There are several contributing factors to periorbital skin changes including genetic factors, prolapse of the orbital fat and prominent subcutaneous venous pooling which are all often refractory to dark circle treatment. The tear trough itself refers to the groove that leads from the inner eye corner down the mid-face, often deepening to a true indentation in susceptible individuals due to lifestyle factors and age. This line casts a dark shadow under the eye often contributing to the ‘tired’ look. Not everyone will be an ideal candidate for non-surgical treatments which is why we always offer consultation and facial analysis first.