Tear trough refers to a groove in the lower part of the inner corner of the eye, near the nose. It is created by the atrophy and sagging of the soft tissue at the lower edge of the orbital septum. In some people, it can extend to the cheeks. Because of the obvious contrast between the tear trough depression and the surrounding skin, it makes the tissues of the lower eyelid look somewhat protruding. That is why many people think of tear troughs as bags under the eyes, when in fact it is not bags. Tear troughs are usually congenital and will be more visible under some people’s eyes while others’ eyes will feel not so obvious. As we age, there is some subcutaneous fat that grows as well, which can make the tear trough very visible and has a great similarity to bags under the eyes.