Tear Trough Filler
from £550
Tired eyes despite a good night's sleep?
Dark circles and hollowness beneath the eyes are among the most common concerns we see at Karwal Aesthetics.
For most people, the appearance of tiredness around the eyes comes down to one of two underlying causes: volume loss creating a shadowed, sunken contour, or pigmentation darkening the skin in this delicate area. Sometimes it is both. What matters is that these changes are driven primarily by genetics, the natural ageing process, and stress — and have very little to do with how well you sleep or how well you look after yourself.
Where hollowness is the dominant concern, tear trough filler can restore a smoother, better-supported contour beneath the eye, lifting the shadow that creates that characteristic look of exhaustion. Where pigmentation is the greater issue, prescription skincare or injectable skin boosters such as Sunekos can work to brighten and even the skin tone with a precision that topical products alone cannot achieve. For many patients, the most natural and lasting improvement comes from addressing both.
What Are Tear Trough Fillers?
Tear trough fillers are a non-surgical cosmetic procedure that involves injecting dermal fillers into the tear trough area - the depression that runs from the inner corner of the eye along the under-eye area. These fillers help reduce the appearance of dark circles, hollowness, and under-eye bags by adding volume to this area.
What Problems Do Tear Trough Fillers Fix?
Tear trough fillers address several specific aesthetic concerns related to the under-eye area:
Hollowness/Depression: They fill in the sunken area beneath the eyes that creates a shadow.
Dark Circles: By reducing shadows caused by hollowness, they can minimise the appearance of dark circles (though they won't address dark circles caused by pigmentation or thin skin).
Under-eye Bags: They can help camouflage mild to moderate under-eye bags by smoothing the transition between the bag and the cheek.
Tired Appearance: By restoring volume loss, they can create a more refreshed, youthful look.
It's important to note that tear trough fillers are not a solution for all under-eye concerns. Issues like severe bags, excess skin, or discolouration due to hyperpigmentation may require different treatments or a combination approach. Where filler is appropriate, Dr Karwal selects the least hydrophilic product available for this area, minimising the risk of swelling and the Tyndall effect that can occur when more water-attracting fillers are used beneath the thin periorbital skin.
Our Prices
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£550
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From £850
Under Eye Concerns
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Malar bags, also known as festoons or cheek bags, are swollen or puffy areas that develop on the cheeks, just below the lower eyelids. They appear as distinct mounds or ridges over the cheekbone (malar) region and can create a tired or aged appearance.
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Under-eye hyperpigmentation, commonly known as dark circles, refers to the darkening of the skin beneath the eyes. This occurs when excess melanin (the pigment responsible for skin colour) accumulates in the under-eye area, resulting in a darker appearance compared to the surrounding skin.
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Under-eye crepiness refers to the thin, wrinkled, and crinkled appearance of the skin beneath the eyes. The texture resembles crêpe paper, hence the name. This condition makes the delicate under-eye area look aged, tired, and less smooth.
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Undereye bags are mild swelling or puffiness that occurs beneath the eyes. They develop when the tissues around the eyes, including the muscles supporting the eyelids, weaken with age. Fat that normally supports the eyes can then migrate into the lower eyelids, causing them to appear puffy. Fluid may also accumulate in this area, contributing to the swollen appearance.
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Undereye hollowing, also known as tear trough deformity, refers to the sunken or shadowed appearance beneath the eyes. This creates a depression or groove that runs from the inner corner of the eye along the lower eyelid. Unlike bags, which protrude outwards, hollowing creates an indentation that can make one appear tired or aged.
FAQs
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Initial Consultation: The process begins with a thorough consultation with Dr Karwal, who will assess your facial structure, skin condition, and discuss your aesthetic goals.
Medical Assessment: Your medical history will be reviewed to ensure you're a suitable candidate. Dr Karwal will check for allergies, previous reactions to fillers, and any contraindications.
Treatment Planning: Based on your facial anatomy and desired results, Dr Karwal will develop a tailored treatment plan.
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Cleansing: Dr Karwal thoroughly cleanses the treatment area to remove any makeup, oils, or impurities.
Topical Anaesthetic Application: A numbing cream is applied to minimise discomfort during the procedure. This typically requires 5 minutes to take effect.
Treatment Mapping: Dr Karwal then marks the areas to be injected, carefully planning placement for optimal results.
Filler Injection: Using a fine needle or cannula, the dermal filler (hyaluronic acid-based) is precisely injected into the tear trough area beneath the eyes.
Massage and Molding: Dr Karwal gently massages the product to ensure even distribution and proper contouring.
Final Assessment: Both Dr Karwal and the patient evaluate the immediate results, with potential touch-ups applied as needed.
Post-Treatment Care Instructions: Dr Karwal provides detailed aftercare guidelines to optimise healing and results.
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Aftercare notes for tear-trough filler treatment:
Needle entry points, redness, bruising, swelling and asymmetry around injection sites immediately after treatment is normal due to the very nature of the treatment.
There may also be some tenderness present as the bruising and inflammation sets in. These symptoms will resolve over the next 2-7 days, depending on your individual response to the treatment. It may take a full 2-4 weeks for all swelling to settle; until this time we cannot re-treat.
For 24 hours avoid:
Touching your face
Applying makeup
Skincare with active ingredients
For 48 hours avoid:
Intense physical activity
Sleeping on side or front
Spa's/Saunas
Massage/facials
Touching/rubbing/massaging/exfoliating/applying pressure to treated areas
Alcohol & blood thinning medications
For 7 days avoid:
Avoid rubbing your eyes
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This treatment typically lasts for approximately 12–24 months before requiring a top-up. The longevity of results varies based on several factors.
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Genetics: Some people are naturally predisposed to darker under-eye skin due to hereditary factors.
Sun exposure: UV radiation can stimulate melanin production, leading to increased pigmentation.
Ageing: As skin becomes thinner with age, blood vessels become more visible, contributing to a darker appearance.
Lack of sleep: Poor sleep can cause the skin to appear paler, making dark circles more prominent.
Allergies: Histamine release can dilate blood vessels and cause inflammation, darkening the under-eye area.
Dehydration: Insufficient hydration can make the skin appear dull and accentuate dark circles.
Medical conditions: Anaemia, thyroid problems, or vitamin deficiencies can contribute to hyperpigmentation.
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Vitamin C serum: A potent antioxidant that brightens the under-eye area, reduces melanin production, and protects against free radical damage from UV exposure and environmental stressors.
Sunekos: An injectable treatment containing hyaluronic acid and amino acids that stimulates collagen and elastin production, improving skin texture and reducing pigmentation in the under-eye area.
Hydroquinone: A topical skin-lightening agent that inhibits melanin production, often considered the gold standard for treating hyperpigmentation (should be used under medical supervision).
Retinol: A vitamin A derivative that accelerates cell turnover, fades dark spots, and improves skin texture, though it should be used cautiously around the delicate eye area.
Tretinoin: A prescription-strength retinoid that's more potent than retinol, effectively treating hyperpigmentation by increasing cell turnover and inhibiting melanin production.
Pico laser: An advanced laser technology that delivers ultra-short picosecond pulses to shatter pigment particles more effectively than traditional lasers, treating under-eye hyperpigmentation with minimal heat damage to surrounding tissue and reduced downtime.
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Ageing: As we age, the skin naturally loses collagen and elastin, proteins that keep skin firm and elastic. This loss is particularly noticeable in the thin under-eye area.
Sun damage: UV exposure breaks down collagen and accelerates skin ageing, leading to premature wrinkling and crepey texture.
Dehydration: Lack of moisture causes the skin to appear dry, thin, and more prone to fine lines and crepiness.
Genetics: Some people are predisposed to thinner skin or earlier collagen loss due to hereditary factors.
Lifestyle factors: Smoking, poor diet, lack of sleep, and excessive alcohol consumption can all contribute to skin deterioration.
Volume loss: Loss of fat beneath the skin can make the area appear hollow and emphasise the crepey texture.
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Moisturise regularly: Use hydrating eye creams containing hyaluronic acid or ceramides to plump and smooth the skin.
Sun protection: Wear sunglasses and apply SPF 30+ around the eyes daily to prevent further UV damage.
Stay hydrated: Drink plenty of water and maintain overall skin hydration.
Healthy lifestyle: Get adequate sleep, eat a balanced diet rich in antioxidants, and avoid smoking.
Sunekos treatments: Sunekos injections contain hyaluronic acid and amino acids that stimulate collagen and elastin production. They can be used on both the lower and upper eyelids to improve skin quality, reduce crepiness, and restore a smoother, more youthful appearance to the delicate eye area.
Tretinoin and retinol: Prescription tretinoin (a stronger form of vitamin A) and over-the-counter retinol are highly effective for treating under-eye crepiness. They work by increasing cell turnover, boosting collagen production, and improving skin thickness and texture. Start with a low concentration and gradually increase usage to minimise irritation in this sensitive area.
CO2 laser resurfacing: Fractional CO2 laser treatment is a highly effective option for under-eye crepiness. It works by creating microscopic columns of thermal damage in the skin, which stimulates collagen remodelling and skin tightening. The treatment can significantly improve skin texture, reduce fine lines, and diminish crepey appearance. Recovery typically takes 5-7 days, with redness and mild swelling. Results continue to improve over several months as new collagen forms. It's important to seek an experienced practitioner, as the under-eye area requires careful, conservative treatment settings.
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Endolift is a minimally invasive laser treatment that uses an internal laser fibre to target and treat malar bags from beneath the skin.
How Endolift Works
Laser fibre insertion: A thin optical fibre (approximately 300 microns) is inserted through a tiny incision under local anaesthesia
Internal heating: The laser delivers controlled thermal energy directly to the deeper layers of skin and subcutaneous tissue
Tissue tightening: The heat stimulates collagen production and causes immediate tissue contraction
Fat reduction: The laser can also target excess fat deposits contributing to the bags
Skin tightening: The thermal effect tightens loose skin and improves elasticity
Benefits of Endolift for Malar Bags
Minimally invasive: No large incisions or extensive surgery required
Local anaesthesia: Performed under local anaesthetic rather than general anaesthesia
Minimal downtime: Most patients return to normal activities within a few days
Immediate tightening: Some results visible immediately, with continued improvement over several months
Collagen stimulation: Promotes long-term skin rejuvenation through natural collagen production
Reduced swelling: Targets the underlying causes of puffiness and fluid retention
Natural-looking results: Gradual improvement creates subtle, natural-looking outcomes
Treatment Process
Consultation: Assessment of malar bags and suitability for Endolift treatment
Preparation: The treatment area is cleaned and local anaesthetic is applied
Treatment: The laser fibre is inserted and moved systematically through the treatment area (typically 30-60 minutes)
Recovery: Mild swelling and bruising may occur for several days
Results: Initial tightening visible immediately, with optimal results appearing over 3-6 months as collagen remodelling occurs
Expected Outcomes
Reduction in puffiness and swelling of malar bags
Improved skin texture and firmness in the cheek area
More defined cheekbone contour
Rejuvenated, less tired appearance
Results typically lasting 2-3 years or longer
Considerations
Not suitable for everyone: Severe cases may require alternative treatments or surgical intervention
Multiple sessions: Some patients may benefit from additional treatments for optimal results
Combination treatments: May be combined with other aesthetic procedures for comprehensive facial rejuvenation
Side effects: Temporary swelling, bruising, and mild discomfort are common but typically resolve within a week
We offer Endolift treatments for malar bags in London, Mayfair, 15 Dover Street, W1S 4LP. For more information and suitability please book a consultation. -
Treatment Area: Fillers in highly mobile areas such as lips tend to break down faster than less mobile areas
Metabolism: People with faster metabolisms may break down fillers more quickly
Lifestyle: Sun exposure, smoking, saunas and intense physical activity can reduce longevity
Injection Technique: The skill of the injector can impact how long results last
Type of Filler: dense fillers tend to last longer than soft fillers.
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Hollowness under the eyes
A sunken appearance to the eye
Dark circles under the eye
Under-eye fillers won't address pigmentation issues. If pigmentation is a concern, it will be identified during your consultation. We can then recommend specific skin creams, including prescribed Obagi products, which will be delivered to you. Alternatively, if you're a suitable candidate for Sunekos, we can discuss its benefits in more detail during the consultation.
In addition, people with severe under eye bags may not respond well to this treatment, in which case we can advise you accordingly on how to treat this issue. Book a consultation.
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This treatment can be performed alongside many of our other treatments. It may sometimes be more convenient to do so if you've been recommended another treatment to complement your features. Sometimes we combine tear trough filler with cheek filler to build up support beneath this area. We can also combine the treatment with anti-wrinkle injections to the crow's feet and brow areas to reduce fine lines and gently lift the brow. The combination of these treatments can result in a dramatic improvement to the entire eye area. If you have both hollowing and hyperpigmentation, we would need to address the hollowing under the eyes first, before addressing skin quality and hyperpigmentation with Sunekos two weeks later, or with medical-grade skin products.
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Yes, tear trough filler can help reduce under eye wrinkles. We also sometimes treat under eye wrinkles conservatively with anti-wrinkle injections and this can help dramatically for certain clients.
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Yes, we use hyaluronic acid fillers to treat the under the eye, reversible at any time. Therefore they can be dissolved if a client does not like the result or if a complication arises (however, this is extremely rare).
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When addressing tear troughs, we use Teoxane Teosyal Redensity 2. Recognised as one of the thinnest and least hydrophilic fillers available on the market, it is particularly effective for this facial region due to the extreme delicacy of the skin beneath the eyes.