The under eye area is one of the most requested treatment zones in aesthetic medicine. And with polynucleotides now firmly on the scene, we’re getting a lot of questions from practitioners about when to use tear trough filler, when to go with polynucleotides, and when to use both.
It is a genuinely important clinical question. These two treatments work very differently, target different problems, and suit different patients. Getting the distinction right means better outcomes and more realistic patient expectations.
This guide covers everything you need to know about tear trough filler vs polynucleotides so you can make confident treatment decisions for your patients.
Table of Contents
Tear trough filler involves injecting a hyaluronic acid (HA) dermal filler into the periorbital region, specifically along the inferior orbital rim. The goal is to restore lost volume that causes that hollow, sunken appearance under the eyes.
HA fillers attract water, which is why the tear trough is one of the most technically demanding areas to treat. Too much product, the wrong product, or the wrong patient and you are in trouble. Swelling, puffiness, and the Tyndall effect are all very real risks if the technique or patient selection is off.
That is why tear trough filler is considered an advanced treatment, not something to attempt without proper training. If you are just starting out in aesthetics, it is worth building a solid foundation before tackling the periorbital region.
Polynucleotides (PNs) are short chains of purified DNA derived from salmon or trout milt. They work biologically, stimulating fibroblasts to produce more collagen and elastin, improving hydration, supporting angiogenesis, and potentially helping regulate pigmentation.
Unlike dermal filler, polynucleotides do not add volume. They improve the quality and condition of the skin itself. This makes them a genuinely different tool, suited to different presentations. They can be injected under the eyes and across the full face.
As a collagen-stimulating treatment, the results take time to peak, typically over two to four months depending on the product used. Products such as Plinest and Newest, for example, may follow slightly different timelines to older formulations. Patients need to understand this. Polynucleotides are not a quick fix, and if that expectation is not managed from the start, you will have unhappy patients regardless of how good your technique is.
A note on contraindications: polynucleotides are fish-derived. Always ask about fish allergies and any concerns about animal-derived products, including veganism, before treatment.
| Tear Trough Filler | Polynucleotides | |
| Mechanism | Adds volume with HA filler | Stimulates collagen, elastin, and hydration biologically |
| Target concern | Under eye hollowing, volume loss | Skin quality: crepiness, fine lines, dehydration, pigmentation |
| Results timeline | Immediate (with some swelling) | Gradual, peaks over 2–3 months |
| Ideal candidate | Good skin quality, infraorbital volume deficit | Poor skin quality, early laxity, crepey texture |
| Fish allergy risk | No | Yes (always screen) |
| Can they combine? | Yes | Yes |
Understanding this table is the foundation of good under eye treatment planning.
Patient selection is everything in this area. Getting it wrong creates more problems than the original concern.
The right patient for tear trough filler has good underlying skin quality and relatively simple hollowing along the inferior orbital rim. The hollowing should be medially positioned, not extending too far laterally.
Candidates with bone or fat resorption causing a concave infraorbital appearance often respond well. The filler supports the skin surface, reduces shadowing, and gives the patient a less tired appearance.
Several presentations are contraindicated or high risk for tear trough filler:
Patients who primarily want to fix dark circles are also often disappointed by tear trough filler. In the vast majority of cases, under eye filler will not resolve dark circles unless they are purely a result of shadowing from hollowing. Be clear about this during consultation.
Patients who benefit most from polynucleotides under the eyes tend to have skin quality as their primary issue rather than volume loss.
Think: crepey texture, fine lines, dehydration, mild laxity, early pigmentation changes, or overall skin dullness in the periorbital region. These are presentations where adding volume is not the right answer, but improving the skin itself can make a real difference.
Polynucleotides can also be used to prepare the skin before tear trough filler. If a patient’s skin quality is borderline and they want filler further down the line, a course of polynucleotides first can genuinely change what is achievable. A patient who might not initially be a great filler candidate can become one after polynucleotide treatment.
They can also be injected into the eyelid skin itself to improve crepiness, which is an area where few other treatments are safely applicable.
Yes, and for the right patient this combination approach can produce excellent results.
If a patient has moderate skin quality alongside hollowing that is suitable for filler treatment, both modalities belong in their treatment plan. The polynucleotides address the skin condition; the filler addresses the structural volume deficit.
The usual approach is to run a course of polynucleotides first, then reassess the patient for tear trough filler once the skin quality has improved. This staged approach is safer and often leads to better, longer-lasting outcomes.
It is also a good business model. Polynucleotide courses involve multiple sessions and regular maintenance, which builds continuity with patients and provides steady clinic revenue alongside single treatment visits.
If you are looking at building a broad injectable skill set, packages like the Complete Clinician Package cover both skin quality treatments and advanced injectables in a structured, progressive way.
Dark circles and eye bags are two of the most common reasons patients come in asking about under eye treatments. Neither is straightforwardly fixed by filler or polynucleotides, and understanding the causes matters.
Dark circles are multifactorial. The main contributing causes include:
Shadowing from hollowing. If the infraorbital area is concave, it sits in shadow relative to the surrounding convex surfaces. This can look dark even when there is no pigmentation issue. In these patients, carefully placed filler can genuinely help.
Visible vasculature. As skin thins with age, underlying vessels become more visible and can contribute to a bluish or purplish discolouration. Polynucleotides may help here over time by improving skin quality and thickness.
Hyperpigmentation. True pigmentation under the eyes needs a different approach. Skincare with low-strength retinol and vitamin C can support improvement, alongside in-clinic skin treatments. There is emerging evidence that polynucleotides may inhibit melanin synthesis, though the evidence specifically for periorbital hyperpigmentation is still developing.
Genetics. Deeper pigmentation with a genetic component, particularly in South Asian and other communities of colour, is difficult to treat significantly with injectable treatments. Managing expectations here is important. This is a good moment to discuss skin health holistically. Our Skin Rejuvenation Masterclass covers this in depth.
Lifestyle. Poor sleep, smoking, stress, dehydration, and sun exposure all play a role. Always discuss these with patients. Any treatment you offer will work better and last longer if lifestyle factors are addressed alongside it. Recommend SPF for the periorbital region, which is an area patients often miss when applying sunscreen.
True eye bags, whether caused by periorbital oedema or skin laxity, are generally surgical territory. Blepharoplasty is the definitive treatment. Adding filler to a patient with puffiness from fluid retention or fat herniation will only make things worse.
Where mild skin laxity is the primary factor, energy-based devices such as radiofrequency or focused ultrasound may offer some modest improvement, alongside a course of polynucleotides. However, for more significant eye bags, referral to an ophthalmic or oculo-plastic surgeon remains the appropriate course of action.
The under eye area is one of the most emotionally charged areas patients come in about. People are often comparing themselves to how they looked a decade ago or are distressed about looking tired despite feeling fine.
A thorough consultation is non-negotiable. Here is what that should cover:
It sounds obvious, but ask specifically what is bothering them. Is it the hollowing? The dark circles? The texture? The puffiness? Many patients use “dark circles” to describe several different problems. What they show you on their face, and what they mean, can be very different things.
Assess the periorbital region systematically. Look for:
This assessment guides your treatment plan. It also gives you objective language to use when explaining the treatment options and the realistic outcomes.
Be honest about what is achievable. Patients who come in expecting tear trough filler to resolve dark circles of genetic origin will be disappointed. Patients who expect polynucleotides to give them the same immediate result as filler will be frustrated by the timeline.
Setting accurate expectations upfront is one of the most important things you can do to protect both the patient relationship and your reputation as a practitioner.
Under eye concerns often require more than one treatment or treatment type. Budget needs to be discussed early. A course of polynucleotides followed by filler is going to involve multiple sessions and a larger investment. Patients need to understand this before committing.
Periorbital lines extending out from the lateral canthus, commonly called crow’s feet, are straightforward to treat with botulinum toxin. Relaxing the orbicularis oculi in this area reduces the lines and opens up the eye, which also contributes to a less tired appearance. This often pairs well with periorbital filler or polynucleotide treatment as part of a full periorbital rejuvenation plan.
Botox training forms the foundation of most practitioners’ injectable skill sets and crow’s feet are one of the classic initial treatment areas.
Polynucleotides are not limited to the under eye area. They can be used full face to address skin quality across multiple zones simultaneously, including the cheeks, forehead, and neck. Many patients benefit from a full face approach rather than treating the periorbital region in isolation.
Our Skin Booster Courses and Advanced Botox and Dermal Filler training cover these wider applications in detail.
Volume loss in the mid-face contributes significantly to tear trough appearance. For some patients, addressing mid-face volume with cheek filler reduces the tear trough appearance without any direct periorbital injection. This is a lower risk approach for patients who are borderline tear trough candidates, and worth considering in your assessment.
The tear trough is one of the areas where clinical knowledge and sound patient selection matter most. Getting it right takes proper training and practice, not just reading about it.
If you want to build confidence treating the periorbital region, whether with filler, polynucleotides, or toxin, building on a strong clinical foundation is the right starting point.
Derma Medical trains doctors, nurses and midwives, dentists, pharmacists, physician associates, paramedics, and other qualified medical professionals across the UK, with hands-on training days in London, Manchester, Birmingham, Newcastle, and Edinburgh.
Our courses are CPD-accredited and led by experienced practitioners. Small group sizes mean you get proper hands-on time with live models, not just theory.
If you are looking at where to begin or what to add to your skill set, our Course Guide walks you through the options based on your experience level and goals.
Ready to take the next step?
Browse all aesthetic training courses or contact our team to talk through which course is right for you.
£1106.00 (incl. VAT)
£1106.00 (incl. VAT)
From: £2101.00 (incl. VAT)
£3213.00 (incl. VAT)
£1106.00 (incl. VAT)
£1106.00 (incl. VAT)
From: £1730.00 (incl. VAT)
£1480.00 (incl. VAT)
From: £1730.00 (incl. VAT)
From: £1730.00 (incl. VAT)
If you’re looking to keep your skills sharp or revisit techniques on your own schedule, our Online Botox and Dermal Filler Training Courses on DermaHub is here to support your aesthetic journey. With easy-to-follow video tutorials, expert insights, and flexible access, you can learn anytime, anywhere. It’s a great way to stay updated, refresh your knowledge, and deepen your understanding, with CPD-accredited content designed to fit around your lifestyle.
Where Aesthetics meets Longevity
Complete the form to receive a personalised consultation on pathways and package deals tailored to your goals.
Receive a free starter kit upon enrolment
