Valley of Tears
back to main page
Tear trough is a characteristic depression running from the medial corner of the eye towards the cheek, along the border of the lower eyelid and the upper part of the cheek. This structure has an anatomical basis and is related to the natural formation of the soft tissues of the face, including the skin, subcutaneous tissue, ligaments, and orbital bones. In some individuals, the tear trough is visible from a young age, while in others, it gradually appears with the aging process. Its presence affects the aesthetic perception of the face, giving the eyes a tired, sad, or aged appearance, even in the absence of actual fatigue or illness.
Valley of Tears – what is it
From an anatomical perspective, the tear trough corresponds to the area of the tear trough ligament and the boundary between the thin skin of the lower eyelid and the thicker skin of the cheek. In this area, there is a natural loss of adipose tissue volume and a change in bone support. Characteristics of the tear trough include:
- Linear or semicircular indentation under the eye,
- More prominent shadow in the medial area of the orbit,
- Contrast between the lower eyelid and the cheek,
- Optical deepening of the orbit.
The tear trough is not a disease entity but an anatomical variant that can intensify due to age, lifestyle, and genetic factors.
The Valley of Tears – Causes
The formation and deepening of the tear trough is multifactorial in nature. The most important causes include:
Anatomical and genetic factors
- congenital structure of the orbit and cheek,
- low position or strong tension of the lacrimal ligament,
- predisposition to thin skin around the eye.
Aging processes
- atrophy of fat tissue in the orbit and cheek area,
- loss of collagen and elastin in the skin,
- resorption of the orbital and maxillary bones.
Environmental factors and lifestyle
- chronic fatigue and lack of sleep,
- smoking,
- exposure to UV radiation,
- dehydration of the body.
Changes in body weight
- rapid weight loss leading to loss of facial tissue volume.
In clinical practice, the tear trough rarely has a single cause – it is most often the result of several mechanisms overlapping at the same time.
Valley of Tears – treatment
The approach to treating the tear trough depends on its cause, depth, and the quality of the patient's skin. The treatment aims to:
- restore lost volume,
- improve skin quality and tension,
- reduce the contrast between the eyelid and the cheek.
Therapeutic methods include:
- conservative treatment (care, photoprotection),
- regenerative procedures improving skin structure,
- volumetric procedures,
- in selected cases, surgical treatment.
Proper patient qualification is crucial, as not every tear trough requires or tolerates volumetric treatment. It is a mistake to treat this area in isolation from the entire midface.
The Valley of Tears – Before and After
The evaluation of the effects of tear trough treatment should be conducted in an objective and multifaceted manner. The comparison before and after the procedure includes:
- the degree of shallowing of the indentation,
- improvement in the continuity of the eyelid-cheek junction,
- reduction of under-eye shadows,
- the naturalness of facial features at rest and in expression.
A properly conducted therapy should not lead to:
- excessive bulging of the under-eye area,
- disruption of lymphatic drainage,
- a "heavy" or swollen lower eyelid effect.
Contemporary medical approaches emphasize subtle correction and improvement of proportions, rather than the complete "erasure" of natural anatomical structures.
Valley of Tears – treatments
Various groups of procedures are used in the treatment of the tear trough, tailored individually to the patient's needs:
Procedures improving skin quality
- needle and microneedle mesotherapy,
- tissue biostimulators,
- therapies stimulating collagen synthesis.
Volumetric procedures
- administration of cross-linked preparations with appropriate rheology,
- volume restoration in the tear trough and medial cheek area,
- working in deep anatomical layers while adhering to safety principles.
Technological procedures
- microneedle radiofrequency,
- fractional laser therapy,
- procedures improving skin tension and density.
Surgical procedures
- lower blepharoplasty,
- redistribution or repositioning of fat tissue,
- correction of ligaments within the orbit.
The choice of procedure should be based on the analysis of facial anatomy, patient age, skin quality, and the desired effect. The treatment of the tear trough requires experience and precision, as it is one of the most demanding treatment areas on the face.
