Patient’s don’t always need the tear trough treated as well as the cheeks. The tear trough can be caused from volume loss of the fat pads that sit under the skin, as we age. Personally, I never treat the tear trough without injecting the cheeks first. This is because the volume loss of the fat pads start from the lateral face. Once we replace the lost volume in the lateral and mid face, the lid-cheek junction shortens and then replaces the volume back up, sometimes, completely correcting the tear trough. I also believe the anterior cheek should also be addressed before the tear trough, to also give the tear trough support.
Once the mid-face has been corrected and supported, then, if a tear trough is still visible, then we may add dermal filler directly into the tear trough. Keep in mind that it is natural to have some sort of tear trough – even babies have them! This is why I always only correct a tear trough to 80%, as over-filling this area makes people look puffy.
Also, if you have had anti-wrinkle injection to the crows feet, I would be careful of placing filler into the tear trough, as the lymphatic system runs right under where the tear trough is. The contraction of the obicularis oculi muscle acts like a pump from muscle contraction. If this muscle is blocked from anti-wrinkle injections and then filler is injected into the tear trough, you may sometimes accumulate fluid under the eyes, in the tear tough. I also never inject both at the same time, for this reason.
For a visual and more explanation of the fat pads depleting under the skin, causing the tear trough, please go to https://cityskin.com.au/dermal-fillers/under-eye-bags-tear-trough-treatment/