Tear trough filler is a cosmetic injection of hyaluronic acid gel beneath the under-eye area to fill in the hollow groove that runs from the inner corner of the eye toward the cheek. The treatment smooths the transition between the lower eyelid and the top of the cheek, reducing the shadowed, tired appearance that hollowing creates. Most people need one syringe per session at an average cost of about $715, and results can last 18 months or longer.
What the Tear Trough Actually Is
The tear trough is a shallow groove that sits about 2 to 3 millimeters below the bony rim of your eye socket, running from the inner corner of the eye to roughly the center of your pupil line. It marks the boundary where the thin skin of your lower eyelid meets the thicker skin of your cheek. A small ligament anchors the skin directly to the bone in this area, which is why the groove stays put even when surrounding tissue shifts with age.
Several things deepen this groove over time. The fat padding beneath your skin and around the bone thins out, the cheek fat pad slides downward, and the orbital fat behind your eyelid can push forward, creating puffiness right above the hollow. Bone loss in the upper jaw area also plays a role. The result is a visible shadow that makes you look exhausted regardless of how much sleep you got. Some people have a noticeable tear trough from a young age simply because of their bone structure and the way this ligament attaches.
How the Filler Works
Hyaluronic acid is a sugar molecule your body already produces naturally. When cross-linked into a gel and injected beneath the skin, it adds volume to the hollow area and attracts water to maintain that volume over time. Two products are specifically designed for this delicate region. Juvéderm Volbella XC is a soft, spreadable gel with a low concentration of hyaluronic acid that distributes smoothly across the under-eye area. Restylane Eyelight, a newer option, is firmer and stays more precisely where it’s placed rather than spreading into surrounding tissue.
The choice between these products matters. Softer gels blend well but can migrate slightly from the injection site. Firmer gels hold their shape but need more precise placement. Your injector will choose based on the depth of your hollowing, your skin thickness, and how much correction you need.
What the Procedure Looks Like
The treatment takes 15 to 30 minutes. After numbing the area with topical cream or a local anesthetic (most under-eye fillers also contain lidocaine in the syringe), the injector places small amounts of gel deep against the bone beneath your tear trough. Most practitioners use a blunt-tipped cannula rather than a sharp needle, entering through a single point near the outer cheek and threading the cannula beneath the skin to the target area. About 71% of expert injectors consider cannulas safer for this region because the blunt tip is less likely to pierce a blood vessel.
That said, some injectors prefer fine needles for greater precision and more controlled placement of product. A comparative study found that needles deposited filler more evenly with less immediate swelling, while cannulas produced slightly fewer bruises. Neither method caused severe complications in the study. The skill of the injector matters more than the tool they use.
Recovery and Results Timeline
Swelling and mild bruising are the most common side effects. Swelling peaks around day two or three, then gradually improves. Most bruising fades within a week. By the end of the second week, the area looks noticeably smoother and more natural. The filler fully settles by week three or four, which is when you’ll see your final result.
During the first 48 hours, you can expect redness, tenderness, and puffiness that may actually make the area look worse before it looks better. This is normal. Sleeping with your head slightly elevated and avoiding strenuous exercise for a day or two helps swelling resolve faster.
A retrospective study tracking patients over time found that results remained significant at 18 months, with no meaningful decline between the 6, 12, and 18-month marks. This challenges the common assumption that under-eye filler only lasts 6 to 12 months. Hyaluronic acid breaks down more slowly in areas with less movement, and the under-eye region moves relatively little compared to the lips or smile lines.
Who Is a Good Candidate
The best candidates have mild to moderate hollowing beneath the eyes without significant puffiness, loose skin, or pre-existing swelling. Your injector should examine you carefully for signs of malar edema (chronic puffiness on the upper cheek) or festoons (wavy folds of loose skin below the eye). These conditions can worsen with filler because the gel disrupts fluid drainage in the area. Filler placed too superficially or in too large a volume near these structures causes fluid to accumulate above a tissue barrier in the cheek, leading to persistent puffiness that’s difficult to reverse.
Skin thickness also matters. The under-eye area has some of the thinnest skin on the body. If your skin is very thin or translucent, filler placed even slightly too shallow can create a bluish discoloration called the Tyndall effect. This happens because small particles of gel scatter blue light more than red light, the same principle that makes the sky appear blue. If this occurs, the filler can be dissolved with an enzyme called hyaluronidase, which typically resolves the discoloration within 24 hours.
Risks and Complications
Common side effects like bruising, swelling, and tenderness resolve on their own within a week or two. The Tyndall effect, while cosmetically bothersome, is treatable. More serious but rare complications include lumps or nodules from uneven filler placement and prolonged swelling from malar edema.
The most serious risk is vascular occlusion, where filler inadvertently enters or compresses a blood vessel. The infraorbital artery runs directly through this region, and blockage can cause skin damage or, in the rarest cases, vision loss. A large-scale analysis calculated the incidence of vascular events from filler injections at roughly 1 in 6,600 treatments (0.015%) across all injection sites. The under-eye area carries higher risk than most regions because of the concentrated blood supply near the eye. This is why the tear trough is considered an advanced injection zone, and choosing an experienced, well-trained injector is critical.
One significant advantage of hyaluronic acid over other filler types is reversibility. If any complication arises, hyaluronidase can dissolve the product. Typical doses range from 30 to 75 units depending on how much filler needs to be removed.
Filler vs. Lower Eyelid Surgery
Filler and surgery address different problems. If your main concern is hollowness or shadowing, filler can smooth and camouflage the area effectively. It works by adding volume to the depression rather than removing anything. For mild to moderate puffiness, filler can also help by evening out the transition between the bulging fat pad and the hollow below it, making the puffiness less obvious.
Lower eyelid surgery (blepharoplasty) is a better option when puffiness is the dominant issue, especially if it’s severe. The procedure repositions or removes the herniated fat that creates bags, spreading it into the hollow tear trough area to simultaneously reduce puffiness and fill the depression. This creates a permanent correction rather than one that needs refreshing every year or two.
For people with significant skin laxity, prominent fat herniation, or festoons, filler alone won’t produce satisfying results and can make things worse. In those cases, surgery addresses the structural problem rather than masking it. Many patients start with filler in their 30s or 40s and transition to surgery later when the aging changes become more pronounced than what filler can reasonably correct.
What to Expect Cost-Wise
The average cost is about $715 per syringe of hyaluronic acid filler. Most people need one syringe for both eyes, though deeper hollowing may require a second syringe or a follow-up session a few weeks later. Since results can last well beyond a year, the annual cost is lower than many other filler treatments that need refreshing every few months. Touch-up sessions typically require less product than the initial treatment.