35 - deep creases and hollowness under eyes. What surgery or treatment would you recommend?

two things for you: 1) continue to do botox and make sure that it also goes into the undereye area. 2) work on your skincare. laser laser laser.

You will need an upper and lower blepharoplasty. You may also need a mid facelift or possibly an extended brow lift.

Best Wishes,

Gary Horndeski, M.D.

This is a fairly common aesthetic problem. I have personally treated these residual (post Botox) crow's feet lines (as well as parallel laugh lines around the mouth) using a low viscosity, malleable, cohesive HA filler fanned properly beneath the lines to elevate and smooth them and provide a "scaffolding" support to minimize their exaggeration with smiling and emoting. You would do well to consult with an experienced, board certified cosmetic dermatologist filler injection expert and best of luck.

This is a common question I get from patients. When smiling your orbicularis muscle will contract and create a crease. This is true for everyone no matter their age. However, it can potentially accenuate a hollow area if present. I would need to evaluate the under eye in a resting state (ie not smiling) to make a determination how best to address your concern. I think your best option is to schedule a consultation with a plastic surgeon to get a thorough evaluation of your under eye to make recommendations on how to address this.
Hope this helps and best of luck,Kyle Kimura, MD