Tear-trough filler, by an oculoplastic-trained injector.

Prices vary by clinic, by the injector\'s experience, by the product chosen and by whether the midface is treated in the same session. Insurance does not cover cosmetic treatment.

• Genuine tear-trough deformity (Barton grade 1 or 2)

  A true bony hollow along the orbital rim in the medial and mid pupil zones, with reasonable skin thickness and minimal fat-pad herniation.

• Age-related midface volume loss

  Loss of malar and suborbicularis fat that deepens the lid-cheek junction and casts a shadow. Often better treated with midface support before the trough itself.

• Genetic under-eye hollowing in a young patient

  A congenital bony hollow, unchanged for years, in a patient with good skin and no fat herniation. Usually the best-responding group.

• Dark circles that lift when you smile

  If the shadow softens when the cheek elevates, structural volume is a large part of the story and filler can help. Pigmented circles that stay put will not respond.

• Previous filler that has migrated or gone lumpy

  Old product placed too superficially, Tyndall blue tinge, palpable ridges or festooning. Dissolving with Hyalase first, then reassessment before any new filler.

• Not right: prominent herniated fat pads

  A visible bag above the trough is not a filler problem. Camouflaging with volume will make the bag look worse. Lower blepharoplasty is the honest recommendation.

• Not right: very thin, crepey or heavily pigmented skin

  Filler under paper-thin skin risks a bluish Tyndall effect and lumpiness. Skin boosters, polynucleotides or laser resurfacing should come first.

• Red flag: unrealistic expectations or body dysmorphia

  If you expect the shadow to vanish completely, or you have been to five clinics chasing the same complaint, we will decline and suggest a different conversation.

• Bruising and swelling

  The commonest side effect. Bruising in around 20 to 30% of cases, swelling for 24 to 72 hours in most patients. The under-eyes hold fluid, so morning puffiness can last a fortnight.

• Tyndall effect (bluish tinge)

  Superficial hyaluronic acid scatters light and looks blue through thin lower-lid skin. Correct depth (supraperiosteal) largely prevents it. If it happens, Hyalase resolves it.

• Prolonged oedema

  Hyaluronic acid draws water and the periorbital lymphatics are shallow. A minority of patients hold puffiness for weeks or months, particularly with more hydrophilic products.

• Lumps, ridges and malposition

  Palpable or visible product, usually from too-superficial placement or too much volume. Managed with massage, further small correction, or dissolving with Hyalase.

• Vascular occlusion (rare, serious)

  Accidental injection into the angular or facial artery, with retrograde flow to the ophthalmic artery, can cause skin necrosis or, very rarely, irreversible blindness. Cannula technique reduces but does not remove the risk.

• Vision-loss protocol

  Immediate stop, high-dose Hyalase flooding of the area, ophthalmology transfer within minutes, aspirin, ocular massage, warm compresses. Every clinic in our panel rehearses this.

• Infection and late-onset nodules

  Rare with sterile technique. Late-onset inflammatory nodules can appear months later and are usually treated with antibiotics, steroids or Hyalase.

• Duration: 12 to 18 months

  Realistic longevity in the tear trough. Product often outlasts its cosmetic effect because subtle changes settle over time. Retreatment on a yearly cadence is typical.

• When to call the clinic urgently

  Severe pain, blanching or grey mottling of the skin, sudden visual change, one-sided headache or nausea within hours of treatment. Call the clinic immediately or go to A&E.