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Considering a Tear Trough Filler? Here’s What You Should Know

A dermal filler in your tear trough can potentially brighten your eyes. But is it the right option for you?

Woman applying concealer under her eyes to mask dark eye bags

The tear trough is the space below the eyes and the cheeks that can lose its volume and brightness over time, giving the appearance of under-eye bags or dark circles. The beauty industry has an entire line of products to combat this cosmetic concern. This is not surprising as we see the eyes as the most expressive part of a person’s face.

In conventional medical understanding, under-eye bags, dark circles, or wrinkles under the eyes aren’t deemed as a medical concern. However, these so-called imperfections can negatively affect the emotional health and psychological well-being of those who are bothered by the way they look. A few different cosmetic procedures can potentially combat deep and saggy tear troughs. Dermal fillers are one of the more popular of such cosmetic procedures. Read on to learn about benefits, risks, and alternatives. 

Different Types of Dermal Fillers for Saggy Tear Troughs

Closeup of hands wearing medical grade gloves injecting fillers into a woman’s tear trough area
Different types of tear trough fillers are injected into the tear trough to restore volume and tightness.

The more invasive cosmetic procedure to re-fill your tear trough is where the doctor takes your body fat through liposuction and injects it into the tear trough. As this is a much longer and more complicated procedure, those looking to brighten their eyes can consider dermal fillers. 

Dermal fillers are substances that can be injected into several sites along the tear trough to fill in the area and plump it up again. Different compounds are used as dermal fillers, with hyaluronic acid being one of the more popular options. Others that may also be used for tear troughs include calcium hydroxylapatite and poly-L-lactic acid.

The Results Are Immediate but Temporary 

Dermal fillers, especially hyaluronic acid fillers, are among the most non-invasive cosmetic options for sagging tear troughs. A trained and expert medical professional will clean and ice your tear troughs and inject the filler using prefilled syringes. Effects are immediate, and 95% of patients indicate feeling high satisfaction with the results. 

However, note that fillers are not permanent, lasting between six months to about two years, depending on the type and brand of filler used. The body eventually absorbs fillers. 

Fillers Are Not for Everyone  

It is important to work with a medical professional who is an expert in dermal fillers first to ensure what type of filler is right for you and whether you are a suitable candidate for the procedure. Note that those with the below conditions are contraindicated from undergoing dermal filler injections: 

  • History of immune disorders 
  • Known allergy to the filler material 
  • Have had other types of fillers injected 
  • Ongoing skin disorders 
  • Pregnant or breastfeeding 

Although Low, There Are Still Risks Associated with the Procedure  

Despite being low, the risks of severe side effects resulting from dermal filler procedures are not zero. One side effect is granuloma, which are small areas of inflammation that form around the injection sites.

Another possible side effect is vascular occlusion, when blood cannot pass through a blood vessel where the filler was injected. This results in structural changes and discolouration, leading to possible tissue death and blindness. 

If you do decide to get a dermal filler, you may want to consider a medical clinic or hospital rather than a spa. Healthcare professionals in medical settings are more likely to be required by law to have medical expertise. 

Alternatives to Dermal Fillers

Various Chinese herbs, potions, and acupuncture needles on a light grey background
Starting a holistic health and beauty regimen earlier in your adult life by incorporating herbs in your diet and using natural remedies can help maintain a youthful appearance and fight early ageing.

Instead of external cosmetic enhancements, you may want to consider a more natural approach to keeping under-eye bags at bay. We spoke with Real Medical Physician Kelvin Goh on the Traditional Chinese Medicine (TCM) point of view when choosing between tear trough fillers and a more natural approach. 

“TCM strongly believes in treating illness from the root cause. As fillers are not permanent and your body absorbs them within months, you’ll need to continuously inject fillers will to stay youthful. We believe in ageing gracefully by working on the body internally, targeting the root cause and slowing down the ageing process,” he reveals, an insight shared by many TCM practitioners. 

The TCM Perspective on Saggy and Hollow Tear Troughs 

In TCM, practitioners use the following framework of five “wheels” to diagnose disorders of the eyes: 

  • The wheel of flesh: Associated with the Spleen, which correlates to the flesh around the eyes 
  • The wheel of blood: Associated with the Heart, which correlates to the inner and outer canthus (corners) of the eyes where the upper and lower eyelids meet  
  • The wheel of qi: Associated with the Lungs, which correlates to the sclera (the white of the eye)  
  • The wheel of wind: Associated with the Liver, which correlates to the irises  
  • The wheel of water: Associated with the Kidneys, which correlate to the pupils  

Physician Goh shares that puffy, tired eyes with dark circles usually stem from a Spleen Dampness or Spleen Qi (life force) Deficiency through this framework. “The Spleen‘s main function is to transport and transform body fluids. Dampness in the Spleen causes it to lose these functions, leading to an accumulation of moisture within the body, causing the eye bags to look puffy and heavy,” he explains.

He also adds that the Spleen governs muscles and has an uplifting effect on our body. If the Spleen is experiencing Qi Deficiency, this will cause eye muscles to sag, speeding up ageing. 

Start early with TCM maintenance for overall health and beauty 

When asked what advice he would give for a youthful complexion, Physician Goh advises to start health and beauty maintenance and preservation as early as in your mid-twenties.

“Regular TCM maintenance will allow us to deter or repair the damages that we have done to our body via external factors like weather, stress, and internal factors like the ageing process,” he says. 

Use both internal and external TCM modalities 

TCM offers internal and external options for health and beauty maintenance. Herbal medicine and superfoods can be consumed for internal wellbeing while acupuncture involves external needles along meridian pathways to affect internal workings.

Some herbs for skin health are goji berries (gou qi, 枸杞), bird’s nest (yan wo, 燕窝), and snow fungus (yin er, 银耳). Meanwhile, you can also incorporate collagen peptides into your diet to help boost your collagen levels. 

In addition to acupuncture, an easy remedy you can try at home is facial gua sha. “Facial gua sha is a TCM facial treatment that uses a flat jade or porcelain tool over the face in an upward stroke to smoothen the fascia and relax the tired face muscles. This will promote tissue drainage,” Physician Goh explains. Benefits of gua sha massage include:  

  1. Clearer skin
  2. Reduced appearance of eye bags
  3. Facial muscle tension relief
  4. Improved skin elasticity

Dermal fillers can provide an immediate but temporary improvement in saggy tear troughs. On the other hand, natural alternatives and remedies have long-lasting effects. “By diagnosing, understanding, and working on your health, you can prolong the ageing process. Ageing gracefully is the key, as ageing is inevitable,” shares Physician Goh.


  1. Cleveland Clinic. 2022. Are Tear Trough Fillers Effective for Undereye Bags? [online] Available at: <https://health.clevelandclinic.org/is-tear-trough-filler-safe/> [Accessed 9 August 2022]
  2. Annals of Dermatology. 2018. Treatments of Infra-Orbital Dark Circles by Various Etiologies. [online] Available at: <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7992473/> [Accessed 9 August 2022]
  3. Johns Hopkins Medicine. Dermal Fillers. [online] Available at: <https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/dermal-fillers> [Accessed 9 August 2022]
  4. Journal of Cosmetic Dermatology. 2021. Recommendations for the treatment of tear trough deformity with cross‐linked hyaluronic acid filler. [online] Available at: <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7818415/> [Accessed 9 August 2022]
  5. ScienceofBeauty.net. 2021. Ask A Dermatologist: Do Gua Sha Facials Really Work? [online] Available at: <https://www.scienceofbeauty.net/ep19-does-gua-sha-really-work/> [Accessed 23 July 2022]
  6. The Journal of Clinical and Aesthetic Dermatology. 2014. Improvement of Tear Trough by Monophasic Hyaluronic Acid and Calcium Hydroxylapatite. [online] Available at: <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4217290/> [Accessed 9 August 2022]
  7. Plastic and Aesthetic Research Journal. 2020. Complications after cosmetic periocular filler: prevention and management. [online] Available at: <https://parjournal.net/article/view/3605> [Accessed 9 August 2022]

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