It is important to note that not all patients require treatment for both the tear trough and cheeks. The tear trough can be attributed to the natural loss of volume in the underlying fat pads as we age. Therefore, at Cityskin, we prioritise treating the cheeks first to restore volume and support in the lateral and mid-face areas. By replenishing the lost volume in these regions, we often observe a significant improvement in the tear trough area, sometimes even complete correction. Additionally, we believe the anterior cheek should also be addressed before the tear trough, to provide support for the tear trough region.

After correcting and supporting the mid-face, if a visible tear trough persists, we may consider adding dermal filler directly into the tear trough. It is essential to maintain a balanced approach, ensuring that we correct the tear trough to a suitable degree, typically around 80%. Overfilling this area can result in a puffy appearance, which is not desired.

It is important to exercise caution when considering tear trough treatment in combination with anti-wrinkle injections to the crow’s feet area. The orbicularis oculi muscle, responsible for muscle contraction, runs beneath the tear trough region, acting as a pump for the lymphatic system. If this muscle is affected by anti-wrinkle injections, and filler is subsequently injected into the tear trough, there is a risk of fluid accumulation under the eyes. To minimise this risk, we do not administer both treatments simultaneously.

For a visual and more explanation of the fat pads depleting under the skin, causing the tear trough, please go to

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