How to Get Rid of Tear Troughs | Fillers Or Surgery?

Tear troughs respond best to treatment matched to their cause: a low-density hyaluronic acid filler for mild hollows, surgery for deeper ones.

Under-eye hollows that survive every concealer trick usually aren’t a skin problem at all — they’re structural. That fact shapes how to get rid of tear troughs, because the hollow sits below the skin and no jar rebuilds lost volume.

Two families of treatment do the heavy lifting. Injectable fillers suit mild hollows with good skin quality; surgery becomes the more predictable choice once the deformity is moderate to severe. The table below shows which fix fits which anatomy.

What Causes Tear Troughs?

Tear troughs come from inherited anatomy plus age-related change, and whichever force dominates decides how deep the hollow runs.

The hollow forms along the tear trough ligament, where the lower eyelid meets the cheek. Some people are born with that contour; others develop it as the face changes. The usual contributors stack up:

• Inherited structure. A recessed infraorbital rim or a flat maxilla leaves the area shadowed from birth.
• Fat atrophy. Infraorbital fat pads shrink with age, removing the cushion under the lid.
• Ligament laxity. The orbital septum and retaining ligaments loosen, letting tissue slide downward.
• Midface descent. Cheeks lose volume and drop, sharpening the boundary between eyelid and cheek.
• Bony remodeling. The maxilla and infraorbital rim resorb over time, deepening the hollow at its base.
• Skin changes. Thinning and laxity make the shadow read darker than it is.

Those causes overlap constantly, so two identical-looking hollows can need different treatment. The American Academy of Ophthalmology’s EyeWiki entry on tear trough deformity breaks down the anatomy behind each one.

Getting Rid of Tear Troughs: Matching The Fix To The Cause

Treatment works best when it targets the cause — a carefully selected hyaluronic acid filler for mild hollows, surgery as the more predictable option for moderate-to-severe deformity.

Not every filler belongs under the eye. Reviews of tear trough correction describe mid- to low-density, low-viscosity hyaluronic acid products with low water retention capacity, and they warn that high-viscosity HA and nonbiodegradable agents should not be injected here. Depth matters too: injections belong deep, on the periosteum. Filler suits a mild hollow with good skin quality and little lower eyelid laxity or fat herniation.

Everything else is a structural fix. Fat grafting adds your own tissue; fat repositioning shifts existing fat pads instead of adding volume; lower blepharoplasty handles herniated fat and lax lid tissue; facial implants rebuild a rim or midface that never projected enough.

No topical rebuilds lost volume, and anything promising that is selling a story. What a good eye cream can do is soften crepey texture and shadowing around the trough. Our tested eye cream for tear trough roundup is clear about where that help stops.

How Do You Lower The Risks?

The rare risk is the serious one — filler or fat injected into a blood vessel can interrupt flow and cause temporary vision problems or, in the worst cases, blindness. The injector and the setting are the biggest variables you control.

Everyday side effects are mild and expected: redness, swelling, and bruising. Infection is uncommon but possible.

Preparation lowers the bruising odds. It also points to a licensed dermatologist, plastic surgeon, or oculoplastic surgeon rather than a med spa, since complications happen even when the injection looks simple.

If the hollow is mild and your skin is in good shape, deep filler can be enough. If it’s deep, descended, or paired with fat herniation, surgery is the more reliable route. A cream belongs in the routine either way — for the skin around the trough, never the hollow.