The tear trough is the groove at the junction between where the lower eyelid and the cheek. As we get older many of us will start to notice dark circles appearing under our eyes. This occurs due to the thinning of the overlying skin and soft tissue over the bony rim of the eye socket. In youth, due to the surrounding plump fat, thicker overlying skin and soft tissue surrounding this structure, this ligament is usually invisible. However, with age atrophy of the adjacent tissues and thinning of the skin occurs, leading to increased visibility of this deep attachment between the skin and orbital rim- the so called tear trough deformity.