Blepharoplasty eyelid surgery, hollowness under eyes

I had a blepharoplasty lower eyelid surgery years ago and now the skin under my eyes is hollow and when I smile it wrinkles really bad, so what non invasive procedure can I do to fix this problem or tighten the skin under the eyes with no downtime if possible. maybe to much fat was removed but it looked great for 15 years and it still looks good until I smile.

Doctor Answers 6

15 years after lower eyelid blepharoplasty

A non-invasive procedure such as CO2 laser resurfacing combined with cautious use of fillers could improve the crepe-like wrinkles and improve the skin texture and contour of the lower lids and tear trough. Be sure to learn the risks and benefits of each procedure prior to making a decision to proceed. Best wishes.

Charlottesville Oculoplastic Surgeon
5.0 out of 5 stars 3 reviews

Lower lid hollowing

This can occur with both aging, and after fat removal from the lower lids.  You are lucky to have had 15 years looking good!  Tough to comment since you did not supply pictures  but a few options things may help.  If you have a lot of skin, some could be removed.  Laser resurfacing would help to tighten the skin.  And some volume would definitely help - either HA fillers such as Restylane or fat.       

John J. Martin, Jr., MD
Coral Gables Oculoplastic Surgeon
5.0 out of 5 stars 24 reviews

Hollow lower lids after blepharoplasty

Without photographs, it is difficult to give a precise answer.  It is fantastic that you had such a nice result for a long period of time after your lower lid blepharoplasty!  None of us can escape ongoing aging, unfortunately.  From your description, you probably have further development of excess lower eyelid skin, which tends to be crepe-like or "crepey," along with the emergence of a flat or hollow look (typical as we age and lose fat from all parts of the face).  This may be amenable to a CONSERVATIVE re-trimming of the skin, or CO2 laser re-surfacing.  Also helpful, perhaps, would be Botox for the crow's feet area so that the muscle movement that tends to exacerbate and facilitate the lines when you smile could be relaxed.  Injections of filler material (one of the hyaluronic acids) could be helpful in "plumping" the area so that the lines have less tendency to form.  Theses fillers are not permanent, so we would expect re-emergence of the lines and less fullness over time.  Injection of microparticulate fat into the lower eyelid is a more long-lasting solution, which is even more powerful when combined with the CO2 laser resurfacing to eradicate the crepey skin.  The best advice is to see a board-certified plastic surgeon with extensive experience in fat transfer and facial procedures who can thoroughly examine you in person and go through the options with you.  Best wishes for a beautiful result!

Loss of lower eyelid fat

Thank you for sharing your question. Dermal fillers are great for improving hollowed eyelids. See an experienced doctor who performs this procedure on this delicate tissue.  Good luck,


Yes, you seem to be a good candidate for lower lid fat injection. This is a simple outpatient procedure and can be done with our without laser resurfacing as an outpatient procedure.

Bahman Guyuron, MD
Cleveland Plastic Surgeon
4.8 out of 5 stars 20 reviews

Fat removal during blepharoplasty

It's very difficult to answer your question without seeing your pictures, however I can tell you that those of us who trained after the 80's rarely remove fat from the lower eyelids, but rather reposition it, because fat removal usually makes the patient appear hollowed out over time.  Dermal fillers or fat injection under the eyes may be the answer.  If your original surgeon is not still in practice, please seek out a Board Certified Plastic Surgeon.  Best of luck to you!

Nicholas Husni, MD, PhD, FACS
Cleveland Plastic Surgeon
5.0 out of 5 stars 5 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.