Tear troughs, or nasojugal grooves if you want the medical term, are one of the most common areas injectors get asked to address, and they’re also one of the easiest areas to get wrong. I’m Dr. Murray from Absolute Cosmetic, and I want to walk through the tear trough filler treatment technique we’ve used for over twenty years.
What Is the Tear Trough Filler Treatment Technique?
The technique I teach treats the cheek first, then adds a small amount of filler onto the bone in the tear trough itself, rather than injecting directly and superficially into the groove. In my experience, using a more superficial injection technique straight into the groove creates risk of lumpiness andswelling.
Why Does the Tear Trough Hollow Happen in the First Place?
It happens because the cheek loses volume and support with age, and once that support drops away, the groove between the lower eyelid and the cheek becomes more obvious. That’s actually why treating the cheek first works so well. Elevating and rebuilding the cheek covers a good part of the tear trough without you needing to touch it directly at all.
How Do You Spot Whether Someone Needs Cheek Support or Direct Tear Trough Filler?
You spot it by looking at how much of the hollow resolves once you support the cheek. For most patients, elevating the cheek does the bulk of the work, and only a small amount of filler placed directly on the bone in the tear trough is needed on top of that. People with very thick skin in that area are the exception. If someone has genuinely thick skin there, and it’s not that many people, you can get away with a bit more direct treatment. But as a rule, I’d rather see a very conservative amount placed right on the bone than anything superficial.
Can Tear Trough Filler Prevent the Groove From Getting Worse?
Tear trough filler doesn’t stop the ageing process, but treating the cheek early does help prevent the hollow from becoming more pronounced, because you’re maintaining the support structure that the tear trough relies on. That’s part of why I think the order of treatment matters as much as the product itself.
What’s the Least to Most Invasive Way to Treat Tear Troughs?
The least invasive starting point is often a skin booster rather than a structural filler, particularly if someone’s after subtle improvement in skin quality around the eye rather than volume correction. From there, the standard approach is cheek filler first, then a conservative amount placed directly on the bone in the tear trough if it’s still needed. If someone ends up with resistant swelling or blebbing that won’t settle, nano fat is an option further down the line, though that’s not something we teach here at the Cosmetic Injector Institute. It’s simply useful to know it exists as an alternate option.
I was the first instructor for Galderma in Australia to teach tear troughs, after seeing the technique demonstrated in San Diego at one of the big meetings back around 2004. We’ve done a lot of these over the years, so I think we’ve got a fair bit of experience to draw on. What I keep noticing is that injectors who start out using a different method tend to evolve toward the same cheeks-first approach we’ve always used once they’ve been doing it a while.
What Are the Risks of Tear Trough Filler?
The main risks with tear trough filler are lumpiness and swelling, particularly when product is placed too superficially. Injecting directly and superficially into the groove is where I see the most blebbing and puffiness, which is why I steer injectors toward placing product on the bone instead, in small amounts. Resistant swelling can occur in some patients, and that’s where nano fat becomes a consideration further down the track.
FAQ
Is tear trough filler the same as cheek filler?
No. Cheek filler is placed to support and elevate the mid-face, while tear trough filler is placed directly in the hollow beneath the eye, and the two are often used together rather than as substitutes for each other.
Why do some injectors treat the cheek before the tear trough?
Treating the cheek first restores support to the area, which often reduces the tear trough hollow on its own, meaning only a small, conservative amount of filler is then needed directly in the groove.
Can tear trough filler cause lumps?
Yes, particularly when it’s injected too superficially. Placing filler directly on the bone in small amounts reduces this risk compared with superficial injection.
What if tear trough filler causes ongoing swelling or lumps?
If swelling or blebbing doesn’t settle, nano fat is one option that can be considered, though it’s a separate procedure from standard filler treatment.
Is a skin booster a good alternative to tear trough filler?
For patients who want subtle improvement without structural volume correction, a skin booster can be a suitable and less invasive starting point.
For more on injector training and technique, visit cosmeticinjectorinstitute.com.au or check out our available courses.
This content is for educational purposes for cosmetic injectors and does not constitute medical advice. All injectable treatments carry risks including bruising, swelling, lumpiness, and in rare cases more serious complications. Practitioners should ensure appropriate training and patient assessment before performing any treatment discussed here.