In Depth
Under-Eye Treatment in Detail
The tear trough is the groove that runs down and outwards from the inner corner of the eye. It forms where skin and muscle are tethered to bone by a ligament, and it deepens as the cheek below loses volume and the fat around the eye pushes forward above. Anatomical work on the tear trough explains why the same reflection in the mirror can come from either side of that groove, and why treatment follows the cause. [1]
Filler has a narrow role here. It helps when there is a hollow, good skin quality and little bulging above it. It does not help a true fat bag, puffiness that comes and goes, or thin crepey skin, and in those cases it can make things look worse. Where the cheek has flattened, supporting the cheek first can reduce how much product the tear trough needs. [2]
The area also carries real risk. The vessels around the eye connect with the blood supply of the eye itself, and the published reviews of filler-related vision loss include the periorbital region among the sites where it has been reported. [3,4] Technique, product choice and a plan for complications matter here more than almost anywhere else on the face.
Which Under-Eye Problem, Which Approach
| What you see | Likely cause | Usual approach |
|---|---|---|
| A groove or shadow, worse in overhead light | Tear trough hollow | Tear trough filler, sometimes with cheek support |
| A bulge that is there morning and evening | Fat pushing forward | Surgical assessment (lower eyelid blepharoplasty) |
| Puffiness worse in the morning or after salt | Fluid | Sleep, salt and allergy review; no filler |
| Fine, crinkled skin | Skin laxity | Energy-based skin tightening |
| Bluish darkness | Vessels showing through thin skin | Careful filler padding in selected cases |
| Brownish darkness | Pigment | Pigment assessment; laser or topical treatment |
A bulge and a hollow can look the same in a mirror. The treatment is decided by which one it is.
What Happens on the Day
- Periorbital assessmentUpright, in different lighting, looking up and down. Dr. Sin Yong checks for fat bulging, skin quality, fluid and cheek support.
- DecisionIf filler is not the right answer, you will be told on the day and given the alternative.
- Numbing and markingNumbing cream is applied. Entry points are usually on the cheek, away from the eye.
- PlacementSmall amounts are placed deep with a blunt cannula, slowly, with skin colour and your vision checked throughout.
- Review at two weeksSwelling settles first. Any top-up is decided then, not on the day.
Risks and Side Effects
- Bruising and swelling, more common here than elsewhere on the face; allow two weeks before an event
- Lumps or a bluish tinge if product sits too close to the surface; treatable with hyaluronidase
- Persistent puffiness in some people, because hyaluronic acid holds water
- Rarely, blockage of a blood vessel, which can affect the skin or, very rarely, vision
Warning signs. Seek help immediately if you have any change in vision, eye pain, or skin that turns pale, grey or blotchy after treatment. Call the clinic, or go to an emergency department if you cannot reach us.
Aftercare
- Cold compresses for the first day
- Sleep with your head slightly raised for a night or two
- Avoid rubbing the area, heavy exercise, saunas and alcohol for 24–48 hours
- No makeup on the entry points for the rest of the day
References
- Hirmand H. Anatomy and nonsurgical correction of the tear trough deformity. Plast Reconstr Surg. 2010;125(2):699-708
- Rohrich RJ, Pessa JE. The fat compartments of the face: anatomy and clinical implications for cosmetic surgery. Plast Reconstr Surg. 2007;119(7):2219-2227
- Beleznay K, Carruthers JDA, Humphrey S, Jones D. Avoiding and treating blindness from fillers: a review of the world literature. Dermatol Surg. 2015;41(10):1097-1117
- Beleznay K, Carruthers JDA, Humphrey S, Carruthers A, Jones D. Update on avoiding and treating blindness from fillers: a recent review of the world literature. Aesthet Surg J. 2019;39(6):662-674
- Health Sciences Authority, Singapore — medical device regulation
General information, reviewed by Dr. Sin Yong, Medical Director, on 6 Oct 2026. It is not a substitute for a consultation, and individual results vary.
