What should I do about my under eye hollowness? (Photo)

I am upset over them and I really want to fix them. I've tried makeup and nothing seems to help. I am currently trying eye exercises to strengthen the muscles around. I hate the crease under my eye too..I'm hoping it doesn't get worse

Doctor Answers 10

Under eye hollowness

The hollow area under your eyes can be improved by conservatively using a hyaluronic acid filler such as Restylane. Depending on the findings of your physical exam, you may also need to layer another filler such as Belotero to help blend your lid-cheek junction and to avoid having overly puffy or bumpy lower eyelid.  Eye exercises to strengthen your muscles will not help your creasea. Theoretically, increasing the bulk of your orbicularis oculi muscle may even make the lines and step-offs more noticeable. Best of luck!

Beverly Hills Physician
5.0 out of 5 stars 12 reviews

Hollow eyes can be caused be genetics, and can be addressed by adding volume and improving the skin non-surgically

Thank you for your question. You describe issues you have with under eye hollowness and under eye creases which cannot be covered up with makeup. You’re currently doing eye exercises in the hope of seeing some improvement.
I can certainly see why you are frustrated with these issues, and I can definitely help you since improving the appearance of people’s eyes is a central part of my practice I deal with every day. To give you a little about my background — I am a Board-certified cosmetic surgeon and a Fellowship-trained oculofacial plastic and reconstructive surgeon, practicing in Manhattan and Long Island for over 20 years.
A majority of people who come to my practice with concerns of under eye hollowness fall into one of two categories: hereditary, for younger people; and age-related, for people in their late 30s or older dealing with natural changes that come with aging.
When it comes to under eye hollowing, people have the perception that they look hollow because there is an area that looks like a valley next to their eyes, otherwise called the tear trough area. Often, people who have dark under eye circles feel like both the hollowness and pigmentation of the skin are problematic. People also often think that if this area had more volume, it would look better.
It is important to understand that the appearance of the tear trough area is subject to two factors: the volume in this space under the skin, and the quality of the skin itself. When someone has hollowness and discoloration, it can be treated with some form of injectable treatment. However, if they also have some puffiness under their eyes, that requires a different procedure altogether.
In your case, you could consider using a hyaluronic acid filler such as Restylane. Restylane is a softer type of hyaluronic acid filler which I personally find very useful because I can place it fairly deep in this area, and it blends in very nicely. Keep in mind that fillers are not permanent and will require constant maintenance because they do eventually break down. Interestingly as a side note, fillers in this area have been known to last longer than anticipated, based on clinical trials. Even though Restylane is expected to last for at least six months, I’ve seen it last for as long as one year or longer in some patients.
Since the area around the eyes is very delicate, and because this is a procedure done around the eyes, you can expect the possibility of some slight bruising and swelling. As such, I make sure to explain to my patients that if they’re having fillers done for the first time, to consider having it done on a Friday so that they have the whole weekend to recuperate, if the bruising or swelling are significant. The aftercare is usually very straightforward — if there is elevation then gently massage the area, though I generally don’t find this necessary. We follow up with our patients after two weeks to see how they look, and see if they need more enhancements, though it is rarely needed.
This is another topic, but in terms of dark under eye circles, this is more a question of skin quality and discoloration. When it comes to issues of skin quality, I use platelet-rich plasma. Platelet-rich plasma is a concentration derived from your own blood that contains important growth and healing factors necessary for wound healing. It stimulates blood supply and collagen, which have a remarkable effect in improving skin quality. Platelet-rich plasma has a multitude of applications all over the body, including wrinkles, acne scars, and scars in general. In spite of the versatility and safeness of this modality, a patient would still require a proper physical examination in order to determine if platelet-rich plasma is appropriate for them.
Ultimately, in your case, I might be dealing with volume loss, or skin quality, or a combination of both. If that is the case, then that would be my thought process on how to approach your treatment.
You also mentioned you’re currently doing eye exercises in the hope of improving the appearance of your eyes. I would have to say that I don’t think eye exercises would be of value to you because the muscle around the eye does not get thick enough to change the appearance of the eye. This, however, is different for people with neurologic issues.
As for the under eye crease you’re concerned about, I think this is just a normal anatomic variation of your eye and not something worth spending a lot of time, effort, and energy to try and reduce it. You could perhaps apply some platelet-rich plasma to that area, but I don’t think it will make that significant of a difference in the end. That said, I suggest you meet with qualified and experienced specialists and learn more about your options. Consider the bigger picture, think about the long-term, and whether you can really commit to this as a plan. The good thing about pursuing fillers is they are not permanent, so if you don’t like the outcome, you can either wait for it to go away, or have it dissolved with the enzyme hyaluronidase.
I hope that was helpful and I wish you the best of luck!
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Amiya Prasad, MD
New York Oculoplastic Surgeon
4.3 out of 5 stars 70 reviews

Under Eye Hollowness

I would recommend an injectable filler made from hyaluronic acid, such as Juvederm or Restalyne. Both fillers can be used in the tear trough area and help reduce the appearance of dark circles by providing volume. They last about 6-8 months and are very common in women your age.

Audrey A. Klenke, MD
Hilton Head Island Plastic Surgeon
5.0 out of 5 stars 6 reviews

Under Eye Hollowness

Dear Liz, 

Thank you for sharing your concerns with us. You should be evaluated in great detail by a Board Certified Facial Plastic Surgeon, who is well versed with injectable fillers in the under eye and upper cheek area and also has an aesthetic sense and an artistic eye. Often times, just by fixing the upper cheek flatness,  (eg with Voluma or Juvederm), it indirectly fixes the under eye hollowness. Someone  really experienced would be able to tell you if that is the case for you, after examining you in person. If that is not sufficient, then you would need some Juvederm to the under eye area as well, but I think you may be able to avoid that part..

Best Wishes to you !
Dr. Anna Petropoulos, 
Boston's North Shore

Anna Petropoulos, MD, FRCS
Boston Facial Plastic Surgeon
4.7 out of 5 stars 20 reviews

Under Eye Hollowness

Thank you for your question. I am sorry to hear about your concerns. Volume can be improved in the tear trough region with hyaluronic acid fillers such as Restylane. Seek an experienced injector for an in person consultation to determine your candidacy.

Dr. Daniel Ritacca

Daniel J. Ritacca, MD
Chicago Oculoplastic Surgeon
4.3 out of 5 stars 18 reviews

Fillers can help

Fillers such as Juvederm or Restylane can help with this under eye hollowness.
Very judicious and only small doses are necessary.

Keith Denkler, MD
Marin Plastic Surgeon
5.0 out of 5 stars 18 reviews

Lower lid "hollowness"

Dear Liz218:
The best answer for your "hollow" lower lids is to "fill up" the contour deficiency. In older patients, we often see this problem, especially if they have had fat removed with a cosmetic lower lid surgery, and the answer for them is to fill this "tear trough" deficit--usually with some of their own fat. Certainly, one of the commercial injectible "fillers" could also be used ( like Juvederm), but fat might be better. If that would be your choice, liposuction would be used to harvest some fat from where you don't want it ( only a small quantity is needed) and it is processed and injected deeply into these "tear troughs", and this is an office procedure for most plastic surgeons, and can be done under local anesthesia, or with some oral sedation in addition, if desired. So you have options; I would recommend you discuss this with a board-certified  plastic surgeon. I wish you luck.
James H. Scheu, M.D.

James H. Scheu, MD, FACS
Saint Louis Plastic Surgeon
4.4 out of 5 stars 24 reviews

There is no question that under eye Restylane is the best option for this.

Given your age and issues, service will last over year and in some cases even longer.  It is delivered by a very comfortable office service-no surgery.  The key is finding a very experiences under eye injector.  This is not a service you want to go to a spa for.  This is far better than any surgery for your issues.  Cute dog.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

What can be done to correct under-eye hollows?

Thank you for sharing your question and photo. The hollows can be filled with Restylane. Make sure your doctor is experienced with this delicate region to ensure good results. 
Good luck,

James R. Gordon, MD, FACS, FAAO
New York Oculoplastic Surgeon
5.0 out of 5 stars 140 reviews

Lower lid hollowing

Eye exercises will not help with this.  You should try some HA filler to the lower lids such as Restylane.  This will provide the additional volume you need and will make the eyes look smoother and less dark. should last for at least 1 year.

John J. Martin, Jr., MD
Coral Gables Oculoplastic Surgeon
5.0 out of 5 stars 27 reviews

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