Is 1ml of filler enough for tear troughs?
It's one of the most common questions we hear at Karwal Aesthetics, and the honest answer is: it depends. While 1ml of filler can produce excellent results for some patients, others may need 2ml or even 3ml to achieve the refreshed, natural look they're after. The reason for this comes down to understanding that not all tear troughs are the same, and the right treatment plan starts with identifying exactly what type of hollowing you have.
What Is a Tear Trough?
The tear trough is the depression that runs from the inner corner of the eye down towards the cheekbone. When this area loses volume or becomes more prominent, it creates shadows and hollowing that can make you look tired, aged, or unwell, even when you feel perfectly fine. Dermal filler is one of the most effective ways to restore this lost volume and create a smoother, more refreshed appearance.
However, what many patients don't realise is that there are actually two different types of tear trough, and each one requires a very different approach when it comes to the amount of filler needed.
True Tear Trough vs False Tear Trough
Understanding the difference between a true tear trough and a false tear trough is essential, and it's something that Dr Karwal assesses carefully during every consultation.
A true tear trough is a genuine hollow or depression that sits directly beneath the lower eyelid, running along the orbital rim. This occurs when there is a loss of volume in the immediate under-eye area itself, often due to ageing, genetics, or naturally thin skin. With a true tear trough, the hollowing is localised to the area just below the eye, and the cheek volume beneath it remains relatively intact.
For patients with a true tear trough, 1ml of filler is often sufficient to achieve a beautiful result. Because the hollowing is confined to the under-eye groove itself, a small, precise amount of filler placed directly into the tear trough can smooth the depression, soften dark shadows, and create a natural, refreshed look.
A false tear trough, on the other hand, is not caused by volume loss in the tear trough itself, but rather by volume loss in the anterior cheek area below it. When the cheek loses its fullness and begins to flatten or descend, it creates a visible separation between the under-eye area and the mid-face. This makes the tear trough appear deeper and more pronounced than it actually is, because the support beneath it has dropped away.
Treating a false tear trough with filler in the under-eye groove alone will not produce a satisfactory result, because the real problem lies lower down. In these cases, anterior cheek support is needed first to rebuild the foundation beneath the tear trough. This means the total volume of filler required is significantly higher. For a false tear trough, 2ml is commonly needed, and in cases of more severe hollowing or significant cheek volume loss, up to 3ml may be required to achieve a balanced, natural result.
Can You Have Both?
Absolutely, and this is more common than many people think. It is entirely possible to have a true tear trough under one eye and a false tear trough under the other, or even a combination of both types under both eyes. Faces are rarely perfectly symmetrical, and the pattern of volume loss can differ from one side to the other.
This is exactly why a one-size-fits-all approach to tear trough treatment simply doesn't work. What your under-eyes need may be completely different from one side to the other, and the amount of filler required for each side may vary accordingly. A thorough assessment by an experienced practitioner is the only way to identify exactly what is going on and to build a treatment plan that addresses each side individually.
Why the Right Assessment Matters
Getting the diagnosis right is everything. If a practitioner treats a false tear trough as if it were a true tear trough, injecting filler only into the under-eye groove without addressing the lack of cheek support, the results are unlikely to look right. The filler may sit unnaturally, the hollowing may persist, or the area could end up looking puffy or overfilled without actually resolving the underlying issue.
At Karwal Aesthetics, Dr Karwal takes the time to carefully assess the entire mid-face structure during your consultation, not just the tear trough in isolation. He will determine whether you have a true tear trough, a false tear trough, or a combination of both, and will explain clearly how much filler is likely to be needed and where it will be placed. This comprehensive approach is what ensures natural, balanced results that actually address the root cause of the concern.
What Type of Filler Is Used?
At Karwal Aesthetics, we use hyaluronic acid based dermal fillers for tear trough treatment. Hyaluronic acid is a naturally occurring substance in the body, making it safe, effective, and reversible. For the tear trough area itself, a thinner, lighter filler is used to suit the delicate under-eye skin. If anterior cheek support is also needed, a slightly firmer filler may be used in the cheek area to provide the structural foundation required before refining the tear trough above it.
Dr Karwal selects the most appropriate filler for each area based on your individual anatomy, ensuring the best possible result.
How Long Do the Results Last?
Tear trough filler typically lasts between 12 and 24 months, depending on the individual, the type of filler used, and lifestyle factors such as metabolism, sun exposure, and overall skin health. Cheek filler used to support a false tear trough can also last well over a year. Many patients find that with repeat treatments, the results tend to last even longer as the skin benefits from ongoing collagen stimulation.
Dr Karwal will advise you on the ideal timing for maintenance appointments to keep your results looking their best.
Book Your Consultation at Karwal Aesthetics
The only way to know exactly how much filler you need is to have a proper assessment with an experienced practitioner who understands the difference between true and false tear troughs and who can evaluate your unique facial anatomy.
Book a consultation with Dr Karwal today and receive honest, personalised advice on the best approach for your under-eye concerns. Whether you need 1ml or 3ml, you can feel confident that the treatment plan is tailored specifically to you.
Get in touch now to schedule your consultation, click here. For any questions, email us. We're here to answer every question you have.
Disclaimer: This blog post is for informational purposes only and does not constitute medical advice. Individual results may vary. Please consult a qualified medical professional to discuss your specific concerns, medical history, and suitability for any treatment. All cosmetic procedures carry potential risks, and a thorough consultation is essential before proceeding.
