What is the Best Procedure to Fix Hollow Eyes?

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

Hello,

Fat transfer works well for undereyes. It can be done in less than an hour in the office under local anesthesia only. There is minimal pain and minimal swelling. The fat that lives will stay forever. 
Mark G. Albert, M.D.

NYC Aesthetic Surgeon

Fat transfer is a wonderful way to naturally and beautifully restore lost facial volume. Although there are numerous options to revolumize, fat transfer has some major advantages: it is the longest lasting option to restore volume in the face, functioning essentially as native facial fat once it is transferred; it is your own fat being used, thus is 100% biocompatible; there is an abundant amount available on almost everybody, so there are no limitations to getting the volume you need and achieving full correction; fat is one of our best sources for stem cells, called adipocyte derived stem cells, which yield additional benefits due to the growth factors contained and their effects collateral tissue growth that extends well beyond just the zone of transferred fat, helping contribute to a global improvement in the facial aesthetic.
An extensive amount of planning goes into the fat transfer process, with a comprehensive look at the balance and proportion of the face being blended with the aging changes and anatomy of each individual patient.
The procedure itself is performed utilizing local anesthesia with or without sedation. Fat can be acquired from numerous sites, but choosing a site is usually best planned to help contour the body in the process, thus the abdomen, thighs, and waist are commonly utilized. 
After the fat is acquired, it is processed and prepared into micro- and/or nanofat, which have different properties and are chosen based on the desired areas to be treated. Transfer is then performed with blunt tipped cannulas, as opposed to needles. Different providers will likely have different processing protocols, but I prefer to maximize the stem cell content of my fat, further magnifying it’s benefit. This is a time-consuming and intricate process, thus some people take shortcuts, but the long-term benefits are well worth the extra effort in the preparation process. I also utilize other regenerative medicine modalities, such as platelet rich plasma, to improve the outcome from the fat transfer and expedite the recovery time.
Recovery from fat transfer includes swelling and some firmness that is subtle and can last several weeks to months after the procedure. The transferred fat establishes a blood supply in its new location, a very favorable process which contributes to that inflammation and swelling. 
It is key that the physician performing the fat transfer is well-versed in panfacial volumization, allowing an equal balance and harmony to be created and maintained in the face. Fat should not just be utilized in large volumes in a few spots, but instead utilized in strategic volumes over multiple areas of the aging face.
Overall, fat transfer provides an incredible option to restore volume that is very natural, long lasting and has the added benefit of a healthy dose of stem cells to rejuvenate aging tissues. 
To ensure you are receiving the highest level of care, seek out a modernly trained, new-school dermatologic surgeon, oculoplastic surgeon, facial plastic surgeon or plastic surgeon who is board certified and fellowship trained in one of these “core four” cosmetic specialties. Membership in organizations like the American Academy of Facial Plastic and Reconstructive Surgery help to identify a highly trained surgeon.
Cameron Chesnut
#realself500 Physician

Thank you so much for your question. Body fat can be transferred to the under eye area to reduce the appearance of hollowing related to volume loss. With structural fat grafting, small amounts of fat are introduced as micrografts and new blood vessel growth allows it to persist indefinitely. I would recommend a consultation with a Board Certified Fellowship Trained Facial Plastic Surgery Specialist.All my best, Dr. Elizabeth."This answer has been solicited without seeing this patient and cannot be held as true medical advice, but only opinion. Seek in-person treatment with a trained medical professional for appropriate care."

Soft tissue fillers when injected in the right tissue plane and in the right hands can have dramatic results.  Using your own fat to fill the hollow eyes can potentially be a long term solution.  Fat needs to be injected in small aliquots and layer smoothly underneath the thin eyelid skin/muscle to prevent lumps and bumps which may be difficult to repair.

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

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.

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.

Thank you for your question. Fat grafting is an excellent way to add volume to the face and fill defects that may be present. Hollowness under the eyes (called the tear troughs) as well as in the upper eyelid region causes shadowing and darkening giving a tired look. Fat grafting to these areas is common and extremely affective. The fat is taken from your own body and put through a delicate process to separate and retrieve only the best fat with the highest stemcell concentration.  My recommendation is to schedule a consult with a board certified Plastic Surgeon who is experienced in fat grafting. They will be able to assess your specific anatomy and take a look at the filler.  In our office, we offer 3D imaging to give our patients an accurate idea of what their final result will look like. Good luck!

Dermal fillers is typically the best option for hollows under the eyes if the treatment is performed by an experienced and expert physician injector and utilizes a product such as restylane or belotero. If dermal fillers are not a good option for you, then fat transfer to the hollows under the eyes is a good alternative for the appropriate patient. Consult with 3 experienced and expert board certified plastic surgeons who are master injectors to understand your options.