Tear Trough (under-eye) Treatment Sydney

About The Under-Eye Area

Changes in the under-eye area usually develop slowly. Various contributors can influence these changes, such as sun exposure, ageing, anatomy, skin quality and even previous treatments. These changes can result in pigmentation, volume loss, thinning of the skin, visible blood vessels and muscle movement patterns around the eyes.

Individuals often request under-eye treatment after experiencing the following:

• Shadowing or hollowing under the eye area
• Thinning under-eye skin or changes in skin texture
• Creasing or fine lines beneath or around the eyes
• Changes in how the under-eye blends into the upper cheek
• Darkening under the eyes, including vascular or pigmentation visibility
• Heaviness in the lower or upper eyelids

Addressing The Under-Eye Area

Rather than treating the tear trough in isolation, we address the entire under-eye area, including its transition into the upper cheek and midface. This approach helps maintain a more balanced transition between the eyes and surrounding areas, reducing the likelihood of creating focal points that may become more noticeable over time.

When addressing the under-eye area, several treatments are available, including volumising treatments, light-based therapy and skin care.

Volumising For Under-Eye Treatment

When volume loss is the cause of under-eye hollowing, some individuals opt for volumising treatment. With this treatment, our cosmetic nurses carefully choose the placement depth and distribution of volumisers to support the broader under-eye region, not just the tear trough. This way, we can help maintain a balanced appearance to the under-eye area

Micro-Droplet Placement

When performing under-eye volumising treatment, we use a microdroplet placement technique. Tiny, precise amounts of product are placed throughout the under-eye region.

This technique is used for several reasons. Volumising products attract water. Therefore, these tiny spaces between the treatment sites are intentionally left to allow for even tissue integration and to avoid unnecessary (short-term or persistent) swelling.

Recovery After Your Under-Eye Treatment

• THE EVENING OF YOUR PROCEDURE: Tenderness, swelling and bruising can increase. This will typically resolve with time. Initially, there may be minor puncture marks. Temporary firmness, tightness and asymmetry can initially occur as the tissues respond and slowly settle.

We typically recommend using cold compresses during the first 24 to 48 hours. Strenuous activities should be avoided for the first 24 hours or until bruising has settled. We often recommend products such as arnica or vitamin K creams to help reduce bruising (as advised by your treating cosmetic nurse and prescribing doctor).

• DAYS 1 to 3: Swelling and bruising often become noticeable.
• DAYS 4 to 7: Swelling typically continues to reduce. Bruising can persist for up to two weeks or longer in some cases.

Final Results & Ongoing Care

The final results following under-eye tear trough treatment will be visible over two to four weeks, once swelling has subsided, and tissues have stabilised. In some cases, further treatments will be required, depending on the treatment response and the individual’s anatomy.

If you experience any unexpected or worsening inflammatory response, please contact the clinic immediately. Late-onset inflammatory reactions can occur weeks to months following treatment. They may need further assessment or management.

If you have concerns outside clinic hours, please go to your local medical centre or the emergency department at your hospital.

General aftercare advice includes gentle cleansing, avoiding active skincare products in the treated area, resuming normal daily activities when comfortable and delaying makeup application for at least 12 hours. Patients should also avoid strenuous exercise, sun exposure, alcohol and additional facial or light-based treatments for a period advised by their appropriately trained health cosmetic nurse.

We recommend sleeping with your head elevated for the first day or two.

Other Upper & Under-Eye Area Treatments

Heavy Upper & Lower Eyelids

Specific patterns of muscle movement (rather than volume or skin quality) can cause heavy eyelids. Typically, ongoing contractions of the muscles surrounding the eyes can cause changes in eyelid position and the development of fine lines.

When appropriate, excessive muscle contraction can be treated with a muscle relaxant. This softens the dynamic lines, allowing the eye area to sit in a more relaxed position.

Muscle relaxant treatment is typically quick. The effects become noticeable over one or two weeks.

Under-Eye Dark Circles

Pigmentation, loss of volume, vascular visibility and muscle activity around the eyes can all influence the appearance of dark circles. By developing a treatment plan, we can consider which factors contribute to this appearance.

Muscle relaxant treatment can sometimes be considered for some individuals. This treatment minimises excessive muscle activity and addresses the eyelid position. Once muscle activity has been addressed, we can reassess the under-eye area to determine whether volumising or additional treatments are appropriate.

When shadowing is caused by volume deficiency, we may introduce volumising treatment along the outer under eye region, blended into the upper cheek support natural contour integration.

Other Under-Eye Treatments

Laser & Other Light-based Therapies

Aside from volume concerns, the under-eye area can also be affected by pigmentation, redness and visible blood vessels. In these cases, we may address the concerns with laser or other light-based therapies.

Laser technology targets pigment or blood vessels, which are then gradually processed and cleared by the body. Multiple sessions are often required, with treatment tailored to individual skin type and response.

Depending on an individual’s anatomy and skin concerns, we may use these treatments in conjunction with muscle relaxants and skin volumisers.

Medical-Grade Skincare

An individual’s skin quality strongly influences the appearance of the under-eye area. Changes in skin texture, thinning and reduced elasticity all affect the under-eye appearance. Medical-grade skincare can support skin health and complement in-clinic treatments such as muscle relaxants.

Although skincare will not replace in-clinic treatments, it can support overall skin quality and help address changes in texture and appearance.

If under-eye pigmentation or visible vascular features are present, we may also discuss incorporating laser treatments into a broader treatment plan.

Special Considerations In The Under-Eye Area

Cosmetic nurses performing under-eye treatment should be appropriately trained and thoroughly experienced in aesthetic medicine. The under-eye area presents several factors that must be carefully considered, including thinning skin, the Tyndall effect, and puffiness and fluid retention. There are also factors such as whether the patient has had previous under-eye treatments, any considerations regarding dissolving products, and whether the patient has been refused under-eye treatment by another practitioner.

Thin Skin

The delicate nature of under-eye skin means treatment planning must be approached with care. However, having thin skin does not automatically rule out tear trough treatment. The choice of technique, product and overall approach is critical when working in this area. In cases where the skin is particularly fine, a needle-based technique is often selected to provide greater precision over placement depth and the amount of product used. Although this method may result in more noticeable bruising initially, this typically settles as healing occurs and the tissues stabilise.

Tyndall Effect

The skin under the eyes is naturally fine and continues to thin as part of the ageing process. If volumising product is placed too close to the surface, used in excess, or applied in a way that does not suit an individual’s anatomy, a blue-grey or shadowed discolouration known as the Tyndall effect can develop. This risk can be reduced through careful product selection, appropriate placement depth and conservative use of volume.

Puffiness and Fluid Retention

Under-eye swelling or puffiness may occur when product selection, placement or volume does not sufficiently account for tissue behaviour or lymphatic drainage. Over time, product migration can also contribute to this appearance. Using small amounts of product, introducing volume gradually and distributing it evenly across the under-eye and upper cheek region can help reduce tissue overload and lower the risk of ongoing puffiness. This is particularly the case in those who are prone to swelling.

Previous Under-Eye Treatment and Dissolving Considerations
Individuals who have previously had tear trough or under-eye volumising treatments may still have residual product within the tissues. If the area appears persistently swollen, feels chronically irritated, or no longer reflects the individual’s aesthetic goals, further volumising treatment is generally not advised.

Adding more product where existing material remains can increase the risk of prolonged puffiness, fluid retention, inflammation or surface irregularities. In such cases, dissolving treatment may be recommended as a first step. Removing or reducing residual product allows the tissues to settle and creates a clearer foundation for future treatment planning, where appropriate.

Being Told You Are Not Suitable for Tear Trough Treatment

Some people explore under-eye treatment after being advised elsewhere that they are not suitable candidates, often because of thin skin, prior treatments or the complexity of the under-eye area.
While not everyone is suited to every treatment option, non-surgical approaches may still be considered following a thorough assessment. A detailed evaluation of anatomy, skin quality and treatment history allows for a personalised treatment plan, rather than applying a uniform approach to every individual.

Imaging & Baseline Assessment

Magnetic Resonance Imaging (MRI) and Ultrasound

In some cases, particularly when the patient has had previous volumising treatments and there is some uncertainty about the treatments, we may recommend diagnostic imaging as part of the assessment.

MRI: An MRI provides a detailed evaluation of soft tissues and can help identify the depth and distribution of previously placed product, fibrosis, scar tissue, areas of fluid retention (oedema) and features that may indicate chronic information within the under-eye or midface region. MRA can also help determine how soft tissues have changed after repeated treatments.

Ultrasound: Ultrasound imaging can be used as an additional assessment tool in select situations. It provides a real-time visualisation of superficial soft tissues and can help identify the presence and approximate location of fluid collections, previously placed products or tissue irregularities. When used appropriately, ultrasound can support clinical decision-making by helping establish a clearer baseline before dissolving or further treatment.

The most appropriate imaging method is selected on a case-by-case basis, and based on an individual’s clinical history, examination findings and broader treatment planning considerations.

Individualised Treatment Planning

Every patient must be thoroughly assessed to allow multiple factors to be considered. These factors include tissue behaviour, anatomy, previous treatments and longer-term implications. Importantly, under-eye concerns should not be addressed solely by volumising treatments.

Sometimes, treatment is done in stages, combined with other therapies, or delayed to ensure safety and optimal results. Your health, tissue condition and professional assessment guide our cosmetic nurses’ decisions.

Lower Eyelid Surgery (Blepharoplasty) vs Non-surgical Options

When an individual is concerned about under-eye skin laxity, we often initially explore non-surgical treatment options, such as skin-focused treatments, laser-based therapies or volumising treatments. These treatments are aimed at supporting the underlying structures and skin quality.

However, sometimes, non-surgical treatments may not be enough to address the issues, and surgical options such as lower eyelid surgery (blepharoplasty) may be more suitable. To make an informed decision regarding treatment options, an individual must undergo a thorough assessment and discussion of available options.

Potential Risks & Side-Effects

All non-surgical aesthetic procedures carry a degree of risk, particularly in delicate regions such as the under-eye area.

Common post-treatment responses can include redness, tenderness, bruising, swelling, itchiness, minor bleeding at treatment sites or temporarily altered sensations. These effects can occur straight after treatment or days or hours afterwards. However, they typically resolve as the tissues settle.

Less common risks may include localised hypersensitivity reactions, skin discolouration, infection, the formation of nodules or areas of firmness or changes related to surrounding muscle activity. As the under-eye area has thin skin, complex vascular anatomy and limited tissue coverage, conservative treatment planning and careful techniques are essential.

Extremely rare but serious complications can occur when the product has been unintentionally placed within a blood vessel. Such occurrences have been reported in medical literature. They can cause temporary or permanent effects such as blindness, visual impairment, haemorrhage leading to stroke, cerebral ischaemia, skin necrosis and damage to underlying structures. These risks are serious, although uncommon, and will be discussed with you during your consultation with both your treating cosmetic nurse and prescribing doctor. Further information is also outlined on our Potential Risks page.

FAQs

Why is it important to administer volumising treatments conservatively?

If volumising treatment is not administered conservatively, long-term issues can result, including persistent puffiness, visible product, fluid retention, chronic inflammation, the Tyndall effect, nodules and fibrous tissue formation. Therefore, cosmetic nurses must have the qualifications, knowledge and experience to place the volumising product conservatively.

Do you only treat their tear trough in tear trough treatment?

No, we don’t just treat the tear trough in tear trough treatment. We must address the under-eye area and its integration with the midface and surrounding structures.

Why is it important to blend the under-eye area into the upper cheek area?

Once your tissues have settled after treatment, it’s vital that the under-eye and upper cheek areas transition and appear natural-looking. By blending across this junction, we support continuity through the middle face and help reduce the likelihood of visible edges.

Is long-term planning essential for under-eye volume treatment?

Yes, when planning under-eye volumising treatments, we must consider not only the immediate response but also how the area may change over time. For example, age-related changes may include bone resorption, thinning of the under-eye skin, loss of facial fat, alterations in lymphatic drainage and changes in ligament support. All these changes can affect how previously placed products behave and appear going forward.

What is the Tyndall effect?

The Tyndall effect occurs when a shadowed or blue-grey discolouration appears beneath the eyes. It can happen when volumising product is placed too superficially beneath the thin, under-eye skin. This effect can be noticeable as skin continues to thin with age or in specific lighting conditions.

Why does the under-eye area change over time?

The area under the eye can become more hollow or appear darker for various reasons. Volume loss, pigmentation changes and visible blood vessels can all create shadowing beneath the eyes. Additionally, fine lines, wrinkles and heaviness in the upper or lower eyelids can contribute to these changes. Treatments for this area are always individualised, as there are multiple underlying causes rather than a single contributing factor.

Should nurses use a cannula or a fine needle for under-eye volumising treatments?

Either a cannula or a fine needle can be used for volumising treatments under the eyes. A cannula allows the product to be introduced to a single entry point and distributed along a treatment plane. It can sometimes reduce the likelihood of immediate bruising.

However, we prefer to use a fine needle for this procedure. A needle allows for greater precision and depth control, which is vital when utilising a droplet placement technique. This method also enables targeted placement (including onto the bone, where appropriate), while minimising unnecessary volume in areas where long-term visibility of the product may be a concern.

Can under-eye treatments cause under-eye puffiness?

Patients can experience under-eye puffiness when a cosmetic nurse makes poor decisions regarding product choices, placement techniques, or product volume, which interferes with lymphatic drainage. Therefore, individuals should choose an experienced and qualified cosmetic nurse who focuses on careful treatment planning, emphasising conservative volume use, strategic distribution, and lymphatic awareness.