The tear trough (tear trough deformity) is a groove on the nasal side of the lower eyelid — extending from the inner corner of the eye outward and downward along the infraorbital rim, forming an arc-shaped depression. Tear trough hollows are one of the most common facial features that make a person look tired — even with adequate sleep and energy, the shadow of the tear trough creates a fatigued, aged appearance. The causes are multifactorial: (1) Anatomical structure — orbital fat pad atrophy and inferior shift with age, weakened bony support at the infraorbital rim, creating a depression step at the rim. (2) Skin laxity — lower eyelid skin thins and sags with age, worsening the visual depression. (3) Ligament traction — the tear trough ligament anchors skin to bone, and as surrounding tissue atrophies, a visible depression forms at this attachment. (4) Shadow effect — the tear trough depression creates shadows under lighting, visually appearing as dark circles even without actual pigmentation. Rappoel Dermatology near Gangnam Station, Seoul, uses premium small-molecule cross-linked HA to precisely fill tear troughs — non-surgical instant hollow elimination and shadow-type dark circle improvement, restoring a youthful, bright periorbital area.
Technical Advantages of HA Tear Trough Filler
- Small-molecule soft HA for thin periorbital skin: The periorbital skin is the thinnest on the face — large-molecule hard HA would create cord-like lumps or unnatural protrusions. Rappoel uses small-molecule low-cross-linking soft HA (such as Restylane Silk, Juvederm Volbella) — with high gel softness and excellent spreadability, blending naturally with surrounding tissue for smooth visual and tactile results
- Cannula injection eliminates vascular risk: The periorbital area has rich vascularity connected to the ophthalmic artery system — sharp needle injection carries devastating risks of embolism and even blindness. Rappoel uses 25G-27G cannulas exclusively — the rounded tip cannot puncture vessel walls, advancing safely in the supraperiosteal plane, dramatically reducing embolism risk
- Supraperiosteal deep injection avoids Tyndall effect: If transparent HA is injected in the superficial dermis, blue-purple translucency may show through the thin skin (Tyndall effect). Rappoel injects HA into the supraperiosteal plane at the infraorbital rim — deep injection prevents translucency and creates a smooth support layer on bone
- Instantly visible and adjustable: HA injection shows immediate hollow elimination — physician and patient confirm results on the spot and make micro-adjustments. If unsatisfied, hyaluronidase can dissolve and redo
- No recovery, no scarring: Cannula injection leaves only pinhead-sized entry points that close within 1-2 days, with no scarring or recovery period
Filling Strategies for Different Tear Trough Types
- Pure tear trough hollow: Good lower eyelid skin condition (no significant laxity), only depression at the tear trough ligament. Strategy: inject small-molecule HA supraperiosteally (0.3-0.5ml/side) to precisely fill the depression, creating a smooth transition from infraorbital rim to cheek
- Tear trough + eye bags: Both tear trough depression and orbital fat protrusion (bags). Strategy: fill the tear trough depression with HA (0.3-0.5ml/side) to level the height difference, visually camouflaging the protruding bags. If bags are severe, consider surgical bag removal before filler
- Tear trough + dark circles: Shadow-type dark circles caused by tear trough depression. Strategy: filling the hollow eliminates the depression, and shadows naturally disappear — the most effective treatment for shadow-type dark circles. For pigment-type dark circles (actual skin pigmentation), filler cannot address the pigment and requires combined laser treatment
- Tear trough + mid-face atrophy: Tear trough depression accompanied by mid-face (cheek/apple zone) volume loss and descent. Strategy: layered filling — first inject large-molecule HA supraperiosteally in the cheek area (0.5-1ml/side) to elevate the mid-face, then inject small-molecule HA at the tear trough (0.3ml/side) to fill the depression, restoring the smooth transition from under-eye to cheek
- Young-type tear trough (congenital): Young patient with naturally prominent tear troughs due to skeletal structure. Strategy: small-volume precise filling (0.2-0.3ml/side), focusing on the deepest point, avoiding over-filling
Rappoel Tear Trough Filler Treatment Protocol
- Periorbital assessment and plan design (10 min): Frontal and side evaluation of tear trough depth, lower eyelid skin laxity, eye bag presence → gentle finger pressure to assess depression depth → evaluate mid-face atrophy → determine dark circle type (shadow vs pigment) → establish filling plan (volume, depth, whether to combine mid-face filling)
- Disinfection and anesthesia (5 min): Facial cleansing → povidone-iodine periorbital preparation → small-molecule HA products often contain lidocaine, or topical lidocaine cream applied
- Cannula deep injection (8-10 min): 27G cannula entry from the cheek side → cannula advances safely in the supraperiosteal plane at the infraorbital rim → retrograde fan-shaped injection of small-molecule HA → precise filling of the tear trough depression → 0.3-0.5ml per side → gentle compression for smooth shaping
- Immediate assessment and micro-adjustment (5 min): Patient sits up for frontal view → confirm tear trough elimination and smooth transition → micro-adjust if slight asymmetry → before/after photography
- Post-care instructions (3 min): Precautions (avoid eye rubbing for 1 week, avoid lying flat for 4 hours, ice for swelling, avoid contact lenses for 24 hours) → 2-week follow-up
The entire tear trough filler procedure takes about 20-25 minutes, with immediate hollow elimination and shadow-type dark circle improvement, lasting 9-12 months. Located 3 minutes from Gangnam Station Exit 10, with seamless English and Chinese consultation.
Frequently Asked Questions
How long does tear trough HA filler last? Do I need regular touch-ups?
Tear trough HA lasts an average of 9-12 months — the periorbital area has frequent movement (blinking, expressions) that accelerates metabolism. Factors: (1) HA type — small-molecule soft products may last slightly shorter than large-molecule. (2) Injection depth — supraperiosteal deep injection lasts longer than superficial. (3) Individual metabolic rate — younger patients metabolize faster, slightly shorter duration. Rappoel recommends: 9-12 month follow-up after initial treatment; if results diminished significantly, touch-up (typically 1/2 of initial volume). Regular touch-ups can extend overall duration.
Will tear trough filler turn into eye bags?
No — tear trough filler and eye bags are different concepts. Tear troughs are under-eye depressions; eye bags are fat protrusions. Proper tear trough filling does not create bags — it actually visually camouflages existing bags by leveling the height difference, making the under-eye area smooth rather than uneven. However, precautions: (1) Avoid over-filling — exceeding 0.8ml per side may cause under-eye over-fullness resembling bags. (2) Correct injection depth is essential — supraperiosteal deep injection ensures HA supports in the right place; incorrect superficial injection may create cord-like lumps. Rappoel uses cannula supraperiosteal injection for precise filling.
Is there blindness risk from tear trough filler? Is it safe?
Periorbital injection does carry vascular embolism risk — ocular vessels connect to the ophthalmic artery and even cerebral arteries, and if HA enters a vessel, it could potentially cause blindness (extremely rare but devastating). Rappoel safety measures: (1) Cannula-only — 27G rounded-tip cannula cannot puncture vessel walls. (2) Supraperiosteal deep injection — few vessels at this depth, much safer than superficial injection. (3) Slow, low-pressure injection — avoid forcing HA into vessels. (4) Pre-injection aspiration to confirm not intravascular. Under strict safety protocols, embolism risk is extremely low. Rappoel has never had a vascular embolism complication.
Can tear trough filler fix dark circles? Which type responds?
Tear trough filler is most effective for shadow-type dark circles — these are shadows caused by the tear trough depression under lighting, appearing as dark under-eyes but without actual pigmentation. Filling the hollow eliminates the depression, and shadows naturally disappear, with significant visual improvement. However, distinguish dark circle types: (1) Shadow type (depression-induced) — HA filler is most effective, can improve 80-100%. (2) Pigment type (actual skin pigmentation) — filler is ineffective, requires laser or brightening treatments. (3) Vascular type (visible vessels through thin skin) — filler can partially improve by adding tissue thickness over vessels, but results are limited. Rappoel physicians assess the dark circle type before recommending a plan.
Which is better: tear trough filler or eye bag surgery?
Depends on the specific situation: (1) Pure tear trough depression without eye bags — HA filler is the first choice: no surgical incision, no recovery, instant results. 15-20 minutes, lasting 9-12 months. (2) Mild eye bags + tear trough — fill the trough first to visually camouflage the bags; if satisfied, surgery may be unnecessary. (3) Severe eye bags + tear trough — surgical bag removal with simultaneous tear trough ligament release is recommended for a one-time solution. HA filler can still be used for fine adjustment after surgery. Rappoel recommends: try HA filler first — if satisfied, continue maintenance; if HA is insufficient (severe bags), then consider surgery. HA filling is also the best way to simulate surgical results.
Tear trough hollows making you look tired? Rappoel HA tear trough filler — 15 minutes for youthful, bright eyes!
📍 77, Seocho-daero, Seocho-gu, Seoul, South Korea
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