Tear Trough (Lacrimal Groove): Anatomy
- Highlighted area
Quick facts
- Location
- A groove that starts at the inner corner of the eye and runs diagonally outward, over the lower rim of the orbit.
- Anatomical basis
- The tear trough ligament, which anchors the skin to the bone at the inferomedial rim of the orbit.
- Skin and tissues
- Very thin skin, almost no subcutaneous fat, over the orbicularis oculi muscle.
- Vascular risk
- High: territory of the angular artery and of branches linked to the circulation of the eye; infraorbital foramen below.
- In Harmy
- Corresponds to the Tear Trough point of the marking.
The tear trough (also called the lacrimal groove) is the groove that starts at the inner corner of the eye and runs diagonally outward, following the lower rim of the orbit. It marks the transition between the lower eyelid and the cheek in the medial portion, near the nose. When it gets deep, it creates the shadow that patients call hollow under-eyes.
Where is it and what forms the groove?
The base of the groove is the tear trough ligament, a firm attachment between skin and bone at the inferomedial rim of the orbit. It is part of the face's retaining ligaments and continues outward with the orbicularis retaining ligament, which draws the palpebromalar groove.
| Portion | Usual name | Structure that marks it |
|---|---|---|
| Medial, near the nose | Tear trough | Tear trough ligament |
| Lateral, under the pupil and outward | Palpebromalar groove | Orbicularis retaining ligament |
| Below and diagonal on the cheek | Midcheek groove | Zygomatic ligaments and the transition between fat compartments |
The skin here is among the thinnest in the body and has almost no subcutaneous fat over the orbicularis oculi muscle. That is why any depression or irregularity shows easily.
Why does the tear trough become more pronounced?
It is rarely a single factor. Usually these combine:
- Loss of volume and descent of the cheekbone fat compartments, which no longer support the transition.
- Herniation of lower eyelid fat (a bag), which increases the contrast with the groove just below.
- Bone remodeling of the orbital rim with age.
- Constitutional factors: many young people have a marked groove by anatomy.
Separating these components is what defines the indication. Severity classifications are described in the literature, but the assessment of each patient, with proper lighting and in different positions, is what guides the plan.
Why does it matter in HOF?
It is the area of under-eye filler, a procedure with good results in well-selected patients and its own complication profile: persistent swelling, irregularities, the Tyndall effect when the product sits too superficially and, more rarely, vascular occlusion.
How does it show up in the assessment?
- With light from above, the groove casts a shadow; with soft frontal light, it nearly disappears. Always photograph with the same lighting.
- Ask the patient to look up: the fat bag usually becomes more evident.
- Look for morning swelling, pigmentation and visible vessels, which do not improve with volume.
- Assess the support of the cheekbone before thinking about the groove in isolation.
Also called: lacrimal groove, nasojugal groove, nasojugal fold.
Frequently asked questions
Are the tear trough and under-eye circles the same thing?
Not exactly. The tear trough is an anatomical groove. Under-eye circles are the patient's concern and can involve a groove, pigmentation, visible vessels, thin skin or bags, alone or together.
Why is the tear trough considered high risk?
Because it lies in the territory of the angular artery, which communicates with the circulation of the eye. An occlusion there can, in rare cases, affect vision. That is why hyaluronidase and an emergency protocol are indispensable.
What is the difference between the tear trough and the palpebromalar groove?
The tear trough is the medial portion, near the nose. The palpebromalar groove is the lateral continuation of the same line, marked by the orbicularis retaining ligament.