Tear Trough Fillers — What's Changed, and What to Consider Instead

The tear trough remains one of the most searched aesthetic concerns in the UK. The hollow or shadowed appearance beneath the eyes — making someone look tired, older, or drawn even when they feel neither — is something many people want to address. And for years, filler was the default answer.

That conversation has changed. Not because tear trough filler is wrong — in the right patient, placed correctly, it remains an effective treatment. But the aesthetics industry has matured considerably around this area, and patients are asking better questions. The alternatives have also improved significantly. What was a binary choice between doing something and doing nothing is now a genuinely nuanced clinical decision.

Here is where things stand in 2026.

Why tear trough filler has a complicated reputation

The tear trough is one of the most technically demanding areas to treat with filler. The skin is the thinnest on the face, the underlying anatomy is complex, and the margin for error is narrow. When it goes well, it goes very well. When it goes wrong, the consequences — puffiness, visible product, the Tyndall effect (a bluish discolouration caused by filler sitting too superficially), or prolonged swelling — are difficult to conceal and often difficult to reverse.

The widespread availability of filler treatments — and the significant variation in training and experience across practitioners offering them — means that poor outcomes in this area are not uncommon. This has understandably made many people cautious, and rightly so.

The other issue is patient selection. Not everyone who wants tear trough filler is a good candidate for it. Filler adds volume. If volume loss is not the primary problem — if the concern is more about skin quality, fine crepiness, dark circles, or mild puffiness — then adding volume will not solve it, and may make things worse.

Who tear trough filler is actually right for

With an experienced, medically qualified injector and appropriate patient selection, tear trough filler remains a valid treatment. The right candidate typically presents with a genuine hollow — a concavity beneath the eye caused by volume loss in the mid-face and orbital area — rather than primarily skin-quality concerns. They have reasonable skin thickness, no significant puffiness, and realistic expectations about the subtlety of the result.

At Mulberry House, all injectable treatments are carried out by Dr John Tanqueray, whose background as a GP and years of experience in aesthetic medicine inform an assessment process that prioritises getting the right treatment for the right patient. That begins with a proper consultation — not a treatment assumption.

What has changed — the polynucleotide alternative

The most significant development in the under-eye conversation over the past two to three years has been the rise of polynucleotides as a credible, often preferable, alternative for patients who are not well suited to filler — or who simply want a more regenerative approach.

Polynucleotides are injectable biostimulators derived from highly purified DNA fragments. Rather than adding volume, they work biologically — stimulating fibroblast activity, encouraging collagen and elastin production, improving skin thickness, and delivering sustained hydration to the tissue. The results are gradual and natural-looking, building over a course of treatment rather than being immediately apparent.

For the under-eye area specifically, this mechanism addresses concerns that filler cannot: crepey or thinning skin, fine lines, dark circles caused by skin transparency, and general under-eye fatigue. Because polynucleotides do not volumise, there is no risk of puffiness or the displacement issues that can affect filler in this area.

At Mulberry House we use both Plinest and Plenhyage XL — both from the Mastelli group, both based on highly purified polynucleotide technology. Plinest is well suited to the periorbital area, improving skin quality and brightness in the delicate tissue around and beneath the eye. Plenhyage XL is a higher-concentration formulation used where more intensive tissue regeneration is the goal. The choice between them — and whether polynucleotides alone are appropriate or whether a combination approach makes more sense — is something we assess at consultation.

When the two work together

It is worth noting that filler and polynucleotides are not always an either/or choice. For patients who have both a degree of hollowing and compromised skin quality in the under-eye area, a course of polynucleotides first can actually improve candidacy for filler — thickening and strengthening the skin so that filler sits better and results are more predictable. The two treatments can complement each other when the clinical picture calls for it.

The question worth asking before any under-eye treatment

Before deciding on any treatment for the under-eye area, it is worth being clear about what is actually bothering you — and honest about whether it is hollowing, skin quality, pigmentation, puffiness, or a combination of these. Each has a different answer, and not all of them involve filler.

A proper consultation will explore this thoroughly. At Mulberry House, that conversation happens before any treatment decision is made — and if filler is not the right answer, we will say so.

To arrange a consultation, call us on 01604 702 630 or email info@mulberryhouseclinic.co.uk.