Age 56, Hollow Under Eyes - Eyelid Surgery or Fillers?

I Am 56 Yrs Old and Have Noticed "Hollows" Under my Eye Area Do I Need Lower Eye Surgery? should I have lower eye surgery to take away the hollowness or have a filler instead? thank you

Doctor Answers 5

Filler V. Surgery

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You can use temporary fillers like Juvederm to fill the hollows under the eyes. You must be careful with this because there is a risk of lumpiness. To avoid this I would recommend a fat transfer to this are. Fat tends to be smoother and less troublesome. It also lasts longer.

New York Facial Plastic Surgeon
4.5 out of 5 stars 96 reviews

Lower eyelid surgery

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Dear 3244anon,

If the eye is just hollowed out, it can be filled in with a temporary filler like Restylane, or with a fat transfer which is usually more permanent.  You also have to take a look to see if there are any lower eyelid bags that need to be removed during surgery. 

Nontheless, treating the lower eyelids has a high patient satisfaction rate because people stop asking you if you are tired.  Overall it gives a nice refreshed look.


Nima Shemirani

Nima Shemirani, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 85 reviews

What to do about under eye hollows

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If the area under the eyes is hollow, hyaluronic acid filler like Restylane can be used to fill it.  Surgery can tighten the skin but without restoring volume to the area, it will still look hollow.

Under eye hollows or circles form from loss of volume in soft tissues (primarily collagen and elastin in the skin), fat and bone of the area surrounding the eye. 

In order to rejuvenate the eye area, volume needs to be restored.

Injections of hyaluronic acid fillers in the periorbital area must be done with great care and expertise.  The choice of filler is important in how much lift and how much swelling there will be after the procedure.

The eyelid area is also highly vascular so bruising can result from injections.  Make sure you are not taking any over the counter or non-prescribed blood thinning medications for 2 weeks prior to the procedure.  Those include aspirin, NSAIDs like ibuprofen or naproxen, gingko biloba, fish oil, vitamin E and multivitamins containing these.  If you are taking a prescribed blood thinner, do not discontinue that, but make your doctor aware that you are taking it.

Consult a board-certified dermatologist or plastic surgeon with training and experience in tear trough injections.

Emily Altman, MD
Short Hills Dermatologic Surgeon

Lowerl lid blepharoplasty or fillers?

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This is a difficult question to answer without a photograph to properly evaluate your complaints. Most patients over the age of 55 will be good candidates for surgery to improve this area. The type of surgery will depend on your particular aging process and what is causing the hollow appearance of the eyes. While fillers are always a possibility I tend to use them in a younger patient who is not a surgical candidate. My web reference is below and if you would like to send a photograph I would be happy to give you an expert opinion. Best regards to you in San Diego!

Michael Elam, MD
Orange County Facial Plastic Surgeon
5.0 out of 5 stars 218 reviews

Correcting lower eyelid hollows.

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A photo is always helpful to assist in answering these questions.  Generally if there is a hollow below the eyes, this can be improved by a hyaluronic acid filler injection, such as Restylane.  This will temporarily add volume to the area and improve the appearance.  Some advocate fat injections but caution should be exercised as the result isn't always predictable as to whether the fat "takes" or not.  Sometimes patients impression of a hollow is due to a low point between lower eye bags and the cheek.  For these patients a careful removal of the herniated fat will correct the problem.

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.