Tear Trough Filler

Tear trough hollowing (or sunken under eyes) can become more pronounced as we age. The tear trough is the junction between two facial muscles that is often made more obvious by bulging of the fat pad under the eye. This can lead to a shadow under the eye which can give a tired and worn out appearance.

There are several reasons that a person may develop sunken eyes and it’s important that your cosmetic injector properly assess the underlying cause of the hollowing and tailor the most appropriate treatment.

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How we conduct this treatment


The first step is to improve the bony support of the lower orbit and create a more neutral vector of the eye in the socket. This is achieved by running columns of structural filler along the lower orbit.


The next step is replacement of volume in the deep fat pads under the eye muscles. This allows for a more youthful convex curve to the area under eye area, offsetting a flat or drawn aesthetic.


Only at this point is the bare bone area at the inner most point of the eye (known as the tear trough hollowing) treated. If this is performed without considering other anatomical elements it could lead to an undesirable result.


Lastly the demarcation between the eyelid area and the cheek (known as the lid-cheek junction) is gently blended to allow for a more smooth and youthful and soft appearance around the eye.

Dermal filler FAQs

What type of filler?

Typically very small amounts of a dense filler are used deep on bone. This allows for the deformity to be corrected without causing a ‘puffy’ look under the eyes.

Pain relief during procedure

Pain is very minimal during the procedure. Topical anesthetic can be used, but is very rarely required.

The tear trough filler procedure

This procedure is often done in two stages spaced 2-4 weeks apart. The reason for this is that filler by its very nature will attract water and a small degree of swelling is expected. So the aim is generally for an 80% correction in the first visit and then to further refine it in the following visit. This allows for adequate correction without causing ‘puffiness’ under the eyes.

Possible side effects

As with any medical procedure there are some risks to consider. Most patients will have some degree of swelling associated with this treatment, but this will settle over the following few days. There may be some discomfort, bleeding or bruising. There have been cases in Australia of vascular injury whereby filler is inadvertently injected into a blood vessel. It is very rare but if it occurred could lead to necrosis of the skin or visual loss. A thorough knowledge of facial anatomy and safe injecting techniques can greatly minimise this risk, however if any signs were to occur the filler would need to be dissolved immediately.

It should be pointed out that this is a common area for bruising to occur due to thin skin and multiple blood vessels in this area. There are certain techniques that can be used to minimise this risk and, although it does not happen commonly, should be expected. Therefore, filler in this area should not be considered if there is a special event that you are planning in the next fortnight where a bruise would not be acceptable in case this should occur. However, if it does occur it can be minimised by applying ice for 24 hours afterwards and camouflaged with makeup.

The other consideration of filler in the tear trough deformity is a poor aesthetic outcome. This can occur for several reasons, including:

  • Filler placed too superficially in the skin. This can lead to a blue appearance in the skin (known as the Tyndall effect).
  • Too much filler used (or overcorrection) causing ‘puffiness’ under the eyes. This is why the procedure should be performed over two visits.
  • Performing the procedure on the wrong patient. Identifying patients who will not get a good outcome is vitally important in tear trough filler. Common times when it would not be appropriate are in patients with poor skin laxity, large eye bags or seasonal allergies.

It is for these reasons that it is important to see an experienced cosmetic physician with a good knowledge of facial anatomy and who understands how to avoid complications so that you can get the best possible outcome in the safest way.


There is generally minimal recovery for this procedure. However if a bruise occurs there may be swelling and discolouration that can take up to 2 weeks to resolve.

After care

No makeup or lipstick for 4 hours. No exercise for the next 24 hours. Avoiding alcohol that evening will minimise any bruising. Applying ice will also help with swelling and bruising. No swimming for one week.


At Ascension, we tailor our treatments to match your facial structure and desired outcome. Since we don’t use a ‘one-size-fits-all’ approach, pricing can differ depending on the unique treatment plan we create during your consultation. For a pricing guide, please click here.

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    Get in touch for an obligation free quote