Tear-Trough Filler: Who Is — and Isn't — a Candidate

Why tear-trough is hard

Thin skin (~0.5 mm), superficial vessels, weak lymphatic drainage, anatomically demanding.

Good candidate

Mild-to-moderate volume loss + normal-thickness skin + non-herniated fat + no festoon. Age 30–55 typical. Expects 50–70% improvement, not perfection.

Poor candidate (alternatives recommended)

Festoon → surgical blepharoplasty. Very thin skin → midface filler + skin quality. Pigmented dark circles → laser. Visible fat herniation → midface first.

Technique

Microcannula, deep (supraperiosteal), low G-prime HA, small volume (0.2–0.5 ml/side), fractional sessions.

Complications

Tyndall (mid-blue) → reverse w/ hyaluronidase. Excess swelling, asymmetry, vascular events (rare with cannula).

Reversible

HA filler dissolvable with hyaluronidase — "safe to try" but still patient-selected.

Midface alternative

Often the real cause is midface volume loss; cheek filler can resolve tear-trough without direct injection.

Bottom line

Excellent in good candidates, problematic in poor ones. Selection is everything.