I'm Desperate for Help Concerning Under Eye Hollows at a Young Age.

I am 23 years old and have dark circles caused by thin skin, bags, and hollows that are genetic. I'm at a total loss as to where to begin. I have read so many mixed reviews on fillers. I also do not like that they are a temporary fix. I also can't afford to have injections on a repeated basis. I'm a firefighter in atlanta, and people always say I look exhausted because I cannot wear makeup to work. I'm desperate for a path to pursue.

Doctor Answers 7

Treatment for Hollowing of Eyes at Young Age

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As you are young, these problems related to your eyes, such as eye bags, thin skin below eyes, and hollowing beneath eyes are not age related but rather are related to genetics and facial structure. A single solution is not the answer to your eye area problems that give you a tired appearance at a young age. Understanding that you have a limited budget, you should seek the guidance of an experienced and established specialist (as opposed to high volume medispa which sell cheap injectables)  and develop a plan which makes sense for you in the long term.

New York Oculoplastic Surgeon
4.4 out of 5 stars 80 reviews

How to improve that tired, wan look on your young face

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Hollowness under the eyes is an entity that has become more and more recognized. This can give patients who suffer with it a tired, aged look. Correction of this can be done in several fashions but primarily either injectable fillers or a fat repositioning during a lower blepharoplasty are the most common treatment methods.
For patients who are young and not ready for surgery, injections are a nice way to soften the under hollows. These grooves, also called tear troughs or nasojugal grooves, can be filled with a variety of fillers including Restylane, Juvederm or Perlane. Juvederm seems to be the most forgiving in this area and has the least issues with nodularity or bruising. Of all the areas that injections are done, tear troughs are the most challenging. The skin is thinner in this area and with this any irregularities are more visible. In addition, because of the vascularity of this area, bruising is more likely. Patients considering injections around the eye area should be sure that they have a definite deformity that would benefit from improvement. With the right patients, however, injections in the tear trough can provide a rejuvenated appearance with minimal down time and at a reasonable cost. For young patients, this can be a great option.
Surgery is another option for under hollows. For patients who have prominent fat pockets with a very visible orbital rim, repositioning of the fat can allow rejuvenation of this area. Fat repositioning during blepharoplasty takes a little bit more time and skill. It involves the surgeon freeing up the redundant fatty tissue in the eye area followed by creating a pocket along the areas of hollowness. The fat is then secured in this area; there are a variety of ways to accomplish this, either being sutured to the deep periosteum or over the skin with an absorbable stitch. Whatever technique is used, repositioning of the fat addresses two issues: 1) Removal of the redundant fat; and 2) Softening of the eye hollows. For patients who have both of these problems, lower blepharoplasty with fat repositioning is a great option.
The first step to seeking help for under hollows is to consult with your facial plastic surgeon to evaluate your anatomy as well as consider possible treatment options.

Mark Hamilton, MD
Indianapolis Facial Plastic Surgeon
4.8 out of 5 stars 50 reviews

Fillers and a laser treatment should improve your under eye appearance

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Hi there-

It is important to understand that there are varying degrees of expertise and skill among those you might choose to perform these procedures... and hence there will be a large variance in patient outcomes and satisfaction.

If you have someone who really know what they're doing perform the procedure, placement of fillers in your tear troughs with a laser treatment to diminish the dark color of the skin should give you a meaningful and relatively long lasting improvement.

Restylane injections in the tear troughs will probably help you.

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1)  This really works, but it is tricky to do.  So you need to find an experienced plastic surgeon.  Restylane is injected in tiny amounts deep, under the muscle.

2)  In this location and when well done, Restylane lasts three years.  So it is not something you constantly need to redo.


George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Treating the chroinc lower eyelid tired apperance

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The options for treating tear troughs are either minimally invasive such as fillers or fat injections or surgical with lower blepharoplasty/eyelid surgery with manipulation of the fat, muscle and septum in that region to create a smoother transition from the lower eyelid and the cheek. I prefer Restylane in that region since it is less hydrophilic (water absorbing) then Juvederm and causes less swelling. In that region it may last up to two years. If for any reason you are not satisfied with the results you can dissolve the HA (hylaronic acid) with an enzyme such as Vitrase.

The surgery with repositioning of the fat and orbital septum as well as release of the origin of the obicularis Oculi muscle work well in most cases to treat the tear trough and are permanent in many cases the incision can be made inside the lower eyelid and avoid the scaring!

Till today nothing really works well to treat the dark circles which are either pigmentation or collection of hemosedrin from blood vessels in the thin skin of the eyelids!


Wish you best of luck

Under Eye Hollows

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Hi Emorel.  If you are 23 years old and have profound hollows under the eyes, then you have correctly identified this as a genetic issue.  There are 2 options in our opinion, lower blepharoplasty and Restylane injections.  If finances are an issue, we would recommend the fillers.

You mentioned that you were concerned about repeating the filler injections and about mixed results.  The procedure typically lasts 9-12 months so is actually quite a good value compared to surgery.  Some filler injections are much less duration.

As for the mixed reviews, this is mostly because the technique used in this area for best results (under the muscle) is not employed by a good number of injectors who have not been properly trained.  Before and after pictures and a quick review with your injector about his/her technique should put you at ease.  Good luck.

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
4.4 out of 5 stars 7 reviews

I'm Desperate for Help Concerning Under Eye Hollows at a Young Age.

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Photos, of your face and eyes would help in the evaluation to define exactly what's causing the tired look which can be hollow, fat bags, excess upper eyelid skin or some other cause.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 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.