tear trough
What are tear troughs? Why are they so often confused with dark circles and under-eye bags?
Real Tear Trough Cases
Our physician has treated tear troughs of every subtype — ligament-related, volume-related, pigment-related and fluid-related. The complete before-and-after gallery, with the product and technique used in each case, is published on the treatment page.
What are tear troughs? Why are they so often confused with dark circles and under-eye bags?
The tear trough (medically known as the nasojugal groove) is a concave groove located along the inner lower eyelid that extends along the inferior border of the orbicularis oculi muscle toward the mid-cheek.depressed groove. Its nature is not truly “dark” — rather it is anatomical hollow— The retaining ligaments pull the skin toward the periosteum, orbital fat protrudes above, and cheek fat descends below — the height difference across these three layers casts a shadow. Among Asian aesthetic patients in Nanjing, tear troughs, dark circles, and under-eye bags overlap incidence exceeds 70%, This is why brightening eye creams alone can never fully address the problem.
Why is it not “dark circles”?
Dark circles are a pigmentation concern (pigmented type / vascular type); the tear trough is Structural hollowing. The two often coexist, but the treatment logic is entirely different — filling the hollow can simultaneously reduce the appearance of dark circles.
Why is it not “under-eye bags”?
Under-eye bags are caused by lower eyelid orbital fat protrusion; tear troughs are the hollow beneath that fat. Together they create an S-shaped contour — the convex bulge above and the concave groove below — making bags appear more prominent. Filling the tear trough actually reduces the visual impact of the bags.
Why is this particularly pronounced in Asian patients?
Asian patients relatively flat periocular bone support, thin subcutaneous fat, and tightly adherent orbital septum ligament attachments, The anatomical tear trough depression is typically deeper in Asian faces than in Caucasian patients — which is why a tired appearance often becomes noticeable after the age of 25.
Why must the supine tilt test be performed first?
Tilt head back 45° toward the ceiling: hollow disappears → yes laxity / volume-loss type, may be suitable for filler; hollow does not disappear → Ligament-anchored type, requires precise deep supraperiosteal filler placement or ligament release.
Clinical note:Many clients have been told elsewhere that “a little filler will do the trick,” only to end up with Tyndall blue discoloration, puffiness resembling an eye bag, or a result that actually makes them look older — all classic outcomes when tear trough subtypes are not accurately assessed. Our physician’s protocol The first step is always classification + supine tilt test + transillumination assessment, rather than proceeding directly to injection.
The five main causes of tear troughs — it is not simply “aging”
Tear troughs can appear as early as one’s mid-twenties and are not purely a sign of aging. In Asian faces, tear troughs are typically Anatomical structure + volume loss + skin changes multifactorial in origin.
1. Congenital nasojugal ligament attachment
Orbicularis Retaining Ligament(the orbicularis retaining ligament) anchors the skin tightly to the periosteum, creating a natural groove at the ligament attachment — this is Congenital structural tear trough at the root of the issue, independent of age.
2. mid-face volume loss
30 With age, descent of the malar fat pad combined with infraorbital bone resorption causes the tear trough to extend downward into Lid-cheek junction and Zygomatic hollow. This is the most common type among Asian women over 35.
3. Orbital septal fat herniation (pseudoherniation / false eye bags)
anterior prolapse of lower eyelid fat, causing the tear trough to relative hollowing more pronounced. In these cases, filling the tear trough alone would make the under-eye bags appear more prominent — a combination approach is needed.
4. Skin thinning / pigmentation
The periocular skin is the thinnest on the body (approximately 0.5 mm) — thin enough to reveal the purple hue of the orbicularis oculi muscle and the underlying vasculature. This visual dark circles compounding the tear trough shadow and intensifying a tired appearance.
5. lifestyle factors / chronic inflammation
Sleep deprivation, allergic rhinitis, frequent eye rubbing, and prolonged screen time all worsen periocular pigmentation and accelerate collagen loss. Any injectable treatment should be paired with appropriate lifestyle management.
4 periocular conditions commonly confused with tear troughs — key differential diagnosis points
Misclassification leads to incorrect treatment. The table below summarizes the 4 most clinically common differential diagnoses that our physician encounters.
True Tear Trough
Nasojugal Groove · Nasojugal groove
| Location | along the orbital rim at the inner one-third of the lower eyelid |
|---|---|
| Nature | structural hollow shadow |
| Head-tilt test | hollowing can diminish or resolve |
| Triggering factors | Retaining ligament / volume loss |
| first-line treatment | HA Deep supraperiosteal filler injection |
Eye Bags (true eye bags / pseudoherniation)
Pseudoherniation · orbital fat prolapse
| Location | Central lower eyelid forward protrusion |
|---|---|
| Nature | Protrusion, not hollowing |
| Head-tilt test | Protrusion unchanged |
| Triggering factors | Orbital septum laxity / forward migration of the fat pad |
| first-line treatment | Lower eyelid fat repositioning surgery / combined with tear trough filler |
Pigmented Dark Circles
Periorbital Hyperpigmentation
| Location | patchy brown discoloration of the lower eyelid skin |
|---|---|
| Nature | Pigmentation present, no palpable hollow |
| Head-tilt test | Color unchanged |
| Triggering factors | Genetics / UV exposure / chronic rubbing |
| first-line treatment | PicoSure Pro Low-energy treatment + topical Cyspera |
Vascular Dark Circles
Vascular Periorbital Shadow
| Location | Bluish-purple discoloration visible through the lower eyelid skin |
|---|---|
| Nature | Thin skin + visible vasculature |
| Head-tilt test | Color has lightened but is still present |
| Triggering factors | Thin skin + allergies / rhinitis |
| first-line treatment | Skin booster injections to thicken the dermis + Vbeam® vascular laser |
⚠️ Caution:Clinically, approximately 40% of patients who present requesting tear trough filler are reclassified after assessment as “primarily under-eye bags” or “primarily pigmentation.” Treating bags as hollows makes the puffiness worse; treating pigmentation as volume loss wastes money while the shadow remains — these are the most common frustrations among our Asian periocular patients.
Why do Asian tear troughs require a dedicated Fitzpatrick III–V specialist protocol?
Blind spots in mainstream North American clinic practice
Most medical aesthetic clinics in North America base their tear trough filler protocols on Caucasian facial anatomy (Fitzpatrick I–II, high nasal bridge, deep orbital bones). Applying these protocols directly to Asian faces consistently creates three core problems:
- ✗ Injection plane too superficial — causes Tyndall effect— Asian periocular skin is thinner — superficial injection carries a high risk of Tyndall blue discoloration
- ✗ over-injection causing visible swelling— Asian orbital bones are flatter; doses calibrated for Caucasian anatomy can cause puffy rolled-eyelid swelling on Asian faces
- ✗ Overlooking mid-face integration— In Asian patients with a lower zygomatic arch, filling the tear trough alone does not address the underlying lack of structural support.
Our physician’s Fitzpatrick III–V Specialist Adjustments
| Parameters | North American standard | Asian-specific adjustments |
|---|---|---|
| Injection plane | Subcutaneous / mid-layer | Supraperiosteal |
| starting dose per side | 0.5–0.8 mL | 0.2–0.4 mL |
| Device | sharp needle | 25G–27G Blunt cannula |
| Filler selection | Standard Volbella | Volbella / Restylane Eyelight low cross-linking |
| Staged treatment principle | Completed in a single session | over 2–3 sessions, spaced 2–4 weeks apart |
6 tear trough treatment options — selected by subtype
There is no one-size-fits-all tear trough filler. We combine the appropriate fillers and therapies based on the supine tilt test, mid-face assessment, and skin thickness.
Juvederm Volbella XC
Vycross technology — low-cross-linked HA filler,Softness + low water absorption + natural tissue integration These three parameters are recognized globally as the gold standard for tear trough treatment. NMPA-registered; Our physician.
Restylane Eyelight(brightening filler)
NASHA technology; NMPA-registered specifically for periocular hollowing, with a firmer consistency,Suitable for targeted deep supraperiosteal placement. The Bright Eye Protocol is specifically designed for the Asian periocular area, where thinner skin tends to reveal a bluish translucency beneath the surface.
Belotero Balance
CPM technology — monophasic HA with excellent spreadability, suitable for the lid-cheek junction transition zone extending laterally from the tear trough— Used in combination with Volbella across different zones to ensure a smooth, natural transition without visible edges.
Skin booster injection (glutathione + polynucleotide)
Micro-droplet injections into the superficial dermis of the lower eyelid to thicken thin skin and reduce the visual blue translucency — used alongside filler for patients presenting with vascular dark circles in combination with tear trough hollowing.
Hyaluronidase (Hylenex)
Used for Revision of failed cases from other clinics: Dissolves over-injected or incorrectly placed prior filler, allowing 8–12 weeks before redesigning treatment. Also serves as the first-line emergency response for Tyndall effect.
Juvederm Voluma(mid-face support)
deep supraperiosteal injection at the zygomatic arch,Restore mid-face support first then address the tear trough — this is a critical preliminary step for patients over 35 with volume loss, and is frequently overlooked.
Considering filler? The filler pathway — product selection, injection technique, candidacy, timeline, pricing and risks — is covered in full on Tear Trough Filler Nanjing.
Why is Luowei Medical Aesthetics Clinic’s expertise in tear trough treatment trustworthy?
Experience
Expertise areas of expertise
Authoritativeness Expertise
Galderma Certified · Published Author
Trustworthiness trustworthy
All cases on this page are shared with written Media Release Form authorization · Clinical records available
Where the medical claims on this page come from
Everything above about tear trough rests on published evidence rather than on our own word. The sources below are the ones behind those statements: peer-reviewed papers indexed in PubMed, and guidance written for patients by dermatology academies and national health services. Read them before you decide — and bring any of them to your consultation.
- Peer-reviewedHyaluronic Acid Dermal Filler-Associated Vascular Occlusion-A Review of Prevention and Management Strategies
- Peer-reviewedHyaluronidase for Dermal Filler Complications: Review of Applications and Dosage Recommendations
- Patient guidanceDermal fillers: Overview
What these references can and cannot tell you. They describe what is known about the treatment itself — how well it tends to work, how long results last, and what can go wrong. They are not an assessment of this clinic, and no published study can tell you whether it suits your skin type, anatomy, or medical history. That judgement comes from the physician who examines you in person, and it may well be “not this one”.