Hi doctor,
In this guide, I’m going to walk you through how I approach tear trough filler — from anatomy to technique, to safety and complications — just like I would if you were shadowing me in a live training. This is one of the most precise, yet rewarding areas to treat, and if you’re planning to offer this to your patients, you’ll want to master every detail.
👁 Understanding the Tear Trough Anatomy
Before anything else, let’s go over the anatomy — because if you understand what’s under the skin, your results will instantly improve.
The tear trough is that hollow groove running from the inner corner of the eye downward and outward. In aging patients or even younger ones with deep-set eyes, this hollow casts a shadow that makes them look tired.
Here’s what’s under the skin:
- The orbicularis oculi — a very thin muscle that surrounds the eye
- The tear trough ligament — it defines the hollow
- Fat pads — orbital fat above and malar fat below
- And crucially, the infraorbital nerve and vessels, which run around 8-10mm below the orbital rim — and we do not want to hit those.
Also, the skin is extremely thin, which means your technique and product choice need to be spot-on to avoid swelling or a bluish tint.
✅ Who Is a Good Candidate?
We’re looking for patients who:
- Have volume loss or hollowing under the eyes
- Have dark shadows caused by that hollow, not just pigment
- Have good skin quality, not too thin or loose
Patients with under-eye bags (prolapsed fat) are not great candidates — filler might make them look worse. So don’t treat everyone. Choose wisely.
💉 Filler Product Selection
Now let’s talk product.
You want something:
- Soft and moldable (low G prime)
- Low in water absorption (low hydrophilicity)
- And most importantly, easy to dissolve with hyaluronidase, just in case
My go-to products are:
- Teosyal Redensity II
- Belotero Balance
- Restylane Eyelight
- Juvéderm Volbella
Avoid thick, stiff fillers like Ultra or Lyft — they tend to cause puffiness or the Tyndall effect.
✍️ Injection Techniques: Cannula vs. Needle
Let’s break down both, but I’ll start with cannula, which is my preferred method.
🔹 Cannula Technique (Recommended)
- Use a 25G or 27G cannula, 38–50mm long
- Entry point: about 1.5 cm lateral to the orbital rim, along the mid-pupillary line
- Use a small needle to make the entry point
- Advance the cannula in the supraperiosteal plane, staying under the orbicularis muscle
- Inject 0.1–0.3 mL per side max — slowly — with retrograde linear threads or tiny boluses
This reduces the chance of bruising and vessel trauma.
🔸 Needle Technique (Advanced)
If you’re using a needle:
- Use 30G, 13 mm
- Inject either deep to bone or very superficial — avoid the middle layer
- Go slow, use micro boluses, and always aspirate
Only use this method if you’re confident and experienced.
🛑 Safety & Common Mistakes to Avoid
Here’s what I’ve seen go wrong most often — and how to avoid it:
- ❌ Overfilling: Go conservative. You can always add more. Removing is harder.
- ❌ Injecting too superficially: Causes a bluish tint (Tyndall effect)
- ❌ Choosing the wrong filler: Puffy under-eyes are often product-related
- ❌ Going too close to vessels: Avoid the infraorbital foramen area
📋 Post-Treatment Instructions
Tell your patient:
- No heavy workouts, alcohol, or pressure for 24–48 hours
- Some swelling or bruising is normal
- No massages unless advised
- Final result usually appears in 7–14 days
| Problem | Cause | What to Do |
|---|---|---|
| Tyndall effect | Too superficial injection | Dissolve with hyaluronidase |
| Edema | Overfilling or poor lymphatics | Wait 1–2 weeks or dissolve |
| Bruising | Vessel trauma | Ice, arnica, time |
| Vascular occlusion | Intravascular injection | Emergency: dissolve + warm compress + refer ⚠️ Complications & What To Do |
Always have hyaluronidase on hand and know how to use it. It’s not optional.
👩⚕️ Final Thoughts
The tear trough is one of the most technically demanding areas in facial aesthetics, but also one of the most transformative. It takes practice, a steady hand, and a good understanding of facial anatomy.
So remember:
Start small. Stay safe. And don’t chase perfection with too much filler.
🎓 Want the Full, Online Course?
If you want a deeper, step-by-step walkthrough — with live video demonstrations, guided injection angles, anatomical maps, product breakdowns, and complication management — then I invite you to join my online masterclass.
It’s designed for medical professionals only, and it’s packed with everything I’ve learned from years of hands-on work and teaching.
👉 Click here to enroll:
🔗 Join the Tear Trough Filler Masterclass (Insert your actual course URL)
I’ll see you inside.