Sunken Tear Troughs, Not Just Fillers

"My under-eyes look hollow—can fillers fix it?"

This is the question most often asked by people who come in for consultations about sunken tear troughs.

To answer right away,

If the tear trough ligament is not released first, the effect of either fillers or fat grafting is limited.

Today, at MOOi Plastic Surgery✨, a beauty unlike any other, we’ll organize everything you need to know about the real cause of under-eye hollowness, why simply adding volume is not enough, and how to find the most suitable method for each individual.

An anatomical diagram of the tear trough ligament — the structure connecting the skin to the periosteum (the anatomical structure in which the tear trough ligament pulls the skin inward and creates under-eye hollowness)

The real cause of under-eye hollowness is the "ligament"

The tear trough ligament is a true ligament that connects the skin to the periosteum.

Because this ligament pulls the skin inward, the under-eye area looks hollow.

What happens if you only add volume with fillers or fat grafting without releasing this ligament?

The volume may be pushed only around the area where the ligament is pulling, which can actually make the surface uneven.

It works much like tying a rope to a piece of fabric and pulling it tight, then filling the inside with something.

Surgery vs. procedure: how are they different?

There are two main ways to release the tear trough ligament.

Comparison of the dissection range for surgical treatment (deep layer) and procedural treatment (shallow layer)

*Red arrow location: the periosteal area released surgically (deep level)

*Blue arrow location: the tear trough ligament area released through a procedure (relatively shallow level)

Category	Surgery	Procedure
Depth of ligament release	Periosteal level (deep layer)	Shallow layer under the skin
Method	Direct dissection during lower eyelid fat repositioning	Ligament relaxation using a radiofrequency device
Incision	Conjunctival incision (no external scar)	Only needle holes (almost no scar)
Degree of effect	Complete dissection even of deep ligaments	Mainly relaxation of shallow ligaments
Suitable candidates	Tear trough with bulging under-eye fat	Mild tear trough only
Volume replenishment	Fat repositioning and grafting possible during surgery	Fillers or fat grafting performed separately after the procedure

For people with very severe tear troughs, the deep layer is released surgically while the shallow layer is also relaxed with radiofrequency.

At MOOi Plastic Surgery, we guide you toward the most suitable method depending on your condition.

Common concerns during consultations

"I got fillers at another clinic, and it became uneven."

Many people come back for a second consultation with this concern.

In most cases, the cause is simply adding volume without releasing the tear trough ligament first.

If the ligament is released first, these problems are reduced.

Before-and-after photo review of tear trough ligament dissection + fat repositioning surgery showing natural results

Frequently Asked Questions (FAQ)

Q. Which should come first, tear trough fillers or surgery?

If under-eye fat bulging is also present, surgery comes first.

If there is only mild hollowness, radiofrequency treatment followed by filler can also be an option.

Q. If I have lower eyelid fat repositioning surgery, will the tear trough also improve?

If the tear trough ligament is released during surgery, it can improve.

However, if the fat is simply repositioned without releasing the ligament, the effect may be limited, so it’s a good idea to check the surgical method carefully.

Q. Is one treatment session enough?

With radiofrequency treatment, you may see results in about 1 to 2 sessions.

If volume replenishment is needed afterward, it will be done separately.

In summary,

the cause of under-eye hollowness is not a lack of volume, but the tear trough ligament.

If you only fill volume without releasing the ligament → unevenness, limited effect If under-eye fat bulging is also present → surgical ligament release + fat repositioning If there is only mild hollowness → radiofrequency treatment + volume replenishment

The key is to "release before filling."

We recommend a clinic that can accurately assess the condition of your under-eye area and knows which treatment is best suited to your eyes.

MOOi

MOOi Plastic Surgery

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As MOOi (無二) means "one and only," not two, MOOi Plastic Surgery designs a face that is uniquely yours—one of a kind in the world.

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This content was written directly by MOOi Plastic Surgery Clinic for informational purposes to make it easier to understand information related to procedures and surgery, in compliance with Article 56, Paragraph 1 of the Medical Service Act. Since all procedures/surgeries may vary by individual and may involve side effects, we recommend consulting with the attending medical staff before proceeding.