Lower Eyelid Hollowness? (photo)

I have lower eyelid hollowness as shown on picture. I try 2 fat grafting procedures already (with Restylane), and fat appeared nice after graft but after 1 year it is gone. You also see lower eyelid is puffy. Is there a way to allow the lower eyelid to appear flat and blend with outside corner of the eye (much like movie actors like Tom Cruise as an example)? Is fat grafting solution, OR, should I look into getting myself an orbital rim implant for a permanent solution? Please advice.

Doctor Answers 3

Lower eyelid hollowness. What to do?

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Many people see lower lid shadows when looking into the mirror. In fact, most of us have a "tear trough" beginning in the inside corner of the lower lid (it funnels our tears from the medial eye down along the cheek).  This is not an abnormality but can become accentuated with aging and skin changes. As we get older, the central midface tissues may migrate downward, and the lower eyelid skin may thin, and these factors may then create "circles" under the eyelids. These unwanted shadows sometimes can be improved with procedures ranging from (1) injection of fillers including fat or hyaluronic acid gel, (2) resurfacing the skin with laser or chemical peel therapy, (3) lower eyelid surgery in select cases.  Note that the lower lids are very sensitive to alterations and all procedures must be performed with great caution, care and expertise. 

Louisville Facial Plastic Surgeon
5.0 out of 5 stars 75 reviews

Lower eyelid hollow

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injections of Restylane and fat, etc., are done, but don't always last and reports of blindness have been reported.

You may also consider a blepharoplasty with vascularized fat transferof periorbital fat to the hollow area.

Fat Grafting for under eye hollows

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Fat Grafting, performed by a plastic surgeon with the appropriate technique should provide a lasting result.
For fat grafting to truly represent 'grafting', the grafted tissue must gain a blood supply in its new location which provides a source of oxygen and nutrients and allows the tissue to persist indefinitely. If the grafted fat does not acquire a blood supply in the first few weeks after surgery, the body will gradually break it down and dissolve it, and no long-term benefit will be achieved in terms of soft tissue augmentation. Successful fat grafting surgery therefore requires a great deal of focus and attention to detail, to ensure that the fat which is harvested is viable tissue (i.e. not damaged by the harvesting process), and that the fat is delivered in such a way that the potential for ingrowth of blood vessels is maximal. If this process of blood vessel ingrowth (neovascularization) does not occur, then the injected tissue cannot truly be considered a 'graft' and is instead just another 'soft tissue filler' of limited duration.
Fat grafting has been performed by plastic surgeons for decades, but it is just in the last ten years or so that techniques and instruments have been refined to the point that it can be accomplished reproducibly and reliably, making it an increasingly important part of facial rejuvenation surgery. The term 'structural fat grafting' refers to a specific surgical technique in which small amounts (less than 0.1 cc at a time) of fat are carefully microinjected in a series of discrete layers to gradually 'build' new soft tissue structure. As there is space between each microinjection, new blood vessels are able to grow into the grafted fat, allowing it to persist long-term.

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