I have sunken and hollow eyes after eyelid surgery and also eye bag removal. Is this normal?

how can my eyes retain volume once again.

Doctor Answers 8

Sunken, Hollow Eyes after Blepharoplasty

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It is not normal to have sunken, hollow eyes after eyelid surgery. But, it is unfortunately somewhat common.  I'm sorry that this is something you have experienced  This can be corrected with fat grafting.

Fat grafting is the only way to correct the hollowness and dark circles that result from excessive removal of lower lid fat during a lower blepharoplasty procedure. From the posted photographs it appears that you most likely had a transconjunctival lower blepharoplasty performed, which is removal of lower lid fat through an incision on the inside of the lower lid (no external skin incision). Fat is missing, and to restore a more youthful appearance it has to be replaced.

Subcutaneous fat is what provides facial skin with a sense of fullness and vitality, and it helps to impart a youthful color and ‘glow’. Where fat is missing, skin looks darker, less robust and less youthful. Fat also serves as an important part of lower lid support, especially over time as a person ages.

Lower lid blepharoplasty should ideally preserve most or all of a patient’s lower lid fat, unless there truly is marked excess that is bulging outward. Fat can not only be treated by removal – it can also be restrained, and it can even be repositioned into areas of hollowness such as the tear trough. In addition, fat can be added to areas of hollowness in and around the lower lids to camouflage or ‘correct’ adjacent areas of fullness. I frequently perform structural fat grafting of the lower lid / cheek junction at the time of lower blepharoplasty, to add lower lid support and to blend the contour of the lid and cheek.

Fat grafting of the lower lid area requires experience and meticulous technique. As the area is covered by a very thin layer of skin and muscle, overcorrection must be absolutely avoided. My approach is to graft fat to the point that the area looks aesthetically ideal, then stop and wait 3 months to assess fat survival. As fat survival is variable, additional fat grafting procedures may be performed based on the results of the first. In most cases of post-surgical lower lid hollowness, two to three fat grafting procedures are required to restore adequate subcutaneous fullness in this area.

Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 123 reviews

Sunken Hollow Eyes After Eyelid Surgery

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Modern blepharoplasty does not remove or leave residual sunken eyelids, as one wants to retain fullness in the upper and lower
eyelids to give a useful non-operative look. You can restore this by volumizing with either fillers or fat restoration.

Rod J. Rohrich, MD
Dallas Plastic Surgeon

Sunken Hollow Eyes after Blepharopolasty

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You should wait about 6 to 9 months after surgery so that you are fully recovered before you consider doing anything. If you are still unhappy you can consider fat grafting or filler such as Restylane to correct the problem.

Best of luck to you,

Dr. Peter Newen

Peter Newen, MD
Orange County Plastic Surgeon
4.6 out of 5 stars 43 reviews

Hollow eyes after bleph

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This is a common issue in a fat removal blepharoplasty.  When the fat is removed, you will often look good while the area is swollen.  Once that resolves, the lid can look sunken and darker than before. You will need to replace the volume that was removed.  Restylane or Belotero are good options for fillers.  Your other option is fat transfer.   

John J. Martin, Jr., MD
Coral Gables Oculoplastic Surgeon
5.0 out of 5 stars 31 reviews

Restoration of sunken eyes after eyelid surgery

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This is a common issue. While attempting to remove fat to improve contour, often times the removal of fat can cause a hollowed appearance to the eyes.

Wait until 6 months after your surgery. Consider fat grafting to the upper lid as well as fat grafting to the lower lid/cheek junction to "fill in the void" and restore the full appearance. Fat grafting is a permanent option. If you are uneasy about undergoing such a procedure, dermal fillers can be used as a temporary option that lasts 6-12 months.

Best of luck.

- Dr. Bryson Richards

Sunken eyes revealed after blepharoplasty !

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Fat removal during blepharoplasty can leave the eyes more hollow. It is also possible that you had hollow eyes to begin with and it became more obvious after removal of skin.  That requires adding volume around the eyes to achieve more youthful appearance. That can be accomplished by fat or filler injection (or combination). See an oculoplastic surgeon.

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 91 reviews

Sunken eyes after lower blepharoplasty

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this is a known result of lower eyelid surgery. Without photos it is very difficult to comment and it depends on whether fat was removed or reposition and the approach - external incision or transconjunctival. Time usually improves hollowness otherwise replacing volume with fat or filler is a possibility. Condiseration should also be given to your mid face. A lot of patients I see concerned about their lower lids actually need a mid facelift to support their infraorbital volume.

Sunken eyes after eyelid surgery

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Without both a before photo and an after photo, this is a hard question to answer.  However, hollowness would be most likely a result of the fat removal during the case.  I try to remove as little fat as possible while still providing a smooth contour and thus a correction of the bags.  If this is the case, fat grafting might be in order.  Voice these concerns to your plastic surgeon.  Best wishes and good luck.

Shayne Webb, MD
Nashville Plastic Surgeon
5.0 out of 5 stars 49 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.