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Safest and Most Effective Treatment for Hollow Eyes?

I have hollow eyes (from missing fat) which causes the dark eye circles and makes me look tired all the time. I'm seriously considering plastic surgery but want to make the safest, most effective decision. I've heard Juvederm and Restylane injections are best. but then some say fat transfer is another good option. Will there be surgical incisions to insert the fat vs. laser? I'm so confused.

Has anyone actually gotten these procedures done, and have recommendations on which has worked for them? What would doctors that recommend on which ways are the most safest and long-lasting? HELP!

Doctor Answers (11)

Safest and Most Effective Treatment for Under Eye Hollows

+5
With each passing year I find myself performing less 'invasive' lower lid surgery (i.e a formal lower blepharoplasty) and more lower lid rejuvenation by means of structural fat grafting.  The reality of aggressive lower lid surgery - which involves some combination of skin excision, fat pad reduction and/or fat pad transposition, orbicularis (muscle) redraping and excision, and canthal support (to hold up the lateral aspect of the lower lid while everything heals) - can easily create an 'operated' appearance.  Every experienced blepharoplasty surgeon understands quite well that the lower lid can be very unforgiving, and that an 'operated' appearance can be produced despite the best efforts of even the most skilled hands.
Some patients absolutely require an aggressive approach to the lower lids: those with bulging fat pads, marked skin and muscle redundancy, and obvious lower lid laxity.  Many patients with mild to moderate aging changes, on the other hand, can obtain youthful and natural-appearing results by means of structural fat grafting - to fill in the tear trough, and to blend the contour at the lower lid / cheek junction.  This can be especially useful for patients with a hollow or gaunt appearance at the junction of the lower lid and cheek, and for those with poorly projecting cheekbones that provide minimal support for the lower lid.  If this area is inherently hollow, then the last thing a surgeon should do is remove fat from behind the lower lid, as doing so will only serve to aggravate the hollow appearance and will actually accelerate the apparent aging of the eye area.
Patients with full cheekbones and excellent lower lid support usually do very well with a traditional lower blepharoplasty, although if I feel that I can produce an equivalent result by means of fat grafting and a modest amount of skin excision I will certainly choose the less invasive (and quicker recovery) fat grafting option.  Patients with poorly projecting, flat cheekbones in which lower lid support is lacking, on the other hand, are at significant risk for post-blepharoplasty complications and that obvious 'operated' lower eyelid appearance.  These patients are often best served by structural fat grafting to camouflage the hollowness and create some lower lid support.
Adding fat definitely improves lower lid support, and it often reduces the amount of lower lid skin excision that is required to produce an improved lower lid appearance and a blended lower lid / cheek junction.  I frequently see patients who have previously undergone a blepharoplasty procedure in which an excessive amount of upper and/or lower lid fat has been removed, and they invariably report that since that surgery they feel that they look tired, older, and even ill.  For patients with post-blepharoplasty hollowness, the only way to restore a healthy and more youthful appearance is to restore the missing soft tissue volume, and this can reliably be accomplished by means of structural fat grafting.
Structural fat grafting is a procedure in which small amounts (less than 0.1 cc at a time) of fat are carefully introduced in a series of discrete layers to gradually 'build' new soft tissue structure. As there is space between each micrograft, new blood vessels are able to grow into the grafted fat, allowing it to persist indefinitely. If this process of blood vessel ingrowth (neovascularization) does not occur, then the transferred fat cannot truly be considered a 'graft' and is instead just another temporary 'soft tissue filler' that is broken down and reabsorbed over several weeks.  Fat grafting requires specialized training and specialized surgical instruments, as well as patience and meticulous attention to detail on the part of the surgeon. When performed properly, permanent and natural-appearing aesthetic enhancements can be achieved.
Because the lower lid tissues tend to be quite thin, a conservative approach is an absolute necessity for fat grafting of this area.  If one overfills the lower lid  /cheek junction, and most of the fat persists, then the patient ends up with unnatural fullness that needs to be corrected.  I tell patients that our plan will be to add fat until an ideal contour is achieved and then we have to let it heal and see how much persists.  Because the amount of fat that survives is variable, some patients require a second and rarely even a third fat grafting procedure to reach the desired endpoint of improvement.  As fat grafting can be performed as an office procedure under mild oral sedation, and fat grafting recoveries are brief compared to traditional lower blepharoplasty surgery, supplemental fat grafting procedures are easily accomplished.


Raleigh-Durham Plastic Surgeon
4.5 out of 5 stars 40 reviews

Lower eyelid surgery

+2

Please post pictures and that can help us to give better recommendations. Injectbles like juvaderm and restylane are good option but they are not long lasting. fat injection last longer but some times you see the uneven fat pockets. Lower eye lift is most long lasting and also it safe if done by qualified surgeons

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.5 out of 5 stars 56 reviews

Filler and fat injections are not recommended for the orbital area.

+2

We do not recommend injectable fillers placed in the orbital area. We have seen too many complications from these with long-term edema that just simply does not go away. The results from fat injections have been very inconsistent, and we do not recommend that either. There is really not much of an option for simply hollow eyes other than makeup for the dark circles.

William Portuese, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 56 reviews

Tough Problem to Correct

+2

This is one of the toughest problems in facial plastic surgery in my opinion. We have tried to make it look simple with the recent trend of injecting hyaluronic acid. However as many of us have noted the rate of problems in this area can be as high as 10% including prolonged swelling, bruising, or irregularities and lumpiness. On the other hand these problems can be even worse with fat injection to the area. And of course there are even the rare cases of blindness that have been reported with injections of any material in this area. Other procedures including mid-face lifting also have potential risks and problems so I guess I am urging caution. Make sure you select a conservative surgeon with lots of experience and someone who is a master of all of the above.

S. Randolph Waldman, MD
Lexington Facial Plastic Surgeon
5.0 out of 5 stars 6 reviews

Treatment for hollow eyes

+1
I agree that filler under the eyes is the best route to take.  A hyaluronic acid filler like Restylane or Belotero is the best way to decrease hollowness under the eyes.  If injected properly it will look smooth and softer under the eyes decreasing darkness. I do not recommend fat injections in that area, you can get uneven results.

David Stoker, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 19 reviews

Juvederm Volbella for hollow eyes

+1
For hollowness under your eyes, in the tear trough areas, I would recommend that you have a treatment with Juvederm filler, like Volbella, which is a very fine product, that can help to soften the hollowness under your eyes, without leaving lumpiness. In this case, I recommend trying an injectable treatment with filler before moving to a surgical option. 

Jerome Edelstein, MD
Toronto Plastic Surgeon
5.0 out of 5 stars 57 reviews

Safest and Most Effective Treatment for Hollow Eyes?

+1

Treatment of the lower eye are soft tissue deficit has evolved into using fillers due to the loss of volume in this area. Presently Restylane works well to fill these hollows and rejuvenate  the face.

Thomas Guillot, MD
Baton Rouge Plastic Surgeon
5.0 out of 5 stars 4 reviews

Safest and Most Effective Treatment for Hollow Eyes?

+1

 It would be helpful to see photos of your lower eyelids in order to make a meaningful evaluation regarding fillers versus surgery.  Fillers work great but they do add volume, so if you have fat bags a filler won't make the bags smaller or go away.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.5 out of 5 stars 12 reviews

Restylane injection is your best choice

+1

The best treatment for hallowness under the eyes is injection of Resylane.

Other Hyaluronic acid fillers such as Juvederm or Prevelle silk may also work well but somehow juvederm causes more swelling in this area.

The only problem is there is a good chance of bruising and occasional lumpiness.

So this procedure should be done by an experienced Physician injector

Nissan Pilest, MD
Irvine Dermatologic Surgeon
5.0 out of 5 stars 9 reviews

Surgery is often unsatisfactory for hollow eyes

+1

Dear Ckone

Under eye filling with Restylane has now become the number one best option for this area. Restylane seems to hold much better than Juevederm for this area. The Restylane is more cohesive than the Juvederm. The Restylane tend to stay in the treated area for about a year. The treatment can easily be adjusted if there are any issues. Fat transfer often appears lumpy in the lower eyelid. In fact, Restylane is often used to improve lower eyelid regularities following fat transfer. I strongly recommend that you see someone with a large body of experience. Dr. Cohen would be a good choice. Alternatively look for a well qualified injector on liquidfacelift.com. Save surgery for when lower eyelid filler options no longer get the job done.

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon
5.0 out of 5 stars 16 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.