Many patients commonly complain of noticing dark shadows, or ‘tear troughs’, under their eyes as they start to age, or that people may comment that they are ‘looking tired’. These changes usually result from the early signs of ageing and early mid-face descent.

As the cheek tissues descend from their junction with the lower lid and orbital margin a small ‘groove’ can appear between the lower lid and the upper cheek tissues, often known as a tear trough. 

Treatment with filler is a common method to address this problem, but this is a complex area – the skin is very thin and treatment should, therefore, be approached with great care. Inappropriate treatment can result in visible irregularities, and over-treatment with visible swelling in the lower lid area.

Only the thinnest form of temporary hyaluronic acid filler should be used, in small volumes, directly onto the underlying bone. This is usually performed over one to two sessions as the contours are carefully corrected.

Some patients may also undergo treatment with a thicker form of filler to the adjacent cheek to improve the appearance of the whole lower lid / cheek area and optimise these contours.