Tear Trough Treatment Without Fillers – What are Your Options?

Medically Reviewed
Medically Reviewed by Dr. Aurora Kalmanson on
Written by Fillers Editorial Team, plastic surgery specialists.

For those seeking relief from the sagging, hollow appearance under the eyes, various non-filler tear trough treatments offer effective solutions. Techniques such as radiofrequency treatments, laser therapies, and microneedling can rejuvenate the delicate under-eye area without the need for injectable fillers.

These advanced procedures work by stimulating collagen production, tightening the skin, and reducing the appearance of dark circles, providing a refreshed and more youthful look. They cater to different skin types and concerns, with specific benefits like minimal downtime and gradual, natural-looking results.

Non-Filler Treatment Options for Tear Troughs

Embracing the latest advancements in aesthetic medicine, a range of non-filler treatment options target the challenging tear trough area. They offer safer and subtler alternatives to injectables, using the body’s regenerative capabilities.

Radiofrequency (RF) Treatments

How RF Treatments Work: Radiofrequency treatments are at the forefront of non-surgical tear trough rejuvenation. Utilizing controlled radio waves, this technology gently heats the skin’s deeper layers, triggering the natural healing response. The thermal energy encourages fibroblasts to produce more collagen and elastin—the building blocks of resilient, youthful skin. As this regenerative process unfolds, the skin under the eyes begins to thicken and tighten, effectively mitigating the tired appearance often associated with tear troughs.

Benefits of RF for Tear Troughs: The appeal of RF treatments lies in their gentle approach to skin tightening and their versatility across skin types. They are particularly beneficial for the tear trough region due to their ability to restore skin integrity with minimal discomfort. As collagen remodels over time, patients see a progressive improvement in under-eye contours. Moreover, the capability of RF treatments to lift and firm without disrupting the skin’s surface translates to virtually no recovery time, which is a significant advantage for busy individuals.

Treatment Process and Results: The process of an RF treatment for tear troughs is straightforward and relatively comfortable. After preparing the skin, a practitioner applies the radiofrequency device to the targeted area, where it emits energy to stimulate collagen synthesis. Patients often describe a warm sensation during the treatment, which indicates the activation of the collagen-producing cells. Following the session, there’s typically no need for significant downtime, allowing a prompt return to daily activities. Results appear gradually, culminating in a firmer, replenished appearance that evolves over several weeks to months.

Laser Treatments

CO2 Laser for Fair Skin Tones: The CO2 laser stands out as a robust treatment for revitalizing fair skin affected by tear trough concerns. Renowned for its efficacy, this reductive laser technique delicately removes layers of skin, stimulating a vigorous healing response. The precision of the CO2 laser allows for targeted treatment, minimizing the risk to the delicate under-eye area while promoting collagen regeneration. As the skin heals, it becomes smoother and tighter, which can dramatically reduce the depth of tear trough indentations.

The full effect of the CO2 laser emerges as the skin progresses through its healing stages, revealing a softer and more youthful under-eye appearance. While downtime is necessary to accommodate the skin’s healing process, the results can be transformative, offering a long-term solution for those fighting with signs of aging around the eyes. However, the CO2 laser’s intensity makes it a better match for lighter skin tones, as it can pose a risk of pigmentation changes in darker complexions.

Nd:YAG Laser for Visible Veins: The unattractive veins beneath the eyes can make the appearance of dark circles worse, making the Nd:YAG laser an ideal option. By emitting a wavelength that specifically targets the pigment in blood vessels, this laser can effectively diminish the visibility of veins without harming the surrounding tissue. As a non-ablative laser, the Nd:YAG focuses on the underlying vascular concerns without disrupting the skin’s surface layer.

Patients who choose the Nd:YAG laser for vein treatment in the tear trough area benefit from the laser’s precision and the minimal downtime involved. The laser sessions are relatively quick, and while multiple treatments may be needed for optimal results, patients often notice visible improvement in the darkness and shadowing under the eyes as the unwanted veins fade away.


Traditional Microneedling: A cornerstone in skin rejuvenation, traditional microneedling is a manual procedure that uses a device covered with fine needles to create micro-injuries in the skin. This minimally invasive practice activates the body’s innate repair mechanisms, culminating in the formation of new collagen and elastin. Beyond enhancing skin firmness and elasticity, microneedling also encourages more even skin texture and tone, which can significantly improve the appearance of the under-eye area.

For tear troughs, traditional microneedling offers a customizable approach, as the needle depth can be adjusted to suit the sensitivity of the under-eye skin. Over a series of treatments, patients can witness the gradual yet noticeable revitalization of the skin, with reduced hollowness and softened lines, making traditional microneedling a cherished tool in the fight against aging.

Radiofrequency Microneedling (Morpheus8): Augmenting the benefits of traditional techniques, radiofrequency microneedling, such as the Morpheus8, delivers an innovative fusion of microneedling and thermal energy. The Morpheus8 device plunges tiny needles into the skin while simultaneously emitting radiofrequency waves. This combination induces deep tissue remodeling and substantial collagen production. Tuned specifically for the delicate under-eye skin, the treatment can address a multiplicity of issues from fine lines to volume loss associated with tear troughs.

After the Morpheus8 session, patients can anticipate minimal downtime paired with progressive skin improvement. As the newly synthesized collagen matures, it lends volume and tautness to previously lax skin. Over time, this leads to a smoother, firmer appearance under the eyes, making Morpheus8 a sought-after choice for those avoiding fillers.

Chemical Peels

TCA Peels for Lighter Skin Tones: For individuals with lighter skin seeking to revitalize the under-eye area, Trichloroacetic Acid (TCA) peels present a compelling option. TCA peels exfoliate the skin by causing the top damaged layers to peel off, revealing newer, less blemished skin underneath. With concentrations that can be adjusted, TCA peels can penetrate deeper than many other peels, making them effective for treating the fine lines and subtle hollowness associated with tear troughs.

The post-peel recovery involves a visible shedding of the skin, which ultimately results in a smoother texture and a more uniform skin tone. While TCA peels are particularly advantageous for treating surface irregularities and stimulating collagen in fairer skin, they require strict sun protection post-treatment to prevent hyperpigmentation. When performed by an experienced practitioner, TCA peels are a powerful tool for under-eye rejuvenation.

Glycolic Acid Peels for Darker Skin Tones: Glycolic acid, an alpha-hydroxy acid (AHA), is renowned for its exfoliating properties and suitability for darker skin tones. In the treatment of tear troughs, glycolic acid peels offer a mild yet effective approach, gently removing the outermost layers of dead skin to reveal brighter, more radiant skin. Their superficial peeling action helps to reduce the appearance of dark circles, improving the overall look of the under-eye area.

The beauty of glycolic acid peels is in their ability to refine skin texture without significant downtime, making them an appealing choice among non-filler options. Customizable in strength, these peels accommodate the unique sensitivity of the tear troughs and are less likely to cause undesirable pigmentary changes in darker skin — a common concern with more invasive procedures.

Platelet-Rich Plasma (PRP) Therapy

How PRP Works for Tear Troughs: PRP therapy takes advantage of the healing power of one’s own blood. The concentrated plasma, rich in platelets and growth factors, is reintroduced to the under-eye area to enhance the natural regenerative processes. When applied to tear troughs, PRP works to restore volume and improve skin quality from within. By promoting the regeneration of healthy tissue and the formation of new blood vessels, PRP can reduce the appearance of dark circles and improve skin texture.

This autologous treatment modality not only fills the troughs but also stimulates longer-lasting rejuvenation. As PRP therapy continues to rise in popularity due to its organic nature and efficacy, it stands as a compelling alternative to traditional fillers for those seeking a natural path to under-eye rejuvenation.

Treatment Process and Results: The process of PRP therapy involves a simple blood draw, followed by a centrifugation to isolate the platelet-rich plasma. The practitioner then carefully injects the PRP into the tear trough area. While some mild bruising or swelling may occur, there is typically no extensive downtime, and patients can resume their activities promptly.

Positive changes can be observed as the skin begins to regenerate, with optimal results manifesting after multiple treatments. As PRP bolsters the skin’s regenerative capacities, patients notice a gradual improvement in the plumpness of their under-eye skin, with outcomes that can last up to a year or longer.

Polynucleotide Treatments

Nucleofill for Under-Eye Volume Loss: Nucleofill is a cutting-edge treatment gaining attention for its ability to tackle under-eye volume loss. This bio-revitalizing product is rich in polynucleotides, which are known for their regenerative properties. When injected into the tear trough area, Nucleofill works at a cellular level. It not only provides immediate volume but also activates long-term biostimulation processes.

The treatment leads to the reinforcement of the skin’s structural integrity, improving elasticity and hydration. As the skin naturally rejuvenates, patients see a reduction in under-eye hollowness. Visible improvements become apparent after a series of treatments, positioning Nucleofill as a promising alternative to traditional filler methods for those seeking a holistic approach to under-eye rejuvenation.

Benefits and Treatment Process: Polynucleotide treatments like Nucleofill offer a multi-faceted approach to under-eye rejuvenation. They excel not only in restoring volume but also in improving the overall skin quality by hydrating from within and defending against stress. Treatment with Nucleofill initiates a flow of cellular renewal, leading to increased resilience and suppleness in the under-eye area.

The procedure involves a series of small injections, delivering the product directly to the areas of concern. Typically well-tolerated, the process requires minimal downtime, and any mild swelling diminishes quickly. The holistic benefits of polynucleotide treatments, including their safety profile and ability to surrender natural-looking results, make them an attractive option in the realm of aesthetic medicine.

Surgical Options for Tear Trough Correction

Advanced surgical techniques provide enduring solutions for those with notable tear trough deformities, offering permanent changes instead of non-surgical alternatives.

Lower Blepharoplasty

Procedure Overview: Lower blepharoplasty stands as a reliable surgical option for correcting tear trough deformities. The procedure entails the removal or repositioning of fat, as well as the removal of excess skin and muscle to refine the under-eye region. Incisions are typically concealed just below the lash line or inside the eyelid, ensuring scars are virtually undetectable once healed.

The surgery is meticulously performed to create a smoother, more youthful contour between the lower eyelid and the cheek. As a result, patients can enjoy a significant reduction in under-eye bags and hollows, with outcomes that are more permanent than non-surgical approaches.

Ideal Candidates: The best candidates for lower blepharoplasty are individuals experiencing persistent puffiness, significant bags, or deep tear troughs that do not respond well to non-surgical treatments. Candidates should be in good overall health, non-smokers, and have realistic expectations about the outcomes of the surgery.

People with good skin elasticity and strong underlying muscle tone tend to experience the most favorable results. It’s also important for candidates to have a thorough preoperative evaluation to ensure any potential risks are mitigated, paving the way for optimal aesthetic and functional results from the surgical correction.

Results and Recovery: The results of lower blepharoplasty can be significantly transformative, restoring a more youthful and rested appearance. Patients typically observe a noticeable reduction in under-eye bags and a smoother transition from the lower eyelid to the cheek. These aesthetic benefits are long-lasting, with many patients enjoying the results for years to come.

Recovery from lower blepharoplasty usually takes a few weeks, during which patients may experience bruising and swelling. It’s critical to follow the surgeon’s postoperative instructions, which may include applying cold compresses, keeping the head elevated, and avoiding strenuous activities. Sticking to these guidelines not only ensures comfort but also optimizes the healing process for the best possible outcomes.

Fat Transfer

Procedure Overview: Fat transfer for tear trough correction requires the harvesting of the patient’s own fat, typically from the abdomen or thighs, via liposuction. The fat is then processed and injected into the tear troughs. This autologous procedure aims to fill the hollow areas, providing volume and improving the region’s contour. As it uses the patient’s own tissue, the risk of allergic reactions is minimized, and the results can blend smoothly with the natural facial structure.

The technique requires precision, but it offers a dual benefit: reducing unwanted fat in the harvest area while rejuvenating the under-eye region. This natural filler alternative is gaining popularity as patients seek more organic and long-term solutions to under-eye concerns.

Benefits and Limitations: Fat transfer offers a natural appearance with the added benefit of long-term results, as the transferred fat integrates into the facial tissue. The procedure also avoids the risk of the body rejecting the material since it’s harvested from the patient’s own body. Additionally, it can improve the overall skin quality in the tear trough area.

However, limitations include variability in fat survival rates post-transfer, which can lead to less predictability in outcomes compared to synthetic fillers. There’s also a more significant recovery period involved due to the liposuction process, and touch-up procedures may be needed to perfect the results.

Frequently Asked Questions

How long do the results of non-filler tear trough treatments last?

Results can vary widely but typically last from several months to years, depending on the treatment type and individual patient factors.

Are non-filler treatments for tear troughs painful?

Most non-filler treatments involve minimal discomfort, with many utilizing topical anesthetics or cooling methods to reduce any potential pain.

What is the recovery time for non-filler tear trough treatments?

Recovery time can range from virtually none to a week or more, largely depending on the specific procedure performed.

Can non-filler treatments be combined with fillers for tear troughs?

Yes, non-filler treatments like laser therapy or microneedling can often be used in conjunction with fillers to enhance overall results.

How much do non-filler tear trough treatments cost compared to fillers?

Non-filler treatments can vary in cost, some of which may be more cost-effective over time compared to fillers due to their longevity.

Are there any risks or side effects associated with non-filler tear trough treatments?

While generally safe, potential side effects can include swelling, bruising, and skin irritation, which are typically temporary.

How many sessions are typically required for non-filler tear trough treatments?

The number of sessions needed can vary; some treatments may require multiple appointments to achieve optimal results.

Can non-filler treatments help with dark circles and pigmentation under the eyes?

Many non-filler treatments can improve dark circles and pigmentation, especially those designed to resurface the skin and stimulate collagen production.

Who is a good candidate for non-filler tear trough treatments?

Good candidates are typically those looking to address tear trough concerns without injectables and who have realistic expectations about the results and process.


Selecting the right approach to tear trough correction is integral to achieving your aesthetic goals. Whether through advanced non-filler techniques, surgical remedies, or a combination of methods, individuals now have too many options for rejuvenating this delicate facial area. Each potential solution comes with specific benefits, appropriate for diverse issues from subtle bags to more pronounced hollows. Personal preferences, desired results, and the expert guidance of a skilled practitioner play crucial roles in shaping the treatment journey towards a refreshed, bright-eyed appearance.

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iang, J., Wang, X., Chen, R., Xia, X., Sun, S., & Hu, K. (2016). Tear trough deformity: different types of anatomy and treatment options.,7,28106,0,1.html

Dr. Aurora Kalmanson

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The information provided in this blog is for informational and educational purposes only and should not be interpreted as personalized medical advice. It's crucial to understand that while we are medical professionals, the insights and advice we provide are based on general research and studies. They are not tailored to individual health needs or conditions. Thus, it is essential to consult directly with a healthcare provider who can offer personalized medical advice relevant to your specific situation.