Tear Trough Deformity: Update on Anatomy and Clinical Management

Tear trough deformity represents a distinct and defining feature of lower eyelid aging and rejuvenation and is a frequent contributor to a fatigued or aged appearance. Management strategies vary widely, reflecting differences in patient anatomy, deformity severity, and surgical philosophy. This review updates contemporary anatomic concepts of the tear trough and integrates these findings with current clinical classification systems and treatment strategies relevant to lower eyelid rejuvenation. Validated grading scales facilitate stratification of deformity severity and guide patient selection. Nonsurgical management with hyaluronic acid fillers and biostimulatory injectables may be appropriate for carefully selected patients with mild deformities, good skin quality, and minimal lower eyelid laxity or fat herniation. Surgical correction remains the most predictable and durable option for moderate to severe deformities and includes techniques such as tear trough release with fat transposition, fat grafting, septal reset, and combined approaches, with emphasis on the senior author's preferred surgical strategy. Optimal outcomes are achieved by matching the treatment approach to the individual patient's anatomy and eyelid-cheek junction support while minimizing complications and contour irregularities.