Tear Trough Fillers: Hyaluronic Acid vs. Fat Grafting — Which Is Better? Can It Really Cause Blindness?

The tear trough is the groove that starts from the inner corner of your eye and runs down toward the cheek. Prominent tear troughs can make you look tired, older, and dull. They often appear together with eye bags, wrinkles, and dark circles — instantly aging your whole face.

Filling the tear trough is one popular treatment option, but there are different types of fillers, each with its own risks and side effects. So what should you watch out for before getting the procedure? Is it safe? Can it be prevented? This article breaks it all down.

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What Exactly Is the Tear Trough?

The tear trough is a natural ligament that runs beneath your eyes, extending from the inner corners to the sides of your nose — and for some people, even as far as under the outer corners, creating what’s called “Indian lines.” Everyone has tear troughs, but the skin in this area is especially thin. As we age or neglect our health (e.g., lack of sleep or eye strain), the tissue here — like collagen, fat, and muscle — weakens and shrinks, making tear troughs more visible.

When tear troughs deepen, they can even create the illusion of dark circles, making you look fatigued and older than you are. Mild cases can be concealed with makeup, but more pronounced grooves may benefit from filler treatments, which plump up the area and help restore a youthful, energized appearance.

The most common tear trough fillers include hyaluronic acid (HA), autologous fat (from your own body), and collagen-stimulating injectables — each with unique pros and cons based on your skin condition and your doctor’s recommendation.

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Tear Troughs vs. Eye Bags vs. Aegyo Sal — What’s the Difference?

They’re all under your eyes, but they’re not the same. Here’s how to tell them apart:

1. Aegyo Sal (Cute Eye Fat)

This is the small, puffy area right under your lower lash line — caused by the orbicularis oculi muscle. When you smile or make facial expressions, this muscle contracts, making the puff more visible. It gives your eyes a sweet, approachable look — hence the nickname “charming fat.”

2. Eye Bags

These are protrusions under the eyes caused by fat and fluid accumulation. They become more pronounced with age as the muscles and tissues weaken and sag. Unlike tear troughs (which are sunken), eye bags puff outward. They give the face a tired, swollen look, especially when your face is relaxed.

3. Tear Troughs

These are the hollow curves running from the inner corner of the eye downward. When both eye bags and tear troughs are present, they often sit right next to each other — bags puffing out and grooves dipping in. The contrast emphasizes fatigue and aging. Dermal fillers can help smooth and lift this sunken area.

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What Causes Tear Troughs?

1. Aging

As we age, we lose collagen and fat — the structures that keep skin firm and youthful. Skin starts to sag, and facial contours become less defined. Changes in fat and muscle distribution around the eyes can deepen the appearance of tear troughs.

2. Lack of Sleep

Chronic sleep deprivation reduces skin circulation, making your skin dry, dull, and prone to sagging. Puffy eyes and dark circles become more prominent, which in turn exaggerates the tear trough. Prioritize good sleep habits to prevent premature eye aging.

3. Eye Strain

Excessive screen time, long drives, poor lighting, or uncorrected vision issues all strain your eye muscles. This tension accelerates skin fatigue and loss of elasticity, worsening tear troughs over time.

4. Environmental and Lifestyle Factors

Polluted environments with dust and wind can irritate your eyes, making you rub them more often. This constant friction stretches the delicate eye skin, speeding up sagging and groove formation. Smoking and heavy drinking can also damage skin and accelerate aging.

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Types of Tear Trough Fillers: Pros & Cons

1. Hyaluronic Acid (HA) Fillers

HA is a natural substance in the body and is commonly used in dermal fillers. It adds moisture and volume to sunken areas like tear troughs. While the effects are visible immediately, dosage is critical — too much or too large a molecule can lead to poor absorption or even Tyndall effect, a bluish tint under the skin from light scattering.

In some cases, low-quality HA products may result in a visible blue line (known as “tear trough worms”) or even small lumps. Worse yet, poorly administered fillers can lead to serious complications — including the risk of blindness if injected into the wrong blood vessels.

2. Autologous Fat Grafting

Fat is harvested from your own body (usually from the eye area, thighs, or waist), purified, and then reinjected into the tear trough. Since it's your own tissue, there’s little risk of rejection. This method offers longer-lasting results than HA and fewer allergic reactions.

However, it requires a longer recovery period and carries the risk of uneven fat distribution. If not done skillfully, it may even create bulges that worsen the look of under-eye bags.

3. Collagen-Stimulating Injections (e.g., "Baby Face Injections")

These contain polycaprolactone (PCL) and carboxymethyl cellulose (CMC), which stimulate collagen production and support the skin’s structure. The goal is to restore elasticity and smooth out the hollows naturally over time.

The treatment is minimally invasive and doesn’t require anesthesia. However, it’s important to confirm the authenticity and quality of the product to avoid complications or poor results.

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Risks & Side Effects of Tear Trough Fillers

1. Allergic Reactions

Some people may experience redness, swelling, or itching due to sensitivity to HA or other filler substances.

2. Poor Aesthetic Results

Unskilled injection techniques or incorrect filler dosage can lead to lumpy, uneven results, overly pronounced troughs, or even enhanced eye bags — the opposite of the intended effect.

3. Long Downtime

HA fillers typically require about 7 days of recovery. Results last 6 to 18 months, which means touch-ups are necessary. For some, this ongoing maintenance can be inconvenient and costly.

4. Uneven Texture

With fat grafting, if the fat is not evenly processed or injected, it may create irregular textures. Fat cells also have a lower survival rate — they may calcify or die off, leading to unwanted lumps.

5. “Tear Trough Worms”

Overfilled HA can become translucent under the skin, giving off a bluish or greenish tint under sunlight — a condition known as “tear trough worms.” In rare cases, this can lead to vision issues or even blindness.

6. Infection

Although rare, infections can occur if hygiene is not strictly followed during the injection. Clean tools and sterile environments are essential. Aftercare is equally important — avoid rubbing or touching the treated area.

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Important Considerations for Tear Trough Fillers

1. Choose a licensed and experienced doctor to ensure the safety and effectiveness of the treatment while minimizing the risk of side effects.
2. Have a thorough consultation—clearly express your expectations and honestly share your medical history and allergies. Make sure you fully understand the potential risks, side effects, treatment process, and recovery period, and whether these are acceptable to you. Also ask how to handle any possible complications.
3. Seek your doctor’s recommendation when deciding between hyaluronic acid, autologous fat, or collagen-stimulating injections.
4. Avoid laser treatments or cosmetic procedures before the injection. After the procedure, follow your doctor’s skincare advice—keep the skin moisturized, apply sun protection, and avoid rubbing the injection site.
5. If you experience any serious side effects, contact your doctor immediately for prompt treatment.

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Six Ways to Prevent and Improve Tear Trough Hollowing

1. Tear Trough Massage

Gently massaging the tear trough area helps stimulate blood circulation, easing facial stiffness and puffiness that can worsen tear troughs. Use your index fingers to press from the inner corners of your eyes outward to the outer corners, then back again. This back-and-forth motion helps reduce swelling and improve tear trough appearance. For better results, include a full eye area massage.

2. Eye Area Hydration

Choose moisturizers that suit your skin type to replenish moisture in the under-eye skin, slowing down aging and the development of hollowing. In addition to eye creams and serums, hydrating eye masks can boost radiance. Look for ingredients like vitamins A, C, E, hyaluronic acid, and collagen.

3. Adequate Sleep

Getting 7–8 hours of quality sleep daily allows the skin to repair itself around 11 p.m. Lack of sleep speeds up skin aging, leads to breakouts, and causes dark circles, eye bags, and tear troughs. Sleeping earlier also reduces late-night snacking and indigestion, so maintain a consistent early sleep schedule.

4. Balanced Diet

Eat foods rich in skin-friendly nutrients such as vitamin C, vitamin E, and antioxidants—like lemons, citrus fruits, berries, and spinach—to boost skin elasticity and reduce aging-related hollowing. Also avoid harmful substances like tobacco and alcohol to maintain healthy under-eye skin and prevent eye-area concerns.

5. Proper Sun Protection

UV exposure can damage the skin, increasing the risk of fine lines, tear troughs, and eye bags. Use high-SPF sunscreen outdoors, wear sunglasses and wide-brimmed hats, and reapply sunscreen every two hours. Indoor sun protection is also important, as UV rays can penetrate through windows.

6. Regular Eye Breaks

Staring at screens for long periods causes dry, tired, and aging eyes. Relax your eye muscles with eye exercises or by simply closing your eyes. Follow the 20-20-20 rule: every 20 minutes, rest your eyes for 20 seconds by looking at something 20 feet (about 6 meters) away.

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Want to Quickly and Easily Get Rid of Tear Troughs? Try the Perfect Medical R6 Miracle Eye Rescue Treatment Now!

Busy modern lifestyles and high stress levels mean long hours in front of screens and poor sleep—perfect conditions for tear troughs to form. When combined with dark circles and eye bags, you may look tired, older, and less energetic. Tear trough surgery comes with downtime and risks, but the Perfect Medical R6 Miracle Eye Rescue Treatment offers a safer alternative!

This treatment uses three types of RF (radiofrequency) energy to target and dissolve fat deposits under the eyes, while stimulating collagen production to smooth out tear troughs, eye bags, and fine lines. It also brightens dark circles. If you’re concerned about loose skin around the eyes, this treatment can firm and lift the area for a youthful appearance. The RF technology is non-invasive, so there’s no damage to the skin and no downtime—you can return to work immediately and see noticeable improvement in a short time.

Perfect Medical’s aesthetic treatments are safe and trustworthy! New to Perfect Medical? Want to try it for yourself? Click the link below to register for a free trial session!