What is the Safest Procedure for Upper and Lower Eyelid Hollowness?

I am a 22 years old female and I have hereditary hollowness of both upper and lower eyelids. I was wondering what is the safest cosmetic procedure for this.

Doctor Answers 18

What is Safest Procedure for Upper and Lower Eyelid Hollowness?

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There are two issues, one safety, and the other effectiveness.  As a  young person you want something safe because you may be repeating the procedure many times, e.g., with the use of fillers.

The problem with fillers around the eyes, is that the skin is so thin. It will show almost anything you inject unless it is done carefully and in small amounts. Also the upper and lower eyelid areas are very susceptible to bruising which can lead to down time.

It is not unusual for me to see patients who have had fillers injected under the lower lid area who are unhappy. The reason? small prominences, or lumpiness, not entirely smooth, or asymmetrical one eye to the other. On occasion I have seen patients very unhappy about fat grafting to their lower lids. It appeared to have been placed too superficially and showed as bumps under the skin. Not easy or straightforward to correct.

At least fillers will go away with time, and the hyaluronic acid fillers can be dissolved on the spot with hyaluronidase if the result is not good for some reason.

When we talk about the upper lid, we are not really talking about adding anything to the eyelid itself, but to the thicker tissue underneath the eyebrow going out toward the orbital rim. This can diminish the upper lid hollowness.

There is a relatively recent addition called Belotero. This hyaluronic acid filler from Merz (who also make Radiesse), has a smaller molecule that allows it to be injected superficially without showing a bluish color that occurs with the other hyaluronic acids fillers like Restyland and Juvederm. It is appropriate for fine lines and may be safer in the sense of less likely to be visible when used around the eyes.

With respect to safety, any facial injection with a filler has the risk of embolization, that is the introduction of the material into a blood vessel. This has been reported with all fillers and fat, and can cause blindness or death of tissue supplied by the blood vessel, such as skin around the lips or nose.

There are now available small injection cannulas instead of needles. They have a blunt tip so would be less likely to enter a blood vessel. Because they are blunt, they are also less likely to injure a blood vessel and so may be less likely to cause bruising. I have adopted them in my practice.

If you are considering fillers or fat grafting for treatment around the eyes, please consult a board-certified plastic surgeon or oculoplastic surgeon. They are very familiar with the delicate anatomy around the eye. This is a very demanding area to get consistent results without problems.

Mountain View Plastic Surgeon
5.0 out of 5 stars 54 reviews

Fat Grafting for Hollow Eyes

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One of the most remarkable and rewarding enhancements I have been able to provide patients using this structural fat grafting is the creation or restoration of soft tissue fullness in the interval between the upper lid crease and the eyebrow. I refer to this location as the 'brow-upper lid junction'. Hollowness in this area projects an image of advancing age, or exhaustion, or illness - and sometimes all of the above. Fullness in this area projects a sense of youth and vitality. Just look at the 20-something models you see in fashion magazines; in almost all of them you'll find that the upper lid is mostly or completely concealed by the soft tissue fullness immediately below the brow.
Careful placement of structural fat into this area can produce a dramatic rejuvenating effect, but one that no observer can ever identify as a surgical change to the eye area - it looks not only youthful but also completely natural. The medical term for the area around the eye is the orbit, so the treatment described above is sometimes referred to as 'orbital fat grafting' or 'peri-orbital fat grafting'.

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 123 reviews

Eyelid Hollowness

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In a younger person, lower eyelid hollowness can be improved by blending the eyelid-cheek junction with hyaluronic acid fillers like Restylane in the tear trough area. Surgery is usually not indicated in this young age group.

Rod J. Rohrich, MD
Dallas Plastic Surgeon

Hollow eyes and how to treat them

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You have received a good summary of what can be done.  You just need to find a surgeon who you will entrust your care to but fillers or fat are you options at this time with fat having the potential for permanence.  You should be informed of all of the potential risks prior to having your procedure.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews

Treating Eyelid Hollowness

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Eyelid hollowness is often a sign of facial aging, due to fat atrophy.  We generally associate fuller facial features, including around the eye, with a more youthful look.  Unfortunately, hereditary hollowness can become apparent much earlier.  The treatment is usually non-surgical and consists of either cautious filler injections (most often Restylane) near the edge of the orbit (eye socket) and within the eyelid, or fat grafting in the same areas.  The fat can be take from the belly wall or the thigh.  Although fat grafting is more of an invasive procedure, the fat can last permanently, as opposed to fillers, which usually last 1 year.  There are pros and cons to fat vs. fillers, so be sure to discuss this thoroughly with your plastic surgeon. 

Richard G. Schwartz, MD
West Palm Beach Plastic Surgeon
5.0 out of 5 stars 32 reviews

Treatments for Upper and Lower Eyelid Hollowness

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Upper eyelid hollowness at your age is very rare, but can be treated with fillers.  Fillers such as Restylane or Juvederm can be removed if you are not happy with the results.  This gives you an additional measure of safety and is a priority for you, as it should be for all patients. I have seen many young patients with under the eye hollowness or tear trough deformity. A filler like Restylane, works very well to reduce dark circles and fill in wrinkles. This treatment usually lasts 18 months. Some of the risks of tear trough treatment include but are not limited to: infection, bruising, lumpiness, redness, swelling, pain, and discoloration. When injecting, I use microcannuals to reduce the chance of bruising and maximize the patients comfort. Another option for under eye hollowness is fat transfer. However if you are most concerned with safety, non-surgical options provide the least amount of risks and complications.  Hope this helps.

Paul L. Leong, MD, FACS
Pittsburgh Facial Plastic Surgeon
4.8 out of 5 stars 50 reviews

Hollows Around the Eyes Respond Well To Fillers

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Combining Belotero Balance with a tiny amount of Radiesse works well for tear troughs below the eyes and hollows above. Tear troughs, hollows, and dark circles are common problems around the eyes. It has become standard practice to treat this region with lighter weight fillers, like Restylane, to lift, straighten, and contour this region. Occasionally, if fillers are inadvertently placed too superficially, a bluish discoloration related to light scattering (a phenomenon known as the Tyndall effect) can occur, which can actually make the dark circles more prominent. Belotero, a new hyaluronic acid product, has been manufactured to avoid this.

In general, I have found that the addition of a very tiny amount of Radiesse, a whitish-colored filler, to Belotero or Restylane L, to be an excellent way of treating tear troughs and hollows and lightening existing dark circles and increasing the durability of the results. However, only an experienced, board certified aesthetic dermatologist or plastic surgeon injector should attempt to treat these delicate areas in this manner.

Nelson Lee Novick, MD
New York Dermatologic Surgeon
4.9 out of 5 stars 33 reviews

Restylane treats hollow eyes

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Surgery is not a treatment for hollow eyes. Although fat injections w/ micro-technique can be used, the issue is w/ bumpiness afterward. We have found Restylane, with it's minimal hydrophillic properties, to be the best long-term solution. It generally lasts 12 months or more and produces the most natural result by replacing a very similar soft tissue volume around the eyes. Seek a specialist with experience in this area for best outcomes. Don't do surgery and avoid Juvederm as it causes long-term, unacceptable swelling around the eyes.


Dr. G in Orlando

Edward J. Gross, MD
Orlando Facial Plastic Surgeon
4.8 out of 5 stars 35 reviews

What is the best treatment for eyelid hollows?

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The answer depends on your specific eye/facial anatomy. Fillers are great options for some, while others may benefit from combination of fillers and blepharoplasty. Fat injections may also be useful in some locations. See an oculoplastic surgeon.

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

Safest treatment for eyelid hollowness

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Please post a photo so we can evaluate you other than in generalities and hypothetically. I will say that you have to take your heredity as you find it and try to make the best you, rather than seek someone else's anatomy. Safety must also be defined. Filler injection is a procedure, not surgery, but it is important to be treated by a board certified plastic surgeon or dermatologist.

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.