Under eye hollows (as well as tear troughs and dark circles) are common problems with aging. They can also be seen in younger people with a family trait predisposition for their development. Whatever the etiology or the age of appearance, they are fortunately amenable these days to treatment with fillers and volumizing agents. If the "platform," i.e. the cheek area below the under eye area needs volume replacement, I prefer to use Juvederm Ultra Plus XC in my Upper East Side Manhattan office and Stylage XXL in my satellite office in Israel where a greater number of regulatory agency approved products are available. For tear troughs and dark circles, I prefer Belotero Balance, since this product has little tendency to result in the unwanted, bluish Tyndall Effect when injected superficially into the delicate tissues under the eyes. Consultation with a board certified core aesthetic physician with experience and expertise in injecting the under eye area in young people is crucial. Be sure to request to see befores and afters of the doctor's work.
The hollowness of your lower eyelids really bothers you. You have mentioned several modalities that can all be used to help with this problem. Each method has its advantages and disadvantages. I could give you all of the pros and cons of each modality but I feel that in your particular situation, though I have not had the opportunity to examine you, with the creation of the newer soft injection cannulas, placement of hyaluronic acid fillers, such as Restylane, in the lower lid is the safest, quickest, and most predictable modality available for treating under eye hollows in a younger patient.
From the description, it appears you may need more volume, but a silicone facial or cheek implant does not seem appropriate. Non-surgical cosmetic treatment options to add volume in the lower eyelid area in young patients generally include facial fillers such as Restylane, fat injection, or combination fillers with fat graft. Most plastic surgeons may avoid cosmetic blepharoplasty in younger patients with lifting tissue or fat removal. However, every patient is unique. Only after a comprehensive evaluation can a plastic surgeon help determine appropriate options for you.
sweetbee1, very hard to answer your question without an adequate exam or at least photographs. In General for hollowness under the eyes side due to 1 of 2 things. Fillers can be used to help this area, however recent evidence just that fillers in this area do carry a risk of blindness. I do make sure the patient's are aware of this. A "SOOF lift blepharoplasty" is the surgical procedure that I use to help with hollowness under the eyes. It works quite well to improve this deformity. Good luck!
In my experience, the gold standard procedure to improve the dark hollows under the eyes, especially in someone your age, is micro fat grafting. Very small amounts of meticulously-placed fat can conceal the concavity as well as the dark shadowing, and produce a plumper, luminous lower eyelid. The lines may also improve with just micro fat grafting, but CO2 or erbium laser could be used at a later time to smooth out the remainder of them. Best wishes!
Thank you for your question. My personal approach is to do open fat grafting as part of a trans-conjunctival lower lid blepharoplasty. This is a permanent correction and can be accurately placed.Dermal filler injections beneath the lower eyelid are often poorly done and can result in visible gray lumps or displacement by the muscles to make the Hollow area look deeper. Next
However an expert board certified plastic surgeon with experience an oculoplastic surgery can use small amounts using only the filler Restylane in very small 0.6 cc amounts
If you think you need filler to correct hollowing or the like, it is best to be seen in person to be properly evaluated. Best of luck.
Under eye hollowness is usually caused by lack of fat over the orbital rim. This can be corrected by refilling the area. Both fat and off the shelf fillers can be used. Of the 2, fat is the longest lasting. Fat grafting may have to be done twice or 3 times to get it just right, but that is better than doing it every 9-24 months which you have to do with a filler, depending on which one you use. At 32, this could be a significant savings over time. See an Expert Injector.