Prominent tear trough is caused by the osteocutaneous ligament (tear trough ligament). This ligament is found on the maxilla (cheekbone), and between the palpebral and orbital portions of the orbicularis oculi muscle (a circular muscle that surrounds the eyelid). It extends from medial canthus to mid-pupillary line, from there it continues on as the orbicularis oculi retaining ligament. This area can cause a tired or aged appearance of the eyelid as fat descends or atrophies with aging. It can be filled with fillers like Juvederm or Restylane (which are temporary lasting about a year) or with fat grafting (more permanent).