Published 10 October 2026 · Reviewed by Dr Sin Yong
The tear trough is the groove that runs from the inner corner of the eye downward and outward along the junction of the lower eyelid and the cheek. It is tethered by a ligament, the tear trough ligament, which is why it shows as a shadow even when there is no loss of volume. It tends to deepen with age as the fat and bone around it change.
Key facts
Where
From the inner corner of the eye, down and out along the lid–cheek junction
Why it shows
A ligament tethers the skin to the bone (Wong 2012)
The skin over the tear trough is among the thinnest on the face, so filler placed too superficially can show as a lump or a bluish tint (the Tyndall effect), and filler placed above the malar septum can hold fluid (malar oedema). In one large series of 1,452 tear trough treatments, contour irregularity was reported in 4.6% and the Tyndall effect in 3.3% (Wilde, PRS Global Open 2023).
The tear trough is not a patch of dark skin. It is a groove in the surface contour that begins at the medial canthus and runs downward and outward along the bony rim of the eye socket. Dissection work by Wong, Hsieh and Mendelson identified a true ligament, the tear trough ligament, that tethers skin and orbicularis oculi muscle to the bone along the medial part of this line; further out, the orbicularis retaining ligament continues the tethering laterally.
Because the skin is held down along the ligament while the cheek tissue below it descends and the orbital fat above it bulges forward, a step forms. Light from above misses the groove, so the groove reads as a shadow. Thinning of the fat pads either side of the ligament deepens the step over time, even without any pigmentation.
Under eye filler places a small quantity of soft hyaluronic acid gel on the bone beneath that groove. It does not move the ligament. It raises the floor of the trough so that the step is shallower and the shadow it casts is smaller. That is the entire mechanism, and it explains everything filler cannot do.
“The tear trough is the least forgiving place on the face for filler. Less is not a style choice there; it is the technique.”
Dr Sin Yongon tear trough
Related Full guide: tear trough filler Singapore — who it suits, how it is placed on the bone by cannula, and how problems are imaged and reversed.
Frequently Asked Questions
A ligament that tethers the skin to the bone, combined with age-related changes in fat, bone and skin. Genetics play a large part, which is why some young people have visible tear troughs.
No. Depending on the cause, energy-based tightening, skin treatments or surgery may suit better. Puffy lower lids and fat bags often do not suit filler.
References
Wong CH, Hsieh MKH, Mendelson B. The tear trough ligament: anatomical basis for the tear trough deformity. Plast Reconstr Surg. 2012;129(6):1392-1402. doi:10.1097/PRS.0b013e31824ecd77. source
Haddock NT, Saadeh PB, Boutros S, Thorne CH. The tear trough and lid/cheek junction: anatomy and implications for surgical correction. Plast Reconstr Surg. 2009;123(4):1332-1340. doi:10.1097/PRS.0b013e31819f2b36. source
Wilde CL, Gupta A, Lee S, Ezra DG. Tear trough filler using the three-point tangent technique: lessons from 1452 tear trough applications. Plast Reconstr Surg Glob Open. 2023;11:e5060. doi:10.1097/GOX.0000000000005060. source
