Hollow Under Eyes - Fillers or Fat Grafting?

Hi drs I suffer from hollow dark under eyes, i have researched both fillers and fat grafting but still unsure. im worried the filler will leave lumps.with fat im concerned it will be non reversible if it goes wrong.I prefer idea of fillers as less recovery time. Im only 25yrs (female) but have lost alot of volume under my eyes. i look foward to ur expert opinions. thanks Nora

Doctor Answers 5

Composite Fat Grafting Not Fillers Best For Hollow Eyes

Thank you for your question. My answer is likely controversial as many physicians are using filler injection around the eyes today. A perfectly placed filler injection can correct the depression beneath the lower eyelid called the dark circle or nasojugal fold which is different from the Hollow Eye which is caused by lack of orbital fat. The problems with filler injection in this area are:

  1. Many physicians with no training or experience in eyelid surgery are using this technique-often the filler is placed incorrectly or the eyelid muscle pushes the filler out of the depression and makes the dark circle worse-I also do not like the idea of repeated injections with a needle into a very delicate important functional area
  2. A true hollow eye-depressed eyelid caused by lack of fat requires volume replacement into the orbit where very vital structures are located-I would not blindly place a needle and inject into this area-blindness following filler injection into the eyelid has been reported in England-the filler was injected into a blood vessel
  3. Fillers are temporary and must be repeated-repeated injections into the eyelid can cause scarring and possibly damage to the eyelid

I use Composite Fat Grafting NOT Fat Injection or Fat Transfer. Composite Fat Grafting utilizes a whole piece of fat which is harvested from the pubic area and transplanted into the depression beneath the puffy lower eyelid or dark circle. My reasons are:

  1. A composite Fat Graft survives better than injected fat
  2. If the graft takes or survives-about 80-90% of the time-the correction is permanent unlike fillers
  3. Injections into the eyelid are avoided
  4. The fat can be accurately surgically placed into the proper position
  5. Transconjunctival incision for graft placement allows for release of the Arcus Marginalis which allows proper placement where volume is needed
  6. For a true Hollow Eye, fat can safely be placed into the orbit to add volume

I hope this helps

Boston Plastic Surgeon
5.0 out of 5 stars 65 reviews

195 Commonwealth Avenue
Boston, MA 02116

Fillers or Fat Grafting - which to choose?

Hollow areas beneath the eyes can be caused by a lack of fat in the upper portions of the face.  It is most commonly seen in older patients, in which case a mid-face lift is often the best and most permanent solution.  In a young person such as yourself, some type of local volume replacement is usually the preferred treatment.

This can be done with HA fillers such as Restylane or Juvederm, or with fat grafting.  Here are the pros and cons of each method:

      Fillers (Restylane, Perlane, Juvederm, etc.)

Advantages:  These are temporary, lasting usually 6 to 18 months. Therefore, if you don't like the result, it will get better with time.  If you REALLY don't like the results, it can easily be reversed with an injection of hyaluronidase.  Also, because these products are fairly thin and are injected through small needles, a smoother and more precise result can usually be obtained if the person injecting is skilled.

Disadvantages: These are temporary, so if you like the result, re-treatment will be necessary in 6 to 18 months.  If large volumes of the product are necessary, a bluish discoloration of the skin  may sometimes result.

         Fat Grafting

Advantages: Fat can be a more permanent solution.  Once the injected fat is "accepted" by your body, it becomes permanent.  It will even enlarge if you gain weight!

Disadvantages:  Only a portion of the fat that is injected will "take", and the remainder will be absorbed by your body.  The amount that takes is unpredictable, and it is therefore necessary to over-correct, injecting more fat than is necessary to compensate for the absorption.  Fat is also much more difficult to inject smoothly, and lumpiness is more common and is very difficult to correct.  Fat grafting is usually more expensive than fillers in the short term, and the area where the fat is harvested from will be tender for a few days.

In your case, because of your age, I would recommend that you try the fillers first to see how you like the look. If you are pleased with the result but want a more permanent solution, then you can always try fat grafting at a later time.

The darkness of the skin (blepharomelasma) is a different issue.  If you can't cover it with makeup easily, you might try using 4% hydroquinone cream, available with a prescription







Kevin F. Hagan, MD
Nashville Plastic Surgeon
4.5 out of 5 stars 3 reviews

6050 Medical Center East
Nashville, TN 37232

Under eye fillers

Fat is a type of filler!! If you need fillers on cheeks , or other ares , fat would probably be a good option. It depends on your dermatologist, or plastic surgeon experience what kind of filler he or she would recommend. All fillers should give excellent results, if done properly.

Khaled El-Hoshy, MD
Detroit Dermatologic Surgeon

14555 Levan Rd.
Livonia, MI 48154

Hollow dark lower eyelid circles

The hollowness may be helped by injecting Restylane or Juvederm underneath the muscle. Darkness of lower eyelids is difficult to treat. Some attempts have been made with skin lightening creams, vitamin K creams to change the iron deposits from sluggish red blood cells and other creams that effect a change in the iron deposits and blood flow. Unfortunately we don't have consistent results with any treatment for this darkness.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
5.0 out of 5 stars 33 reviews

317 East 34th St
New York, NY 10016

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.