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What is the Best Procedure to Fix Hollow Eyes?

I recently had juvederm injected under my eyes as an attempt to fix my hollow eyes.The procedure only seemed to make them worse. Is there any other procedure that could fix my hallow eyes.

Doctor Answers (10)

Fat Grafting to Correct Hollow Eyes

+8
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 37 reviews

Hollow Eyes are Best Treated with Fat Grafting, Be Cautious of Fillers

+4

Thank you for your important question.  Your experience is common as I see many patients who have had Filler Injections to treat Dark Circles or Hollow Eyes and who have felt that the injections make the problem worse.

Problems with Filler Injections around the eyes:

  • Poor technique-many doctors doing filler injections do not have experience in eyelid surgery and knowledge of the anatomy. There are a few expert plastic surgeons who can successfully use this technique-you must find an expert
  • Fillers are not permanent, thus repeated injections are required-I am concerned about repeated injections into the eyelid damaging important structures
  • If fillers are not placed properly the action of the eyelid muscle pushes the filler down out of the hollow or depression and make the dark circle worse
  • There is a potential for injection into a blood vessel which can cause blindness-cases have been reported

I use a technique called Open Composite Fat Grafting in which I surgically place a fat graft under direct vision into the proper position to plump the Hollow Eye or Dark Circle. This is NOT Fat Injection or Fat Transfer.

The benefits of Open Composite Fat Grafting to the Eyelid are:

  • Accuracy
  • The Fat Graft is a permanent fix
  • The Fat Graft is your own tissue and better accepted by the body
  • The Fat Graft has a beneficial effect on the overlying skin
  • The Fat Graft reconstructs the actual problem

For more detailed information check the link below.

Brooke R. Seckel, MD, FACS
Boston Plastic Surgeon
5.0 out of 5 stars 26 reviews

Blepharoplasty, eyelid surgery

+2

Instead of removing fat under the eyes with a eye procedure, I have been repositioning it. This could also help with your hollow eyes.

Edward J. Domanskis, MD
Newport Beach Plastic Surgeon
4.5 out of 5 stars 24 reviews

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Fixing Hollow Eyes

+2

There is no easy way to fix hollowness of the orbits. Such hollowing is caused by the age-related loss of fat inside the eye socket which causes sinking in of the eye ball into the orbit. This is made worse by a sagging of the cheek exposing the rim of the orbit creating the Tear Trough. While the Tear Trough can be covered with several fillers, increasing volume INSIDE the eye socket is a challenge and can only be accomplished by either bone grafting or placing a plate along the floor of the orbit. These operations are usually done in severe trauma reconstruction cases and not in cosmetic cases.

Dr. Aldea

Peter A. Aldea, MD
Memphis Plastic Surgeon
5.0 out of 5 stars 58 reviews

Balancing the lower eyelid with the cheek

+1

Treating the lower eyelid hollow is one of the most technically challenging areas to treat!!  It is the person treating you not the product that you should be most concerned.  I recommend you consider surgery vs. non surgery. Surgery can include moving the fat around to fill the hollow, with an outpatient procedure that requires a week or two of cosmetic recovery time. Extreme caution for fat injection to this area, as it is very easy to overdo.  Non surgical is the off label use of injectable fillers, several options exist depending on the injector preference.  Remember, if you feel the injection you had made things worse, there is a product that can be injected to erase the effect, called Hyaluronidase.  Go to your nearby expert, ideally a member of the coalition for injectable safety, to make you better!

Julius W. Few, MD
Chicago Plastic Surgeon
3.5 out of 5 stars 4 reviews

Best Treatment for Eye Hollows....Restylane by an Experienced Physician

+1

Hi Onlyone,

First of all, Juvederm is a bit too hydrophillic (attracts too much water) to be used in the lower lid hollows.  Restylane is the only filler that I use in this unforgiving and delicate area.  Secondly,"it is not the filler, it's the filler", in other words, your results are due to the person who injected you, not the filler.   Good luck and be well.

Dr. P

Michael A. Persky, MD
Los Angeles Facial Plastic Surgeon
5.0 out of 5 stars 23 reviews

Hollowness of eyelids

+1

Fat grafting can be done by experts and this may help. See a plastic surgeon or oculoplastic surgeon.

Ronald Shelton, MD
Manhattan Dermatologist
5.0 out of 5 stars 31 reviews

Lower Eyelid hollowness

+1

Hollowness under the eye is caused by fat loss due to aging.  Also, cheek descend during the process of aging will enhance the hollowness. Although there is no easy fix, lower eyelid blephraplasty with septum repositioning and fat grafting does work well. I have had good results in several patients with this procedure.

Siamak Agha, MD, PhD, FACS
Orange County Plastic Surgeon
4.5 out of 5 stars 56 reviews

Under eye hollows

+1

The contour "deformity" of under the eyes can be addressed by either fat removal, fat repositioning, filler (restylane) over hollows, or combination of the above.  The best treatment method depends on your individual eyelid anatomy.

Dr T.

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
5.0 out of 5 stars 7 reviews

Many options available

+1
Many dermal fillers may be placed in the hollow periorbital areas. Hyaluronic acid fillers are the safest to place, but may cause bluish discoloration if placed superficially. Radiesse may also be placed in the area of the zygomatic arch though care must be taken as to not cause any lumpiness to occur as the filler is quite viscous. Collagen may also be placed, though with the Cosmoderm and Cosmoplast being pulled out of the market, this leaves only Evolence, whuch is quite a thick filler in its own right. Fat may be another option, but also has its risks in causing swelling and some unevenness when placed. Whatever filler is placed, the most important factos is that the physician knows exactly what they're doing and how to deal with complications if they ever occur.

Hassan Galadari, MD
Dubai Dermatologist

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.