Tear Trough and Under-Eye Treatment in Marylebone, London
Dark, hollow shadows under the eyes read as fatigue and add years to the face. The right treatment depends on whether the shadow is volumetric (filler), skin-quality driven (polynucleotides), or pigmentary — so patient selection matters more here than for most concerns.
Book Consultation
What you're seeing
The concern
The tear trough is the hollow groove that runs from the inner corner of the eye outward beneath the lower eyelid. When the skin is thin or the soft-tissue volume below the eye reduces with age, light falls into the groove and casts a permanent shadow that the eye reads as tiredness — present even after a full night’s sleep. What looks like one problem is usually three: true volume loss (the hollow itself, responsive to filler), skin-quality decline (thin, crepey lower-lid skin, responsive to regenerative treatment), and pigmentation (hereditary or sun-related darkening). Many patients have a mix.
Dr Elgey’s approach here is cautious and selective. The under-eye is one of the highest-risk areas in aesthetic medicine because of the blood vessels around the eye, and not every under-eye shadow is filler-appropriate — placing filler into a shadow that is actually pigmentary or skin-quality driven under-delivers and can worsen how light catches the area. The consultation tests for all three mechanisms in good light. HA filler is used only where genuine hollowing is the cause, placed conservatively and chosen for low water-retention so it does not produce puffiness or a bluish tint in the thin lower-lid skin; it remains fully dissolvable. Where skin quality is the driver, polynucleotides are usually the better answer.
Why it happens
What drives it
- Volume loss in the soft-tissue fat pad below the eye with age
- Hereditary skeletal anatomy (a deep tear trough present from a young age)
- Thin, crepey lower-eyelid skin that loses light reflection
- Hereditary periorbital pigmentation, more common in darker skin types
- Cumulative UV damage producing under-eye pigmentation
- Lifestyle: chronic poor sleep, dehydration, and smoking
Treatment approach
How Paul treats it
Dermal Fillers
By consultationFor true volumetric hollowing, hyaluronic acid placed conservatively along the bony rim restores light reflection and softens the shadow. A low-water-retention product is chosen so it integrates cleanly without puffiness or a bluish tint in the thin lower-lid skin, and it remains fully dissolvable. This is a high-risk area treated only where genuine hollowing is the cause.
See treatment detail →Polynucleotides
By consultationWhere the under-eye shadow is driven by thin, crepey skin rather than volume loss, polynucleotides stimulate collagen and improve the quality of the lower-lid skin over a short course — frequently a safer and more appropriate choice than filler for textural under-eye concerns.
See treatment detail →UltraClear Laser Resurfacing
By consultationWhere surface texture and tone around the eye contribute to the tired appearance, UltraClear laser resurfacing can be considered as part of the plan, with suitability and settings confirmed for your skin type at a doctor-led assessment.
See treatment detail →FAQ
Common
questions
Will tear-trough filler completely remove my under-eye shadows?
Only if the shadow is mainly caused by hollowing. If thin skin or pigmentation is the driver, filler alone will under-deliver and can even worsen the look by changing how light catches the area. The consultation tests for all three causes — many patients leave with a plan that combines polynucleotides for skin quality with a small amount of filler for residual hollowing, rather than filler alone.
Is under-eye filler safe?
It is one of the higher-risk aesthetic areas because of the blood vessels around the eye, so it should only be done by an experienced medical practitioner. Risk is reduced by conservative technique, the right product choice, and a doctor who knows the anatomy and screens you first. Hyaluronic acid is used precisely because it can be dissolved with hyaluronidase if there is ever a concern.
How long does under-eye filler last?
Typically 12 to 18 months, because the under-eye area moves less than most facial sites so the product breaks down more slowly. The product is selected specifically for low water-affinity to avoid the puffiness or bluish "Tyndall" tint that more water-loving fillers can cause in the thin lower-lid skin. Results are reviewed and refined rather than over-corrected on the first visit.
What if my dark circles are just hereditary pigmentation?
Then filler is the wrong answer and would not help the colour. A pigment-led shadow is better managed with a topical skincare regimen (such as vitamin C, a retinoid, and daily SPF) and, where appropriate, resurfacing treatment — and sometimes simply accepted as a feature of your anatomy. An honest consultation will tell you if filler is not the right tool rather than treating regardless.
Does polynucleotides under the eye really work?
For skin-quality-driven shadows — thin, crepey lower-lid skin — yes. A short course of sessions stimulates the skin to thicken and improves light reflection, with visible change over the weeks following treatment. It is often the more appropriate first step than filler when texture rather than hollowing is the main issue. Progress is best judged with photographs at each visit rather than the bathroom mirror.
Get Started
Ready to begin?
Book today.
Dr Paul Elgey Aesthetics • Unit 1, Orchard Street, London W1H 6HJ
BookAppointments typically available within 1–2 weeks