A short note on tear-trough technique, with the usual caveat that it is a very small series. Published December 29, 2025 in the Indian Journal of Ophthalmology, this single-center prospective case series followed 5 patients (ages 25 to 60, mean 38.6) treated with a bilaminar, two-plane hyaluronic acid approach. A high-G-prime filler (such as Voluma) went deep, supraperiosteal under orbicularis oculi, in 0.05 to 0.1 mL aliquots for structural support. A low-G-prime filler (such as Volbella) went superficial, subdermal, at 0.1 to 0.2 mL for contour, using both needle and cannula. Outcomes were judged by a blinded surgeon and by patient satisfaction at 2 weeks.

Blinded review rated 76.67% of assessments as significantly improved and 86.67% as symmetric, with mean patient satisfaction of 4.24 out of 5. Matching filler to plane let the firm product carry the deep skeletal support while the soft product smoothed the surface shadow, and the authors reported fewer surface irregularities and lower Tyndall risk. Adverse events were transient and bruising-related (ecchymosis 53.34%, hematoma 43.34%), a pre-existing Tyndall resolved, and no new Tyndall appeared.

The practical read: rather than one filler in one plane, consider matching rheology to depth, a firm high-G product on periosteum for support and a soft low-G product superficially for contour. Read the efficacy numbers cautiously, though. With n=5 and only 2 weeks of follow-up, this is hypothesis-generating, not a settled technique.

Source: Indian Journal of Ophthalmology (Vol 74, Issue 1, pp 133-140). https://pubmed.ncbi.nlm.nih.gov/41460143/