Dermal Fillers
Looking to rejuvenate your appearance but keep a natural and authentic image? At Health & Aesthetics, we are proud to offer premium quality dermal filler treatments that can subtly yet effectively refresh your look.
Hollow Eyes & Tear Troughs
If you’ve ever looked in the mirror after a good night’s sleep and still seen shadows under your eyes, you’ll know that hollow eyes have very little to do with how tired you actually are. I see this misunderstanding in clinic every week. Patients tell me they’ve tried every eye cream and every extra hour in bed going, and nothing shifts the darkness. That’s because in most cases, tiredness isn’t the cause at all. Structure is.
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What causes Hollow Eyes?
The tear trough is the groove that runs from the inner corner of your eye down towards your cheek. When it’s well supported, the skin sits flush against the bone and you get a smooth transition from lower lid to cheek. When it isn’t, you get a visible dip, and that dip casts a shadow. It’s simple physics, not fatigue.
There are three things I look for at consultation, because the cause changes the treatment:
Genetics. Some people are simply built this way. Thin skin, a naturally deep bony orbit, or minimal fat padding under the eye can mean hollow eyes are visible from your twenties, sometimes even in childhood photos. I have patients in their late twenties who’ve had this look their entire lives and assumed nothing could be done. Quite a lot can be.
Volume loss with age. As we get older, we lose fat and bone from the face, and the eye socket itself actually enlarges. The fat pad that used to cushion the lower lid drops and thins, and the cheek beneath it loses support too. The result is a hollow that appears gradually, usually from the mid-thirties onwards, and gets more noticeable each year.
Pigmentation. The skin under the eye is thinner than almost anywhere else on the face, so blood vessels sitting close to the surface show through more easily, giving a bluish or brownish tinge. This is often layered on top of a structural hollow, which is why some tear troughs look dark as well as sunken.
Most of the patients I see have a combination of all three, which is exactly why a proper consultation matters more here than almost anywhere else on the face.
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Why this area needs a genuinely experienced hand
I’ll be blunt about this one. The tear trough is, in my view, the single riskiest area to treat with filler on the whole face. The skin is thin, the tissue plane is unforgiving, and there’s a real artery running close by. Get the technique wrong and you can end up with lumps, a blue-grey discolouration under the skin called the Tyndall effect, or in rare but serious cases, vascular compromise. This isn’t an area for a quick top-up between other treatments, and it certainly isn’t one for a practitioner without significant injecting experience specifically in this zone.
I say this not to alarm anyone but because I think patients deserve honesty. When it’s done well, tear trough filler is one of the most transformative treatments I offer. When it’s done poorly, it’s one of the hardest to put right.
Treatment options
Dermal fillers
This remains the gold standard for restoring lost volume in the tear trough. A very soft, low-viscosity hyaluronic acid filler is placed carefully beneath the muscle, close to the bone, to cushion the area and smooth the transition between lid and cheek. I use only products I trust completely for this area, including Teoxane, Revanesse and Radiesse, chosen depending on the individual’s anatomy and skin thickness.
Results are visible immediately, though final settling takes a couple of weeks as any swelling resolves. Most patients need a top-up at nine to twelve months, though this varies from person to person.
Polynucleotides
For patients whose main concern is skin quality and fine crepiness rather than significant volume loss, polynucleotides are a lovely option. They work by stimulating your own fibroblasts to improve skin thickness, hydration and elasticity over a course of sessions. I often use these alongside filler, or on their own for younger patients who have some darkness and thin skin but not yet the structural hollow that needs volumising.
Combination approaches
In many cases, the best result comes from combining filler for structure with a skin quality treatment for the surface. There’s no single answer that suits everyone, which is exactly why we don’t offer a one-size-fits-all package for this area.
What to expect from your consultation
I spend real time assessing this area before I recommend anything, looking at your skin thickness, the depth of the hollow, your bone structure and how your face moves when you smile. Some patients need very little product and see a dramatic change. Others have expectations that filler alone can’t meet, usually because the main issue is loose skin or excess fat rather than a lack of volume, and I’ll tell you honestly if that’s the case rather than treating regardless.
Addressing the Signs Of Ageing With Dermal Fillers
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