Tear trough hollows
A tear trough is the groove between the lower eyelid and upper cheek. A visible hollow can create shadow and a tired appearance even without dark pigment. It may be inherited or become more prominent as facial fat, bone and supporting tissues change with age.
What you may notice
- A curved hollow from the inner eye towards the cheek
- Shadow that changes with lighting
- Contrast between a hollow and a lower-lid bag
- Greater visibility on one side
- Thin skin or visible vessels nearby
Why it can happen
The appearance reflects the lid-cheek anatomy, including bone shape, retaining ligaments, fat compartments and skin thickness. Age-related volume loss or descent can deepen the groove. Pigmentation, visible vessels and oedema may coexist but are separate contributors.
What may help
Skincare cannot replace structural volume, although sun protection helps preserve skin quality. Carefully placed hyaluronic acid filler or fat transfer may soften selected hollows, while lower-eyelid surgery with fat repositioning may suit more substantial bags or laxity. Filler in this area can cause persistent swelling, contour irregularity and rare vascular complications, including skin injury and vision loss, so not every hollow is suitable. Anatomy and eyelid support should guide the choice.
When to consult
Consult an appropriately trained clinician if the hollow is a persistent concern. New one-sided hollowing, swelling, pain or eye symptoms should be medically assessed rather than treated as routine ageing. Vision changes, unusual severe pain or pale, grey or blue skin during or after filler require immediate medical care.
Evidence and sources
- DermNet. Dark circles under the eyes [Internet]. Auckland: DermNet New Zealand Trust; 2015 [cited 2026 Nov 7]. Available from: https://dermnetnz.org/topics/dark-circles-under-the-eyes (new tab)
- DermNet. Facial lines and wrinkles [Internet]. Auckland: DermNet New Zealand Trust; 2004 [cited 2026 Nov 7]. Available from: https://dermnetnz.org/topics/facial-lines-and-wrinkles (new tab)
- National Health Service. Eyelid problems [Internet]. London: NHS; 2023 [cited 2026 Nov 7]. Available from: https://www.nhs.uk/symptoms/eyelid-problems/ (new tab)
- American Society of Plastic Surgeons. Eyelid surgery [Internet]. Arlington Heights (IL): American Society of Plastic Surgeons; [cited 2026 Nov 7]. Available from: https://www.plasticsurgery.org/cosmetic-procedures/eyelid-surgery (new tab)
- US Food and Drug Administration. Dermal fillers (soft tissue fillers) [Internet]. Silver Spring (MD): FDA; [cited 2026 Nov 7]. Available from: https://www.fda.gov/medical-devices/aesthetic-cosmetic-devices/dermal-fillers-soft-tissue-fillers (new tab)