Can You Perform Blepharoplasty for Hollow Lower Eyelids?

Can you perform Blepharoplasty for hollow lower eyelids to pull the skin upward?

Doctor Answers (10)

Lower Blepharoplasty for Hollow Eyelids

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Cosmetic lower eyelid surgery has undergone a paradigm shift over the twenty years since I began my plastic surgery training, as has facial rejuvenation surgery as a whole.  The trend has been to move away from highly invasive procedures that focus on skin and fat excision and pulling skin structures as tight as possible (which tends to make a patient look less youthful and more like a stereotypical ‘plastic surgery patient’), and towards procedures that accomplish not only soft tissue preservation but also soft tissue enhancement – in the form of structural fat grafting. A typical 1970-1980’s era lower blepharoplasty usually consisted of the surgical removal of large volumes of lower lid fat, pulling the lower lid skin very tight and anchoring the lid laterally in a manner that often distorts the natural anatomy of the lateral canthus (lateral corner of the eye). I suppose you could say that this matches a windswept, pulled tight facelift - but it is not in any way truly rejuvenating.

Current, state-of-the-art lower blepharoplasty focuses on soft tissue preservation, including some or most of what appears to be ‘herniated fat’. A number of techniques have been described that restore ‘herniated lower lid fat’ to a more ideal anatomic position, although ideally such a procedure leaves the orbital septum intact as shortening of the septum by suture tightening or cauterization carries with it some risk of lower lid retraction. 

The trend has been towards limiting fat reduction to primarily older patients with very prominent lower fat pads. In many cases, the appearance of lower lid fat pad fullness can be effectively corrected by a combination of structural fat grafting of adjacent hollow areas like the tear troughs, elevation of the midface and smoothing of the lid – cheek junction by means of a High-SMAS facelift (if indicated), and tightening the orbicularis oculi muscles to the lateral orbital rim – which effectively restrains the fat pads and improves lower lid contour.  Lateral orbicularis oculi muscle suspension is a very powerful means for reversing lower lid aging changes, and for doing so in a manner that does not distort natural lower lid external appearance.

Preserving lower lid fat as much as possible, and restoring fullness in adjacent hollow areas by means of fat grafting, is a truly rejuvenating approach to lower lid surgery. Preserving and adding fat serves to enhance the soft tissue support of the lower lid and helps to maintain an ideal and youthful lower lid position over time. The more support you provide for the lower lid, the less you have to rely on internal support measures such as canthopexy and canthoplasty, which are useful for very lax and for overly long lower lids, but which also may distort the natural anatomy of the lower lid and upper lid.  


Raleigh-Durham Plastic Surgeon
4.5 out of 5 stars 42 reviews

Fat Grafting Best Treatment For Hollow Lower Eyelids

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Thank you for your question. Correction of hollow lower eyelids requires specialized fat grafting or fat repositioning techniques.

Standard lower Blepharoplasty techniques can make the hollow look worse.

Please read the link below for specific discussion of the treatment of hollow eyes.

Brooke R. Seckel, MD, FACS
Boston Plastic Surgeon
5.0 out of 5 stars 37 reviews

Many techniques available

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There are many different options available for this problem, some temporary [fillers] others permanent [blepharoplasty with reposition of fat or fat grafting].

Different surgeons may have different recommendations depending on their experience and comfort with one technique or another.

Best of luck

A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 23 reviews

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Treating hollow lower eyelids

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Lower eyelid hollowness is best addressed by improving the overall volume in the area. This usually involves either a skin filler injection (such as restylane) or facial fat grafting. This usually produces a natural, non-operated appearance given that tissue isn't being removed.

Thomas A. Lamperti, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 15 reviews

Hollow eyes, blepharoplasty

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Hollow  eyes can be augmented with fat grafting and  fillers such as restylane.  In certain cases patients can benefit from conservative blepharoplasty with fat preservation and or repositioning.  Selphyl which  involves injecting platelet rich plasma is also helpful in treating hollow eyes.

Philip Solomon, MD
Toronto Facial Plastic Surgeon
4.0 out of 5 stars 32 reviews

Surgery on hollow lower eyelids.

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A photo would be helpful to evaluate your lids but in general yes you can do surgery on hollow lower lids.  The type of surgery is the real question.  If the hollow is due to lack of fat then perhaps only skin needs removal.  If the hollow is due to a fat pad bulge, then the fat pad can be removed or repositioned to minimize the hollowing.  Pulling the skin upward on the lower lids must be done carefully and the lid supported in various ways to prevent retraction and ectropion.  Check with a board certified plastic surgeon for their recommendations.

Jeffrey M. Darrow, MD
Boston Plastic Surgeon
5.0 out of 5 stars 37 reviews

Hollow lower lids

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You can have surgery on hollow lower lids if there is excess skin or distinct fat bulges. It is very important that you see a surgeon who has lots of experience on lower lid surgery and can discuss exactly what you are looking for and where potential problems may exist. I generally do not recommend trying to correct lower lid hollows with fillers unless the hollow area is overlying bone.

Andrea Nowonty Hass, MD
Palm Beach Oculoplastic Surgeon
5.0 out of 5 stars 1 review

Can You Perform Blepharoplasty for Hollow Lower Eyelids?

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Yes you can.  The main question to ask  would be is this the best operation for you?

Sam Goldberger, MD
Beverly Hills Oculoplastic Surgeon
4.5 out of 5 stars 16 reviews

Blepharoplasty

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In a word , yes. If the lids are "hollow" I would only remove the excess skin and not remove any fat. A good picture would help to see what is needed.

Walter D. Gracia, MD
Arlington Plastic Surgeon
4.5 out of 5 stars 3 reviews

Eyelid surgery for eyelid hollows.

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Eyelid surgery for eyelid hollows will only be improved with filling the hollow. This can be done with a blepharoplasty or fillers to fill the hollow such as Juvederm or Radiesse.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 17 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.