Genetic, worse with weight loss. How to fix my undereye hollows? (Photos)

Question

These are genetic and have gotten worse with weight loss because I’m pretty sure I lost midface and cheek support, but even before that my hollows were pretty bad. I have gotten so much filler but the issue is definitely bone structure. Also, whenever I get filler, it helps with the hollowness near my cheeks but I still can’t figure out how to fix that strip right underneath my lash line. It kind of bulges out but it doesn’t feel like extra fat, it just feels like my hollows are so deep and it is thin skin resting against my eyeball and hollowing into my eye socket to make that crease if that makes sense.

Zoran Potparic, MD · Answer

It is very likely, based on these photos, that you have mild malar hypoplasia, small cheek bones. A periorbital augmentation with fat grafts would help with discoloration and hollowness. In person consultation with a board certified plastic surgeon with experience in this procedure is recommended. Good luck.

Mehmet Ozdemir, MD · Answer

Based on your photos, your concerns appear to be related to congenital tear trough hollowing with midface volume deficiency rather than excess under-eye fat. If filler has not provided the desired result, structural fat grafting to the tear trough and upper cheek may offer a more natural, long-lasting improvement. If eyelid support is also contributing, additional procedures may be considered after a detailed evaluation by an experienced oculoplastic surgeon.

Julian De Silva, MD · Answer

Hi Dynamic721700, you have diagnosed yourself well. The strip right under the lash line, over the bony rim, is the hardest area to improve with filler and the easiest to make worse. The skin there is the thinnest on the body, the tear-trough ligament tethers it down, and filler placed in that spot tends to look puffy or take on a bluish tint rather than smoothly filling a structural hollow. Chasing it with more filler often compounds the problem. When the hollow is genetic and bony, as you suspect, the more reliable answers are surgical. A lower-eyelid procedure that repositions your own under-eye fat to drape over the rim can soften that lash-line strip in a way filler cannot, and where the deficit is truly skeletal the rim itself can be augmented. Your weight loss unmasking midface and cheek support is a separate but related issue, more about volume and descent than the lash-line strip itself. One practical point: a lot of existing filler in this area often needs to be assessed, and sometimes dissolved, before your true anatomy can be seen. This really needs an in-person oculoplastic assessment. I trained in eye surgery before facial surgery, and the lower lid is exactly the area I would want to examine directly before advising you.

Michael McCracken, MD · Answer

It looks like there could be some residual filler in your lower lids.  Have you ever had filler there?  If so, you will need to have it dissolved to get a reliable evaluation.

Genetic, worse with weight loss. How to fix my undereye hollows? (Photos)

Answers (4)

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