Anatomy and nonsurgical correction of the tear trough deformity

Plast Reconstr Surg. 2010 Feb;125(2):699-708. doi: 10.1097/PRS.0b013e3181c82f90.


The development of dark circles under the eyes is one of the early signs of periorbital aging, lending a fatigued and aged appearance to the face. Loeb, in 1961, used the term "nasojugal groove" to describe the concavity at the border of the eyelid and the cheek medially. Flowers, in 1969, first named this groove the "tear trough." In the present article, the author presents a detailed description of the anatomy and nonsurgical correction of this deformity. Nonsurgical correction of the tear trough deformity with hyaluronic acid is effective and safe and is associated with high patient satisfaction. The procedure offers both an adjunct to surgery and an alternative to it in some patients. It also provides an opportunity for global midfacial volume correction. Careful patient selection and attention to technique will minimize side effects.

MeSH terms

  • Adult
  • Cosmetic Techniques* / adverse effects
  • Ecchymosis / chemically induced
  • Edema / chemically induced
  • Eyelids / anatomy & histology
  • Eyelids / pathology
  • Face / anatomy & histology
  • Face / pathology*
  • Female
  • Humans
  • Hyaluronic Acid / administration & dosage*
  • Hyaluronic Acid / adverse effects
  • Patient Satisfaction
  • Patient Selection
  • Rejuvenation*
  • Skin Aging / pathology*
  • Viscosupplements / administration & dosage
  • Viscosupplements / adverse effects


  • Viscosupplements
  • Hyaluronic Acid