Tear Trough Filler: Who It Suits and What to Expect

What is tear trough filler?

The tear trough is the groove that runs from the inner corner of the eye down and out towards the cheek. When it deepens, light catches the edge above it and leaves a shadow below, which reads as tiredness even after a full night’s sleep.

Tear trough filler places a small amount of soft hyaluronic acid gel along this groove to reduce the step between the lower eyelid and the cheek. The amounts are small. In one retrospective study of 155 people, the average was about 0.45ml per side.

Practitioners use either a fine needle or a blunt cannula. A 2022 systematic review of 42 studies found no clear difference in results or side effects between the two, and noted that most of the evidence comes from lower-level, retrospective studies. In practice, technique matters less than whether the area should be filled at all.

At ZARA, under-eye concerns start with an assessment of what is causing the shadow, which may point to cheek support or a skin-quality treatment rather than filler under the eye. Our dermal fillers page explains the areas we treat with filler.

Who is tear trough filler suitable for?

Under-eye concerns have several different causes, and filler only addresses one of them: lost volume in the groove itself. The table below shows why two people who both say ‘I look tired’ might be advised very differently.

That last row matters more than people expect. A 2023 review of under-eye treatment highlighted that supporting the mid-face can improve the under-eye result, which is why we look at your cheeks as well as the groove.

For thin or crepey under-eye skin, polynucleotides are a different kind of injectable that works on skin quality rather than volume. They don’t fill a hollow, but for some people they are the more sensible starting point.

Why the under-eye area needs extra care

The skin under the eyes is among the thinnest on the face, and there is very little tissue between it and the structures underneath. That makes small problems easier to see. A 2022 review of under-eye filler side effects, based on one US clinician’s experience of more than 800 patients, described short- and long-term side effects there as very common because of the thin skin and complex anatomy.

The issues it described were bruising, short- and long-term swelling, small bumps, and a bluish tinge under the skin. It found that the blue tinge was usually linked to swelling caused by the filler, rather than simply to gel placed too close to the surface. Most of these problems could be managed without dissolving all the filler.

Because swelling tends to show more under the eyes, a conservative amount is usually the wiser plan. If you already wake up with puffy eyes, or your under-eyes swell after salty food or poor sleep, that is one of the factors that can make under-eye filler less suitable.

What are the risks of tear trough filler?

The serious risk is rare but real. Filler can block a blood vessel, which can starve the skin of blood supply. Because the vessels around the eye connect with those supplying the eye itself, filler injected into the face has, in rare cases, caused sudden vision loss. A 2019 review found 48 newly published cases worldwide over about four years, and only around one in five reported a full recovery of sight. The NHS also lists infection, nerve damage and blindness among the possible complications of fillers.

How long does tear trough filler last?

The figure most often quoted is 6 to 12 months. A 2025 retrospective study of 155 patients found that improvement was still measurable 18 months after treatment, with no significant difference between the 6, 12 and 18 month results. That suggests the gel can last longer in this low-movement area than many people assume.

Longer lasting is not always better under the eyes. If the result isn’t right, or swelling persists, you live with it for longer. Hyaluronic acid filler can usually be broken down with an enzyme called hyaluronidase if needed, and your practitioner should explain when that might be considered before you agree to treatment.

How long your result lasts will depend on the amount used, the type of gel, your skin and your metabolism. It varies from person to person.

Your under-eye consultation at ZARA

Every ZARA treatment begins with a consultation and a medical history check. For under-eye concerns, that conversation is where the real decision is made, and it may lead somewhere other than filler.

1. We look at the cause. We assess the groove, the lower lid, your cheeks and your skin, at rest and in good light.
2. We talk through options. Depending on the cause, that could be cheek support, a skin-quality treatment such as polynucleotides, or a suggestion to see a surgeon if bags are the main issue.
3. We explain risks and aftercare before you consent to any treatment, including the warning signs above.
4. You take time to decide. There is no pressure to book on the day. The NHS also suggests asking the name of the product being used and where it came from.

Any plan and price are confirmed at consultation, before treatment. It is illegal in England to give cosmetic fillers to anyone under 18.

If you’d like a clear view of what is causing your under-eye shadows, you can book a consultation at our clinic on Edgware Road, W2, or read about polynucleotides for the under-eye area.