Tear trough filler

Not all dark circles are the same

Three different things produce the same tired look, and only one responds to filler:

• Hollow tear trough. There is a real depression between the lid and the cheek. This one is the filler indication.
• Pigmented dark circle. The skin is darker, with no hollow. Filler lightens nothing; it can even make the colour more obvious by reflecting light differently.
• Dark circle from fat herniation. There is protrusion of orbital fat. Filling under a bag increases the total volume of the area and makes it heavier. Here the solution is usually surgical.

Mixed pictures are common, and there filler improves one part and leaves the rest. Saying so beforehand is the difference between a satisfied patient and one who feels misled.

Why it is the highest-risk area

The tear trough is crossed by the angular artery, a branch of the facial artery, which connects with the ophthalmic circulation. That is the anatomical reason the visual complications described with fillers concentrate in this area and in the nose and glabella.

Hence three conditions that are not negotiable here:

• Hyaluronic acid and only hyaluronic acid, fluid and with low water affinity. No Radiesse, no biostimulators.
• Hyaluronidase available in the clinic, that same day.
• Small volumes. Here you work in tenths of a millilitre, and always conservatively: it is easier to add at a review than to correct an excess.

The other typical problem in this area is not vascular but product-related: a gel with high water affinity holds fluid under very thin skin and leaves a permanently puffy bag. It is the cause of the «my eyes ended up swollen» you read in forums, and it is resolved by dissolving it.

What it costs

Filler is not quoted by «area» but by product and volume, and for a reason worth understanding before you compare: two people with the same complaint can need 1 ml and 4 ml. A closed per-area price that does not say how many millilitres it includes cannot be compared with anything — the same problem as botox units.

How it works here:

• The consultation is free and is not charged in advance. You are assessed, told which product, how much volume and the total, and you decide then.
• The quote is given in writing with the brand, the batch number and the millilitres before anything is applied. That document is what makes comparison possible.
• You pay for what is applied. If your case needs less volume than expected, you pay less.

Payment: cash, debit card and credit card, with the option to split into instalments at the terminal under your own bank plan.

Frequently asked questions