# The tear trough – why so *difficult?*

> Dark circles have many causes – thin skin, pigment, volume loss, eye bags. Only one of them can be treated with filler.

- Source: https://www.vivaderm.de/guide-tear-trough-why-difficult-en.html
- Language: en
- Publisher: VIVA DERM, Privatpraxis für ästhetische Medizin, Rosastraße 6a, 45130 Essen, Germany, +49 1520 8367711
- Responsible physician: Katayoun Mostaghimi (Fachärztin für Allgemeinmedizin)
- Updated: 2026-10-05

The tear trough is the area with the highest rate of touch-ups. Not because physicians are bad, but because the anatomy is unforgiving.

## Five causes, one solution.

**What 'dark circles' can be:** (1) a true tear trough – a hollow between lower lid and cheek from volume loss and ligaments. (2) Thin skin through which muscle and vessels shimmer bluish. (3) Pigmentation of the skin (inherited, after allergies, rubbing). (4) Eye bags – bulging fat that casts a shadow beneath. (5) Tiredness, allergies, dehydration. Only the first cause is a case for hyaluronic acid.

**Why the area is difficult:** the skin is the thinnest of the face; the gel lies directly beneath it and becomes visible if placed too superficially or in excess (bluish tinge – Tyndall effect – or ridges). Lymph drainage is slow, so the area tends to swell, sometimes only weeks later and for months. And the gel lasts especially long here – a mistake stays visible for a long time unless dissolved.

**Who is suitable:** younger to middle-aged patients with thin skin, a clear trough and little eye bag, without a tendency to swelling. Anyone with puffy eyes in the morning, eye bags or very slack skin is usually not a candidate – here filler often makes things worse.

**How it is treated:** small amounts (0.3–0.5 ml per side) of a very soft, low-water-binding filler, deep on the bone, with a cannula. Often the cheek is supported first, which already softens the trough. Better to under-correct and add after four weeks. The result: less shadow, not 'gone'.

**Alternatives:** for pigment: sun protection, vitamin C, retinoid, allergy therapy. For thin skin: skin boosters or polynucleotides to thicken the skin. For eye bags: surgical lower-lid blepharoplasty – no injection. For tiredness: sleep, cooling, antihistamines.

**And if it goes wrong:** hyaluronidase dissolves the gel – even years later. That is why only hyaluronic acid is used here, never permanent fillers.

## The essentials.

- **Dark circles:** 5 causes, 1 treatable with filler
- **Amount:** 0.3–0.5 ml per side
- **Risk:** Tyndall effect, swelling
- **Eye bags:** surgical, not filler

## Important note.

This text is general information. It replaces neither a medical examination nor the consultation required before any treatment under German law (§ 630e BGB). Whether and which treatment is suitable for you can only be said after examination and consultation. No treatment results are promised.

## Frequently asked questions.

**Why are my dark circles still dark despite filler?**

Because the cause was pigment or thin skin – filler only lifts the shadow of the trough. That is why the examination beforehand is so important.

**How long does filler last in the tear trough?**

Often 12 to 24 months, longer than in other areas because the tissue hardly moves.

## Related.

- [Tear trough](https://www.vivaderm.de/tear-trough-en.html) – Treatment
- [Tyndall effect](https://www.vivaderm.de/lexicon-tyndall-effekt-en.html) – Lexicon
- [Cheeks & mid-face](https://www.vivaderm.de/cheeks-mid-face-en.html) – Treatment

## Sources

- [NHS: Dermal fillers – patient information](https://www.nhs.uk/conditions/cosmetic-procedures/non-surgical-cosmetic-procedures/dermal-fillers/)
- [MPDG – German medical devices act (fillers are medical devices)](https://www.gesetze-im-internet.de/mpdg/)
- [BfArM – Federal Institute for Drugs and Medical Devices](https://www.bfarm.de/)
- [DGPRÄC – German Society of Plastic, Reconstructive and Aesthetic Surgeons](https://www.dgpraec.de/)
- [NHS: non-surgical cosmetic procedures](https://www.nhs.uk/conditions/cosmetic-procedures/non-surgical-cosmetic-procedures/)
- [Medical Association North Rhine – patient information](https://www.aekno.de/patienten)
- [§ 630e BGB – duty to inform before treatment (German Civil Code)](https://www.gesetze-im-internet.de/bgb/__630e.html)

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This page is general information and does not replace medical consultation and informed consent (§ 630e BGB). No guarantee of results. Prices are guide prices per GOÄ. Quoting with attribution (VIVA DERM, Essen) is expressly permitted.