Periorbital Hollowness and Tear Trough

Abstract

Background: Periorbital hollowness and tear trough deformity represent common aesthetic concerns affecting the infraorbital region and contributing to a fatigued or aged facial appearance. The tear trough is defined as a concave depression extending from the medial canthus toward the mid-pupillary line at the lid–cheek junction. Its development is multifactorial, involving age-related changes in skin elasticity, redistribution and atrophy of orbital and midfacial fat, ligamentous tethering, muscle dynamics, and progressive skeletal remodeling of the infraorbital rim and maxilla. These anatomical and physiological alterations lead to a visible hollow that may be accompanied by hyperpigmentation, shadowing, and orbital fat prolapse, significantly influencing facial aesthetics and patient perception of aging. Because the periorbital region plays a key role in facial expression and social interaction, the presence of tear trough deformity can negatively affect self-confidence and quality of life. Understanding the anatomical basis, pathophysiology, and clinical presentation of infraorbital hollowness is therefore essential for accurate assessment and appropriate management. This mini-review highlights the current concepts regarding the anatomy, etiology, classification systems, and clinical significance of tear trough deformity, providing an overview that can guide clinicians in evaluation and treatment planning.