Today, let’s talk about tear trough and lacrimal groove evaluation. Currently, many skin care products claimed that they could mitigate the tear trough and the lacrimal groove.
Actually, tear trough and lacrimal groove are two different periorbital issues. Sometimes they conflated, likely because they often coexist.
Let’s take a look at the differences between them:
Definition and Location
Category | Tear Trough | Lacrimal Groove |
Definition | The tear trough is a natural line that starts at the inner corner of the eye and runs downward across the under-eye area. Under normal conditions, it's not very noticeable. However, with age growing older or other causes, this groove can get deeper, which casts a shadow and creates the appearance of dark circles or hollows. | Lacrimal grooves are the skin wrinkles or fine lines on the surface of the tear trough area. They are typically caused by skin aging, dryness, or expressive habits and present as superficial lines, rather than a deep hollow. |
Location | It is primarily located on the medial (nasal) side of the lower eyelid, at its junction with the cheek, and may extend into the apple of the cheek (malar area). | It often adheres to the skin surface overlying the tear trough hollow. It may coincide with the trough but do not involve the underlying structural layers. |
Figure 3. Tear trough and the surrounding structure [1]
Causes and Mechanisms
Category | Tear Trough | Lacrimal Groove |
Causes | Structural Factors: Atrophy and descent of the soft tissues beneath the orbital septum, along with fat pad prolapse or volume loss. | Skin Aging: Loss of collagen and elastic fibers, leading to dry and sagging skin. |
Skeletal Changes: The bone beneath the eye (infraorbital rim) may break down or become weaker, reducing its supportive function. | Facial Habits: Habits like frequent squinting or rubbing eyes can make lines worse. | |
Loose Ligaments: When the ligaments that support the eye muscle loosen, it causes the skin to droop. | Environmental Factors: UV radiation, sleep deprivation, and chronic stress can accelerate skin aging. | |
Genetic Factors: Some people are naturally born with a deeper tear trough. | ||
Mechanism | It involves the degeneration or displacement of supporting structures, such as subcutaneous fat, bone, and ligaments. | It affects only the surface layers of the skin (epidermis and dermis) and does not affect the deeper structures. |
Characteristics
Category | Tear Trough | Lacrimal Groove |
Visual presentation | There is a noticeable depression, particularly under direct light where it creates a shadow. It can occur together with under-eye bags or loose skin, resulting in a sunken eye socket look or a tired appearance. | Superficial wrinkles that can appear as a network of tiny lines or a single distinct line. Their color is darker than the surrounding skin, either from casting a shadow or containing excess pigment. |
Tactile sensation | When pressed, you can feel a gap between the skin and the deeper structures. The sunken area is notably firm. | It can only be identified solely by observation. |
How to Mitigate
Tear Trough | Lacrimal Groove | ||
Dermal filler injections | Hyaluronic Acid (HA) Fillers [2][3]: Directly plumps the hollow area, but requires regular touch-ups (lasts 6-12 months). Autologous Fat Grafting [4]: Offers long-lasting results, but carries a risk of fat absorption, potentially requiring multiple surgeries. Collagen [5]: Stimulates the body's own collagen generation. Suitable for mild to moderate tear troughs with longer-lasting results (1-2 years). | Daily skincare | Hydration & Anti-Aging: Use eye creams containing hyaluronic acid and collagen to maintain skin moisture and elasticity. Sunscreen: Reduce UV-induced skin damage to delay aging. Massage: Gently massage the area to promote blood circulation, to reduce dullness and fine lines |
Surgical correction | Septum Reset: Repositions lower eyelid fat pads to fill in the tear trough hollow. Ideal for patients with prominent under-eye bags. Facelift: Addresses significant skin laxity by tightening sagging skin and restoring facial contours through surgical lifting or thread lifts. | Aesthetic intervention | Laser or Microneedling: Stimulates collagen regeneration and improves skin texture. Aqua Gold/Facial Rejuvenation Injection: Replenishes skin nutrients, enhances radiance, and reduces the appearance of fine lines. |
Energy-based treatments | Energy-Based Therapies (e.g., Radiofrequency, Ultrasound): Improve skin elasticity and tightness but have limited efficacy on deep hollows. They are often used in combination with supplemental filler injections for optimal results. | ||
Figure 6. Mitigating tear trough via hyaluronic acid injection[3]
Figure 7. Mitigate tear trough hollowing via autologous granular fat combined with Nanofat grafting[4]
Tear Trough Grading
Currently, there are mutiple tear trough grading systems, including the Hirmand Tear Trough Grading Scale [3], the Barton Grading System for Tear Trough Deformity [6], and the multifactorial classification system proposed by Sadick et al. [1], etc.
Hirmand Tear Trough Grading Scale
The Hirmand grading system, based on clinical appearance, categorizes tear troughs into three types (I, II, and III):
Type I: Characterized by volume deficit confined to the medial portion of the tear trough.
Type II: Exhibits volume loss extending across both the medial and lateral infraorbital regions, where the tear trough becomes continuous with the palpebromalar groove.
Type III: Combines features of Types I and II, presenting as an arc-shaped hollowing along the entire infraorbital rim from medial to lateral.
While this system includes illustrative diagrams, its grading remains relatively coarse and is not fully applicable to Asian demographics.
Figure 8. Hirmand Tear Trough Grading Scale [3]
The Barton Grading System for Tear Trough Deformity
Grading | Analysis |
0 | There is a smooth, uninterrupted transition along the entire orbital rim from its medial to lateral aspects. The orbitomalar junction is well-defined and youthful, lacking any noticeable contour irregularities or step-offs. |
I | A mild depression or shadow can be seen on the medial part of the orbital rim. The lateral eyelid-cheek junction shows a smooth contour. |
II | A distinct ridge is present along the entire eyelid-cheek junction. A moderate bulge can be observed above this line. |
III | A well-defined groove is visible at the junction of the eyelid and cheek, forming a distinct, stepped contour between the orbital and malar areas. |
Figure 9. Barton Grading System for Tear Trough Deformity
This grading system provides an anatomical description of the grades, but it has poor clinical applicability.
Tear Trough Rating Scale (TTRS) [1]
Proposed by Sadick, the TTRS is used to assess the aesthetic changes of infraorbital hollowing. It measures the severity of tear trough deformity through a cumulative score—a higher score indicates greater severity. The scale evaluates four dimensions:
Tear Trough Depth: Measures the distance from the anterior lacrimal crest to the lowest point of the hollow. Each millimeter scores 1 point.
Degree of Pigmentation: Although pigmentation does not directly cause hollowing, it accentuates its visual appearance. Scoring: 1 point for no pigmentation, 2 for mild, 3 for moderate, and 4 for severe or deep pigmentation.
Ptosis of the Malar Fat Pad: Descent of the malar fat pad exacerbates tear trough depth. Scoring: 1 point for mild ptosis, 2 for moderate, and 3 for severe.
Degree of Skin Folding: Skin folding in the lower eyelid aggravates fat prolapse and tear trough depth. Graded as: mild (1 point), moderate (2), severe (3), or very severe (4).
"Definition of the tear trough and the tear trough rating scale" provides illustrative examples, but these are based primarily on Caucasian facial features. Significant anatomical differences exist between Asian and Caucasian faces, limiting the scale’s clinical applicability in Asian populations.
Tear Trough and Lacrimal Groove Improvement Evaluation
In summary, the tear trough is a structural depression. Severe cases require deep structural support through fillers or surgery, while mild cases can be improved with skincare products combined with massage (e.g., massaging the orbicularis oculi muscle and performing periorbital exercises).
The lacrimal grooves, on the other hand, are superficial wrinkles primarily addressed through moisturizing, anti-aging treatments, and superficial therapies.
Then, how to evaluate the improvement of tear troughs after the use of cosmetics or medical treatments?
A comprehensive assessment of cosmetic and medical treatments for tear troughs should integrate three core methodologies: instrumental analysis (providing quantitative metrics and visualized images), expert evaluation, and consumer satisfaction surveys.
Expert Evaluation
The two periorbital concerns often coexist. Therefore, it lacks comprehensiveness to assess their severity based solely on the degree of hollowing.
The "Establishment and validation of visual assessment for the severity of lacrimal groove wrinkles in Chinese females," led by Professor Tan Yimei from the Cosmetology Research Laboratory of the Shanghai Dermatology Hospital, presents a clinically validated assessment scale specifically designed for Chinese females. This scale combines standardized reference images for grading tear troughs and tear trough wrinkles and has undergone reliability validation. The scale includes the following components:
Figure. 10. Clinical Assessment Scale for Tear Trough and Lacrimal Grooves in Chinese Females
The scale consists of five distinct grades, with half-point increments (0.5) permitted between adjacent levels to allow for more nuanced assessment of tear trough severity.
This grading system enhances the clinical applicability of tear trough and lacrimal groove evaluations, making it suitable for assessing the efficacy of both cosmetic products and medical treatments.
Instrumental Analysis
The Vectra H2 3D imaging system is used to capture three-dimensional facial images before and after product application. By focusing on changes in the volume of hollowing in the tear trough area—which often presents together with eye bags and dark circles (these should be distinguished during assessment)—improvement in the tear trough can be evaluated. The measurable extent of this improvement depends on the efficacy of the product; medical treatments typically yield more pronounced results.
Figure 11. VectraH2 3D-Anterior View
The PRIMOS-CR optical 3D imaging system is used to capture high-resolution three-dimensional images of the tear trough region before and after product use. Wrinkle parameters (including number, depth, area, volume, etc.) are analyzed to evaluate improvement in lacrimal grooves.
Figure 12. Primos-CR-Lacrimal Grooves Mitigation
Consumer Satisfaction Survey
- Example evaluation dimensions include:
- Degree of reduction in the appearance of lacrimal grooves after use
- Level of improvement in tear trough hollowness
- Firming and lifting effect on the periocular skin
- Long-lasting moisturization and hydration
- Improvement in dark circles or under-eye bags
- Overall satisfaction
References
Sadick NS, Bosniak SL, Cantisano-Zilkha M, Glavas IP, Roy D. Definition of the tear trough and the tear trough rating scale. J Cosmet Dermatol. 2007;6(4):218-222.
Yang Y, Ouyang DM, Gu QM, Zhou WH, Han C, Qi XD. Efficacy analysis and 3D evaluation of hyaluronic acid injection in the deep ligament layer for mid and lower facial rejuvenation. Chinese Journal of Aesthetic and Plastic Surgery. 2020;31(9):516-518.
Hirmand H. Anatomy and nonsurgical correction of the tear trough deformity. Plast Reconstr Surg. 2010;125(2):699-708.
Han X, Chen XF, Ji DS, Liu Y, He H, Hu SD. Clinical observation of autologous granular fat combined with Nanofat grafting for improving tear trough deformity. Chinese Journal of Aesthetic and Plastic Surgery. 2023;34(5):280-281.
Bai Y, Wang B, Li XJ. Clinical evaluation of collagen filler for tear trough deformity and a retrospective analysis of time-effect in regular users. Chinese Journal of Medical Aesthetics. 2022;12(7):1-4.
Barton FE Jr, Ha R, Awada M. Fat extrusion and septal reset in patients with the tear trough triad: a critical appraisal. Plast Reconstr Surg. 2004;113(7):2115-2121.
Tan Y, Amano S, Jiang Y, Chen Y, Qiu Y, Gu J, Bao J. Establishment and validation of visual assessment for the severity of lacrimal groove wrinkles in Chinese females. Skin Res Technol. 2023;29(1):e13244.
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