If the lower lids are hollow either by way of surgery or genetics, the treatment of choice is to add that volume-there can also be volume loss with the normal aging process. An easy alternative is to use fillers such as Restylane, Juvederm etc. to add volume. This is done in a chair under local anesthesia and recovery is very short- some mild swelling and possibly some bruising. However, these fillers last for a certain amount of time and will need to be redone two or three times per year. The injections should be deep to the muscle in order to avoid visible superficial blebs.
A longer lasting result can be obtained with fat grafting (fat transfer). I prefer to use a small cannula (2 mm) so that the little bits of fat transferred are small. This is important because the the smaller bits of fat vascularize faster and so live with the patient and last longer. If the fat pieces are too large, they will not survive, turn to oil and be resorbed. There is also a special technique for applying it so that is not visible- In general, the fat has to be placed below the muscle layer so that it will not be seen through the thin tissues of the eyelids.
