Legal disclaimer

This guide provides general information about cosmetic tear trough injections for adults aged eighteen years and over and does not replace individual medical advice, diagnosis, or treatment.^{1 9}

Any decision to have tear trough filler should follow a proper consultation with a suitably qualified health practitioner, including discussion of risks, benefits, alternatives, and the option not to proceed.^{2 10}

Products used for tear trough injections are usually prescription-only medicines, and their use and advertising are regulated under the Health Practitioner Regulation National Law and Commonwealth therapeutic goods legislation.^{1 3}

This document is written to align with AHPRA advertising guidelines and TGA guidance on advertising health services by avoiding medicine names, promotional claims, discounts, testimonials, or guaranteed outcomes.^{1 3}

1. Scope of this guide

This guide covers cosmetic use of hyaluronic-acid-based injectable gels to the tear trough and under-eye region in adults, focusing on mechanism, appearance changes, governance, risks, and typical recovery.^{2 7}

It does not cover reconstructive or therapeutic indications, permanent or non-hyaluronic fillers, adolescent procedures, or treatment during pregnancy or breastfeeding, which all require individual medical advice.^{2 9}

The content is intended as neutral patient education about a regulated health service, not as promotion of a specific clinic, practitioner, or product, and is consistent with AHPRA and TGA expectations for health-service information.^{1 3}

2. What is tear trough filler?

2.1 Plain-language description

Tear trough filler is a cosmetic injectable procedure where a registered health practitioner places very small amounts of hyaluronic acid gel into selected areas under the eyes to soften true hollows and reduce shadowing.^{2 9}

Hyaluronic acid is a sugar molecule that occurs naturally in the body and helps bind water; in regulated injectable form it can provide subtle structural support beneath thin under-eye skin when used in appropriate patients.^{3 7}

In clinically led practice, the goal is to create a more rested and blended under-eye appearance rather than a dramatic or artificial change, and patients are counselled that results are modest and temporary.^{2 9}

2.2 Regulatory context in Australia

Injectables used under the eyes are typically Schedule 4 prescription-only medicines, and health professionals and cosmetic clinics are not permitted to advertise these medicines to the public, even indirectly, as named products.^{3 4}

TGA guidance explains that clinics may describe cosmetic injection services in general terms but must not promote specific prescription-only products, use coded references to them, or offer inducements that encourage unnecessary use.^{3 4}

AHPRA’s cosmetic procedure guidelines also set expectations for consultation, patient assessment, consent, psychological screening, and cooling-off periods for higher-risk non-surgical cosmetic procedures, which includes facial injectables.^{2 10}

Clinical pearl

If a clinic presents tear trough filler as “quick”, “simple”, or “no risk”, that approach is out of step with how Australian regulators describe cosmetic procedures and patient-protection obligations.^{1 2}

3. How does hyaluronic acid filler work in the tear trough?

3.1 Volume support and shadow reduction

In tear trough treatments, hyaluronic acid gel is usually placed on or near deeper planes at the junction between the lower eyelid and the cheek, where structural support has been lost with age or is naturally lacking.^{2 9}

By restoring some of this underlying support, the hollow can appear shallower and the shadow that previously made the eyes look tired can be reduced, so light reflects more evenly over the under-eye region.^{2 9}

Because under-eye skin is very thin and prone to puffiness, clinicians typically use a softer, lower-density hyaluronic acid product and very conservative volumes to limit the risk of over-filling or visible irregularities.^{2 7}

3.2 Tear trough anatomy and technique

The tear trough region includes the orbital rim bone, deep and superficial fat compartments, the infraorbital nerve and vessels, retaining ligaments, and thin overlying skin, making it one of the more anatomically complex cosmetic injection areas.^{7 10}

Techniques may involve needle or cannula, but should always use careful depth control, slow injections, and very small boluses to reduce the risks of surface lumps, Tyndall effect, prolonged swelling, or vascular compromise.^{2 10}

Australian cosmetic procedure guidance states that higher-risk non-surgical cosmetic procedures, including facial injectables, should only be performed by suitably trained and registered practitioners working within clear governance and escalation frameworks.^{2 10}

Clinical pearl

Most tear trough problems arise from too much product or product in the wrong plane; in this area, subtle and deep is almost always better than large and superficial.

4. What results should patients expect?

4.1 Visual changes

Tear trough filler can soften genuine hollows and reduce the shadowing that contributes to a tired or drawn appearance, so that the transition between the lower eyelid and cheek looks smoother and more blended.^{2 9}

Some patients notice that they receive comments such as “you look more rested” even if others cannot specifically identify that a cosmetic procedure has been performed around the eyes.^{2 9}

4.2 Time course of change

In the first few days, swelling and puffiness are common and can make the under-eye region look more pronounced or uneven before it improves, particularly on waking in the morning.^{6 7}

Most people see a more realistic impression of the result after one to two weeks once the majority of swelling has resolved, and final contour and symmetry are best assessed around four weeks in a review.^{7 10}

4.3 Limits and expectations

Tear trough filler does not remove all wrinkles, fine lines, pigment-based “dark circles”, or loose skin, and it does not correct puffiness caused by fat prolapse or fluid retention, which often require different or additional treatments.^{2 9}

A realistic goal is improvement in the appearance of hollowing and the shadow it creates, not complete removal of every sign of ageing, and many patients still benefit from skincare, sun protection, mid-face support, or surgical assessment alongside or instead of filler.^{2 9}

Clinical pearl

If the main change is that you look less tired rather than that your under-eyes look “done”, the result is more likely to age well and remain consistent with conservative cosmetic practice.

5. How long does tear trough filler last?

5.1 Typical duration

Tear trough filler is temporary, and hyaluronic acid is gradually broken down and cleared by the body’s normal processes.^{3 7}

In practice, many patients notice a useful under-eye effect for around twelve months, although some experience shorter or longer durations depending on individual factors and product choice.^{8 9}

5.2 Factors influencing longevity

The duration of effect can be influenced by injection depth, product properties, baseline mid-face support, age, skin quality, metabolism, sleep patterns, allergies, and tendencies to under-eye fluid retention.^{2 7}

Because this area moves less than the lips but is still affected by smiling and expressions, tear trough filler often lasts longer than lip filler but may not last as long as carefully placed deep cheek fillers.^{3 7}

5.3 What happens when it wears off?

As the filler is degraded, the additional volume reduces gradually and the under-eye contour moves back towards its earlier shape over months rather than changing suddenly.^{3 7}

Professional submissions and expert commentary on cosmetic procedures focus on appropriate training and governance rather than suggesting that correctly performed hyaluronic acid tear trough filler accelerates the natural ageing process.^{9 10}

Clinical pearl

Top-up treatments should be based on visible changes and patient need, and a conservative, staged plan is more compatible with Australian regulatory and professional expectations than frequent aggressive re-filling.

6. Is tear trough filler painful?

6.1 Sensation during treatment

Some discomfort is expected because injections pass through thin under-eye skin and deeper tissues, but most adults tolerate tear trough injections with appropriate anaesthetic measures and a careful technique.^{7 10}

Patients most often describe pressure, a feeling of fullness, or a brief ache rather than constant sharp pain, and these sensations usually last only for the duration of the injections.^{7 10}

6.2 Comfort strategies

Clinics commonly use topical anaesthetic creams, cool packs, and distraction techniques, and may choose filler products that contain local anaesthetic to improve comfort during the procedure.^{3 4}

Additional local anaesthetic methods may be used where clinically appropriate, provided they fall within the practitioner’s scope of practice and the clinic’s governance policies.^{2 10}

6.3 Tenderness after treatment

It is normal for the under-eye area to feel tender, heavy, or bruised for a few days after treatment, especially when touching the region, smiling, or washing the face.^{6 7}

Simple measures such as cool compresses, sleeping with the head slightly elevated, and using appropriate analgesia if recommended by the treating practitioner often help early discomfort.^{7 15}

Clinical pearl

Severe, escalating, or unusual pain, especially when associated with skin colour change or visual symptoms, is not typical and should prompt urgent review by a clinician.

7. What are the risks and side effects of tear trough filler?

7.1 Expected short-term effects

Short-term effects are common due to the sensitivity and visibility of the under-eye area. Swelling, puffiness, mild redness, and bruising often appear in the first few days and can temporarily make the area look more noticeable or asymmetrical.^{6 7}

Many patients find swelling is worse in the morning and improves throughout the day as fluid redistributes, and this pattern is considered a normal part of the early healing process.^{6 7}

The region can feel firm, tight, or slightly lumpy while swelling is present and while the filler is integrating into deeper tissues, and these sensations usually lessen as healing progresses over one to two weeks.^{7 15}

Patients should be informed before treatment that this short-term phase is expected and does not in itself mean something has gone wrong, provided symptoms steadily improve and no warning signs appear.^{2 9}

7.2 Less common issues

Less common issues include prolonged swelling or malar oedema, where fluid persists under the eyes or on the upper cheeks for weeks or months, particularly in people with a pre-existing tendency to puffiness or impaired lymphatic drainage.^{2 11}

Other issues can include visible lumps, contour irregularities, or a bluish colour (Tyndall effect) when filler sits too superficially or the skin is very thin, which can be cosmetically troubling even if not medically dangerous.^{11 12}

These problems may require additional review by the treating clinician, and possible management options include watchful waiting, guided massage, conservative adjustment, or dissolving some or all of the filler with hyaluronidase.^{3 11}

Delayed inflammatory reactions can occasionally occur after illness, trauma, or dental treatments and may present as intermittent swelling or tenderness, requiring assessment to rule out other causes and to decide on appropriate management.^{12 13}

7.3 Serious but rare complications

Serious complications are rare but must be discussed because the under-eye is close to important blood vessels and structures around the eye. The most significant risk is vascular compromise, where filler blocks or compresses a blood vessel and reduces blood flow to skin or deeper tissue.^{3 11}

Warning signs can include sudden severe pain, skin turning pale, mottled or dusky, unusual coldness, or new visual changes, and these symptoms require immediate assessment and urgent management according to established protocols.^{10 11}

Clinics providing tear trough filler should have written emergency procedures, ready access to hyaluronidase, and clear escalation pathways, and must comply with infection-control and skin penetration requirements under state public-health law.^{2 5}

Infection, although uncommon, may present with spreading redness, warmth, throbbing pain, or fever and requires prompt medical review and management.^{5 6}

Clinical pearl

Any clinic offering under-eye filler should be able to describe, in clear terms, how they recognise and respond to complications, including who they would contact and where they would refer you if needed.

8. Who is a suitable candidate for tear trough filler?

8.1 Potentially suitable adults

Tear trough filler may be considered for adults with true under-eye hollowing that creates a visible groove or shadow, and whose hollow improves when the clinician gently supports the area during examination.^{2 9}

Suitable candidates usually have reasonably good skin quality, no major fat prolapse, and no strong tendency to chronic under-eye puffiness, and they accept that improvement will be modest and not perfect.^{2 11}

They should also be willing to follow aftercare instructions, attend review appointments, and understand that ongoing skincare, sun protection, and sometimes mid-face support or other treatments may still be needed.^{2 9}

People who are looking for a softer, more rested appearance rather than a dramatic transformation often adapt best to the subtle changes achieved with tear trough filler.^{2 9}

8.2 When treatment may be delayed or avoided

Tear trough filler is generally avoided in people with significant eye bags from fat prolapse, because adding filler can make bags look larger instead of smaller.^{2 11}

It is also often unsuitable for those with chronic fluid retention, severe allergies, sinus disease, or very thin and lax skin, where the risk of prolonged swelling or visible irregularities is higher.^{2 11}

Treatment is usually postponed in the presence of active infection, recent surgery or trauma in the area, uncontrolled systemic illness, or during pregnancy or breastfeeding, in line with a precautionary approach used in cosmetic medicine.^{3 9}

In patients whose primary concern is pigment, fine lines, or unrealistic expectations of perfection, alternative treatments or further counselling are typically more appropriate than filler.^{2 10}

8.3 Psychological and ethical considerations

Australian cosmetic guidelines emphasise psychological screening, realistic expectations, and voluntary informed consent for all cosmetic procedures, including non-surgical treatments.^{2 10}

Patients with a history of severe dissatisfaction with previous reasonable results, or who show signs of significant body image disturbance, may need further assessment and possibly referral before considering tear trough filler.^{9 10}

Practitioners are expected to provide clear information, allow time for reflection, and be willing to decline or delay treatment when they believe the requested procedure is not in the patient’s overall best interests.^{2 10}

In some cases, referral to another health professional—such as a dermatologist, oculoplastic surgeon, or psychologist—may be more appropriate than proceeding with filler.^{9 13}

Clinical pearl

Tear trough filler works best in the context of a trusted therapeutic relationship where both patient and practitioner agree on modest, realistic goals and a conservative plan.

9. What is recovery like and what aftercare is recommended?

9.1 Early recovery (first 72 hours)

Most people can return to light daily activities soon after tear trough treatment, but the first two to three days are usually the most noticeable in terms of swelling and bruising.^{6 7}

Puffiness may be more pronounced on waking and can cause the under-eye area to look more uneven in different lighting or when viewed closely in a mirror, which can be unsettling if not anticipated.^{6 7}

Patients are generally advised not to rub or massage the under-eye region, to avoid sleeping face-down, and to be gentle when washing or applying skincare around the lower eyelids during the early recovery period.^{7 15}

Mild discomfort is expected and can often be managed with cool compresses applied intermittently and appropriate over-the-counter analgesia if recommended by the treating practitioner.^{7 15}

9.2 First 2–4 weeks

Over the following one to two weeks, swelling typically reduces, bruising fades, and the filler begins to soften and integrate into the surrounding tissues so that the under-eye region looks more natural.^{7 8}

Minor day-to-day fluctuations are common and can be influenced by sleep quality, stress, fluid intake, allergies, and sinus issues, but the overall trend should be towards smoother and more stable contour.^{7 8}

By around four weeks, healing is usually advanced enough for a meaningful review of contour, symmetry, and patient satisfaction, and this is often the time when adjustments are discussed if needed.^{7 15}

Making major decisions about success or failure in the first few days is discouraged, because the final result cannot be accurately judged until swelling and tissue response have settled.^{2 10}

9.3 Typical aftercare advice

After tear trough filler, aftercare instructions commonly include avoiding strenuous exercise, saunas, steam rooms, hot yoga, and significant alcohol intake for at least 24–48 hours to reduce the risk of increased bruising and swelling.^{3 14}

Patients are also advised not to undergo strong facial massages, facials, peels, or energy-based treatments around the lower eyelids for at least two weeks, and to avoid sleeping on the face or using tight eye coverings that press on the treated area.^{5 6}

Maintaining good hydration, moderating salt and alcohol intake, and managing allergies or sinus problems can help minimise recurring puffiness around the eyes.^{2 9}

Clinics should provide written aftercare instructions and clear contact details, so patients know exactly when to call the clinic and when to seek urgent help if recovery does not follow the expected pattern.^{2 10}

Clinical pearl

Under-eye filler should be judged over weeks, not days; allowing a full month before drawing conclusions on the result leads to better decision-making and less anxiety.

10. Common myths and misconceptions about tear trough filler

“Tear trough filler removes dark circles completely”

Most dark circles are caused by pigmentation, visible veins, or skin thinness rather than hollowing alone, so filler can help with the groove but cannot erase all darkness.^{2 11}

“Tear trough filler and eye bags are treated the same way”

Eye bags caused by bulging fat or fluid retention often need different approaches, and adding filler in front of them can make them more obvious rather than less.^{2 11}

“More filler always gives a better result”

In the under-eye area, excess filler tends to make the region look puffy or swollen, so small, precise volumes are usually more effective and consistent with conservative practice.^{2 11}

“Tear trough filler is the same as cheek filler”

The tear trough has thinner skin, different anatomy, and higher perceived risk, so techniques and doses suitable for cheek fillers are not automatically appropriate for the under-eye.^{2 11}

Clinical pearl

Tear trough filler is a precision procedure; success is measured in small, natural improvements rather than dramatic volume changes.

Sources

1. Ahpra (2024), Guidelines for advertising a regulated health service (Advertising hub — guidance document), Australian Health Practitioner Regulation Agency. https://www.ahpra.gov.au/Resources/Advertising-hub/Advertising-guidelines-and-other-guidance/Advertising-guidelines.aspx ↩
2. Ahpra / National Boards (2023–2025), Guidelines for registered health practitioners who perform cosmetic surgery and non-surgical cosmetic procedures (Cosmetic surgery hub), Australian Health Practitioner Regulation Agency. https://www.ahpra.gov.au/Resources/Cosmetic-surgery-hub ↩
3. Therapeutic Goods Administration (2024–2025), Advertising health services & cosmetic injections: FAQs and Advertising a health service, Australian Government Department of Health and Aged Care. https://www.tga.gov.au/.../advertising-health-services-and-cosmetic-injections-frequently-asked-questions-and-answers ↩
4. Therapeutic Goods Administration (2024), Referring to cosmetic injectables in advertising (media release + guidance), Australian Government Department of Health and Aged Care. https://www.tga.gov.au/news/media-releases/referring-cosmetic-injectables-advertising ↩
5. NSW Health (2025), Beauty, body art and skin penetration industries (Public Health Act 2010 & Public Health Regulation 2022 fact sheet), NSW Government. https://www.health.nsw.gov.au/environment/factsheets/Pages/beauty-treatment.aspx ↩
6. NSW Health (2025), Skin penetration resources (hygiene, infection control & business design), NSW Government. https://www.health.nsw.gov.au/environment/skinpenetration/Pages/default.aspx ↩
7. Australian Commission on Safety and Quality in Health Care (2021), National Safety and Quality Health Service (NSQHS) Standards, second edition (clinical governance & safety standards), ACSQHC, Sydney. https://www.safetyandquality.gov.au/standards/nsqhs-standards ↩
8. Australian Commission on Safety and Quality in Health Care (2017–2023), NSQHS Standards consumer resources & factsheets (Partnering with Consumers Standard), ACSQHC, Sydney. https://www.safetyandquality.gov.au/standards/nsqhs-standards/partnering-consumers-standard ↩
9. RACGP (2015–2022), Submission: Regulation of medical practitioners who provide cosmetic medical and surgical procedures, Royal Australian College of General Practitioners. https://www.racgp.org.au/.../submission-to-medical-board-consultation-regulatio ↩
10. Medical Board of Australia (2023–2025), Cosmetic surgery & procedures guidelines and FAQs, Medical Board of Australia & Ahpra. https://www.medicalboard.gov.au/Codes-Guidelines-Policies/Cosmetic-medical-and-surgical-procedures-guidelines.aspx ↩
11. Zein M, Tie-Shue R, Pirakitikulr N & Lee WW 2020, Complications after cosmetic periocular filler: prevention and management, Plast Aesthet Res, 7:44, viewed 2025, https://pubmed.ncbi.nlm.nih.gov/33102629/. ↩
12. Hong GW, Hu H, Chang K, Park Y, Lee KWA, Chan LKW & Yi KH 2024, Review of the adverse effects associated with dermal filler treatments: Part I – nodules, granuloma, and migration, Diagnostics (Basel), 14(15):1640, viewed 2025, https://pubmed.ncbi.nlm.nih.gov/39125515/. ↩
13. Karlin J et al. (2023), Post-hyaluronic-acid recurrent eyelid oedema (PHAREE) — case-series review, viewed 2025, https://pubmed.ncbi.nlm.nih.gov/38828092/ ↩
14. Therapeutic Goods Administration (2025), Restricted and prohibited representations in advertising, Australian Government Department of Health and Aged Care, viewed 2025, https://www.tga.gov.au/products/regulations-all-products/advertising/applying-advertising-code/restricted-and-prohibited-representations-advertising. ↩
15. NSW Health (2025), How to clean and sterilise reusable skin penetration equipment and instruments (fact sheet), viewed 2025, https://www.health.nsw.gov.au/environment/factsheets/Pages/how-to-sterilise-instruments.aspx ↩