Tear trough filler is a hyaluronic-acid treatment that softens the hollow under the eye. When the right candidate has the right amount of product placed by an experienced practitioner, the result is among the most life-changing in aesthetics. The face looks rested, the dark circles become less visible, and the overall appearance shifts noticeably. When the wrong candidate has it, or when the product is placed badly, the result ranges from disappointing to seriously concerning.
I am Cristina Pardo, an NMC-registered aesthetic nurse practitioner in Norwich. Tear trough filler is one of the most common requests I receive, and a meaningful proportion of clients I assess turn out to be poor candidates. This post explains the honest assessment process: who suits it, who does not, and why polynucleotides are often a better answer.
What the tear trough actually is
The tear trough is the natural groove that runs from the inner corner of the eye downward and outward. Almost everyone has one. The visibility of the groove depends on volume in the under-eye area, the strength of the orbital ligaments, and the colour of the skin sitting over the underlying structures.
What clients usually want treated is one of three things: the groove itself (true tear trough hollowing), the dark colour visible through thin skin (vascular pigmentation), or puffiness of the under-eye fat pads (orbital fat herniation). Filler addresses only the first of those three. Confusing the three is the most common reason for poor outcomes.
An honest assessment involves looking carefully at which of the three problems is dominant in your specific face. Most clients have some combination of all three.
Who is a good candidate for tear trough filler
Clients with genuine volume loss in the under-eye area, where the skin still has reasonable elasticity, and where the dominant visible problem is the depth of the groove rather than the colour of the skin.
Clients who have not had filler in the area before, or who have had it and want a refresh of the same plane.
Clients in their 30s to early 50s. Younger clients usually do not have true volume loss and are seeing pigmentation or anatomical features. Older clients usually have skin laxity that makes filler look uneven.
Clients with no underlying medical issues affecting the eye area: no dry eye, no recent eye surgery, no thyroid issues that affect the under-eye, no current allergic conjunctivitis.
Who is not a good candidate
Clients with significant under-eye fat pad herniation (puffy bags). Filler here makes the puffiness worse, not better. The honest answer for this client is usually surgical (lower blepharoplasty) or nothing.
Clients with very thin, very pigmented under-eye skin where the darkness comes from blood vessels showing through. Filler does not change the colour. It can sometimes make the area look worse by lifting the discoloured skin closer to the surface.
Clients with skin laxity in the under-eye. Filler tends to settle unevenly in lax skin and creates visible bumps or shadows.
Clients with active eye conditions or recent eye surgery.
Clients who have had aggressive filler in the past that has caused build-up. These clients usually need dissolving with hyaluronidase first, and a fresh assessment afterwards.
Why polynucleotides are often the better answer
Polynucleotides regenerate the skin in the under-eye without adding volume to a high-risk area. They improve skin quality, increase collagen, and reduce the visibility of dark circles caused by thin skin and vascular pigmentation.
Many clients who come to me asking for tear trough filler actually need polynucleotides instead. The assessment is clear: if the dominant problem is colour and texture rather than depth, polynucleotides are safer, last longer, and give a better long-term result.
Polynucleotides can also be used alongside tear trough filler. Filler addresses the volume component, polynucleotides address the skin quality. The combination is increasingly common at the better Norwich practices.
How a tear trough filler appointment actually runs
Free video consultation first. We look carefully at the under-eye on camera, talk through which of the three problems is dominant, and discuss whether filler or polynucleotides is the right answer.
If filler is appropriate, the in-person appointment takes around 60 minutes. Detailed numbing, careful marking, and very slow placement of small amounts of product using a cannula. The cannula technique is important in this area to reduce the risk of vascular complications.
Most clients use 0.5ml to 1ml total across both sides. More than 1ml is rarely appropriate in a first treatment.
Bruising is more common in the tear trough area than elsewhere on the face. Most clients see some bruising for 7 to 10 days. This is normal and resolves fully.
Result settles by day 14. Photo review at 2 weeks. Follow-up at 4 weeks to assess whether any small refinement is needed.
Frequently Asked Questions
When delivered by an experienced practitioner using cannula technique in the appropriate plane, yes. The risk of vascular complications is higher in this area than elsewhere on the face, which is why technique and practitioner choice matter so much.
12 to 18 months for most clients. The under-eye area moves relatively little, so filler holds well. Some clients see longer durations on subsequent treatments.
Partially, if the dark circles are caused by shadowing from volume loss. Not at all if they are caused by pigmentation or vascular show-through. The honest assessment matters here.
Depends on what is causing the appearance. If the dominant problem is the groove, filler. If the dominant problem is colour and texture, polynucleotides. Many clients benefit from a combination.
Filler does not fix under-eye bags. It often makes them more visible. The honest answer for this client is usually either polynucleotides for skin quality, or a referral to a surgeon if the bags are significant.
At Pardo Medical Aesthetics, £330 per ml during the launch offer (regular £350). Mobile within the 15-mile zone, no travel charge.
Related treatments at Pardo Medical Aesthetics
Written by Cristina Pardo, NMC-registered aesthetic nurse practitioner at Pardo Medical Aesthetics. Mobile aesthetics across Norwich and Norfolk. Read more at Save Face guidance on tear trough filler for further reading.
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