Under-eye hollowing at 24 - fat transfer, filler, or Rejuran? (Photos)

Question

I'm 24, mixed Caucasian/Hispanic skin, 5'4" / 117lbs. I have PCOS and hormonal fluctuations caused facial fat loss, leaving me with hollow tear troughs. I'm weighing several options and would love an expert opinion on which direction makes the most sense for my case. 1. Filler: Would hyaluronic acid filler be appropriate for tear troughs at my age and skin tone? Which product would you recommend to avoid the Tyndall effect? 2. Rejuran: Would polynucleotide injections be worth considering for this area, either as a standalone treatment or combined with filler for skin quality improvement? 3. Fat transfer: Given that the hollowing is likely due to hormonal fat loss rather than aging, would fat transfer be the better long-term solution? And would you combine it with lower bleph or is this purely a volume issue?

Yily De Los Santos, MD · Answer

Looking at your age and what you described, this appears more like a volume deficiency/hollowing issue than true aging. At 24, the goal should usually be subtle restoration and maintaining natural anatomy rather than aggressive correction.

For tear troughs, hyaluronic acid filler can work very well when performed conservatively and with the correct product. The key is using a softer filler with low water attraction and placing it very precisely to avoid puffiness or the Tyndall effect. In younger patients with thinner skin, technique matters more than the amount of product.

Rejuran or other polynucleotide treatments can improve skin quality, hydration, and crepey texture, but they do not replace volume. They are better viewed as supportive treatments rather than a true correction for hollowing. In some patients, combining them with conservative filler gives a more refreshed overall result.

Fat transfer can absolutely be an option, especially if the hollowing is truly related to facial fat loss and you want a longer-lasting approach. However, under-eye fat grafting requires extreme precision because this area is delicate and changes over time. At your age, I would generally lean toward starting conservatively before moving to permanent-type procedures.

Under-eye hollowing at 24 - fat transfer, filler, or Rejuran? (Photos)

Answers (1)

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