue death or vision loss at worst.
Cadaveric studies mapping the exact positions of these arteries relative to the tear trough have found that the artery sitting closest to the lower orbital rim is the palpebral branch of the infraorbital artery, while closer to the inner corner of the eye, the angular artery (a branch of the ophthalmic artery) takes over as the nearest vessel.12Plastic and Reconstructive Surgery. The Feasibility Determination of Risky Severe Complications of Arterial Vasculature Regarding the Filler Injection Sites at the Tear Trough Because the ophthalmic artery supplies the eye, accidental injection into this branch is the pathway to the most feared complication: blindness. This is not a hypothetical concern; it is the reason many experienced injectors use blunt-tipped cannulas rather than sharp needles in this area and inject slowly with small volumes.
The choice of filler product also matters more here than in most facial areas. For deep structural support behind the groove, practitioners tend to use firmer gels with higher resistance to deformation, placed against bone or deep muscle. For superficial blending closer to the skin surface, softer, more elastic fillers are preferred to avoid visible lumps or a bluish discoloration called the Tyndall effect, which happens when hyaluronic acid sits too superficially in thin skin.13Journal of Plastic, Reconstructive & Aesthetic Surgery. Anatomical-based filler injection techniques for the midcheek groove and infraorbital region: Narrative review The skin under the eyes is among the thinnest on the body, so even a small placement error is noticeable.
One complication that can develop weeks or months after filler injection is malar edema, a persistent puffiness in the cheek area caused by the filler disrupting normal lymphatic drainage. When this occurs, it can be treated with small amounts of injected steroid (triamcinolone) delivered via cannula to the affected area.14PubMed Central. Triamcinolone Injection in the Treatment of Malar Edema The condition is another reminder that the infraorbital region does not tolerate careless volume addition.
Surgical Approaches to the Nasojugal Groove
When the groove is severe or driven largely by bulging orbital fat (the puffy lower lids that make the hollow below look even deeper), surgery becomes the more durable option. The field has moved decisively away from older techniques that simply removed fat from the lower eyelid. Those subtraction-only procedures often left the area looking even more hollowed out over time. Modern lower blepharoplasty techniques instead reposition the bulging orbital fat, draping it over the orbital rim and into the groove to fill the depression from the inside.15PubMed Central. Evaluation and treatment of the tear trough deformity in lower blepharoplasty
A key step in many modern procedures is releasing the orbicularis retaining ligament, the tethering structure described earlier. Releasing this ligament allows the soft tissue to drape more smoothly over the orbital rim instead of being pulled into a crease. A comparative study found that releasing the ligament specifically improved outcomes for patients with prominent nasojugal grooves, because it eliminated the tethering effect that kept the groove visible even after fat was redistributed.16PubMed Central. Management of tear trough deformity with and without tear trough-orbicularis retaining ligament complex release in transconjunctival blepharoplasty: a comparative study
Extended transconjunctival lower blepharoplasty, performed through an incision inside the lower eyelid (leaving no visible scar), has emerged as a particularly effective approach. The technique accesses the midcheek soft-tissue spaces to redistribute fat into the groove area.17Plastic & Reconstructive Surgery. Extended Transconjunctival Lower Eyelid Blepharoplasty with Release of the Tear Trough Ligament and Fat Redistribution In one series using a modified transconjunctival technique with fat repositioning, the groove improved in roughly 98% of cases, and the small number of patients who did not improve underwent revision procedures that ultimately corrected the deformity as well.18PubMed. Modified Lower Blepharoplasty with Fat Repositioning via Transconjunctival Approach to Correct Tear Trough Deformity
Energy-Based Devices as Alternatives
For people who want improvement without needles or surgery, energy-based devices represent a newer and still-evolving category. Radiofrequency (RF) and microfocused ultrasound (MFU) devices work on different principles, but both aim to tighten skin and, in some cases, reshape the underlying fat.
Monopolar radiofrequency has shown the ability to target facial collagen as deep as the fat layer, and in a prospective study, it produced measurable improvement in periorbital hollowing and puffiness by redistributing volume in the fat pads rather than simply tightening the skin surface.19Journal of Cosmetic Dermatology. Monopolar radiofrequency for reposing drooping fat planes and facial rejuvenation: A prospective study on 30 subjects towards true antiaging Microfocused ultrasound, meanwhile, creates small zones of coagulation at about 3 mm depth, which anatomically coincides with the superficial parts of the infraorbital fat pads. The controlled heat both destroys some fat cells and contracts collagen fibers, offering a potential non-invasive route to reducing mild lower eyelid fat bulging.20Medical Lasers. Surgical and Non-Surgical Treatment of the Lower Eyelid Fat Bulging Using Lasers and Other Energy-Based Devices
The honest assessment of these devices is that they work best for mild cases. They cannot replicate what surgery does for someone with significant fat herniation or deep groove formation. The improvements tend to be subtle, and multiple sessions are usually needed. But for someone in their thirties or forties noticing early groove formation who is not ready for filler or surgery, they represent a low-risk entry point.
How Fat Pads Behave During Expression
An aspect of nasojugal fat pad anatomy that rarely comes up in cosmetic consultations is how these compartments move when you make facial expressions. Ultrasound imaging has revealed a striking difference between the superficial and deep fat layers. During smiling, the superficial midfacial fat compartments shifted upward by an average of about 3.7 mm, while the deep compartments barely moved at all.21Journal of Cosmetic Dermatology. The mobility of the superficial and deep midfacial fat compartments: An ultrasound‐based investigation No gender differences in this mobility were found.
This matters for treatment planning in a practical way. If you inject filler into the superficial layer to correct a groove at rest, that filler is going to ride upward nearly four millimeters every time you smile, potentially creating a visible ridge or asymmetry during expression. Filler placed in the deep, nearly immobile layer stays put regardless of what your face is doing. Understanding this dynamic is one reason experienced injectors favor deep-plane placement in the nasojugal area and reserve superficial product for final blending only. It also helps explain why some people complain that their under-eye filler “looks great until I smile” — the product is likely sitting in a compartment that moves more than intended.
The Vascular Map That Makes Injectors Nervous
Beyond the specific vessels mentioned earlier, the broader vascular anatomy of the infraorbital region deserves its own discussion because it is the single biggest source of serious filler complications. The face has extensive blood supply and numerous anastomoses (connections between arteries), which means that filler accidentally injected into one artery can travel to unexpected places. The angular artery, which sits very close to the medial tear trough, connects to the ophthalmic artery system. This connection is the anatomical basis for the rare but devastating cases of vision loss after tear trough filler.22Plastic and Reconstructive Surgery. The Feasibility Determination of Risky Severe Complications of Arterial Vasculature Regarding the Filler Injection Sites at the Tear Trough
Cadaveric dissection studies have been the primary tool for mapping these vessels, and they consistently show high variability between individuals. The angular artery does not always sit in the same spot. Some people have a detoured branch of the facial artery running through the infraorbital region that others lack entirely.23Archives of Plastic Surgery. Definitions of groove and hollowness of the infraorbital region and clinical treatment using soft-tissue filler – Section: TREATMENT USING SOFT-TISSUE FILLER This unpredictability is why even the most skilled injectors approach the nasojugal area with caution, typically using aspiration techniques, slow injection, and cannulas to minimize the chance of an intravascular event. For anyone considering tear trough filler, this is a region where provider experience matters far more than it does for, say, lip augmentation. The margin for error is smaller, and the consequences of getting it wrong are more severe.
When Fat Compartments Are Studied Up Close
Much of what clinicians now know about nasojugal fat pad anatomy comes from cadaveric dissection, which remains the gold standard for understanding three-dimensional tissue relationships that imaging cannot fully capture.24Journal of Craniofacial Surgery. Unravelling the Complex Anatomy of the Tear Trough and Lower Eyelid Folds These studies have progressively refined the understanding of how many distinct compartments exist, where their boundaries lie, and how they interact with surrounding structures.
The discovery that facial fat is compartmentalized rather than continuous was itself a relatively recent development in anatomy. Earlier generations of surgeons thought of subcutaneous fat as a single continuous layer that sagged uniformly.25PubMed Central. Facial fat compartments: a guide to filler placement The realization that individual compartments deflate independently is what shifted surgical thinking toward volume restoration rather than just pulling skin tighter. For the nasojugal region specifically, this means that the deep medial cheek fat pad can lose volume while the overlying superficial fat remains relatively full, or vice versa, creating patterns of hollowing and bulging that earlier anatomical models could not explain. This compartmental thinking now guides both surgical fat repositioning and the layered filler strategies used by dermatologists and plastic surgeons treating the tear trough.