Hollow, thin, wrinkly under eye area - what are the best treatment options? (Photos)

Question

I think I have hollowness and my under eye skin is thin and wrinkly I have added more photos looking for something that will help that area open to anything

Joel E. Kopelman, MD, FACS · Answer

Thin, crepey skin together with hollowing under the eyes is very treatable, and the best plan depends on which of the two is the bigger problem. Hollowness at the tear trough and lid cheek junction responds to volume, either with a soft hyaluronic acid filler placed conservatively or with fat grafting if you want a longer lasting correction. Thin, wrinkly skin, on the other hand, needs skin quality treatment rather than volume. Options include fractional laser or a light chemical peel to improve texture, radiofrequency microneedling, and daily retinoid use to thicken the skin gradually. A lower blepharoplasty is only worth considering if there is true excess skin or a bulging fat pad, because it is not the right tool for hollowness alone. In many people the best result comes from combining volume restoration with a skin tightening or resurfacing step, done in stages so the thin skin is not overloaded. Be careful with filler in very thin skin, since placing too much or too superficially can cause a bluish tint or lumps. I would start with a short exam to decide how much of your look is hollowing versus skin laxity.

Frank Agullo, MD · Answer

If you push up on your cheek with your finger and it fills in, then you likely need volume. That is what your pictures look like to me.

The hollow area under the eye that you are concerned about is most likely from two things: thinning of the skin, and volume loss in the medial cheek and tear trough area. The hollowing of the cheek accentuates the tear trough because of the shadowing effect that occurs.

The fix I use is fat grafting to the medial cheek, which can help fill out that hollowed out area and can help plump out the tear trough. I typically perform fat grafting in this area instead of HA fillers since HA fillers are more likely to lump in this area and are temporary. I also typically inject a very thin layer of nanofat just underneath the skin in the lower lid to help thicken the skin. This is a very small procedure that can be performed under sedation. Swelling can last up to two weeks and some of the fat will be reabsorbed (sometimes requiring a second procedure to top off the area).

Skin tightening procedures such as radiofrequency microneedling (Morpheus8) can help improve the texture of the skin. Ablative lasers can also help improve the texture of the skin, however I would want to see your skin in person before recommending an ablative laser since it depends greatly on your skin color.

Lower blepharoplasty would not be indicated for your concerns. I do not see a fat bag pushing forward, and removing skin in the lower lid would most likely result in your lower lid being pulled down further.

#StayBeautiful,
@RealDrWorldWide

Zoran Potparic, MD · Answer

It appears that you have discrete malar hypoplasia (small cheek bones) which causes these changes relatively early in life. A combination of lower transconjuctival blepharoplasty, fat grafting and chemical peel can significantly improve this condition. Good luck.

Thanapoom Boonipat, MD · Answer

Under-eye hollowness and thin, wrinkly skin are two separate problems, and most people have some of both &mdash; which is why single treatments often disappoint. The hollow, the tear trough groove, is a volume issue. Options range from a small amount of carefully placed filler, to fat grafting with your own fat, to lower blepharoplasty with fat repositioning, where the fat bulging just above the groove is moved down into it for a smooth, permanent blend. The thin, crepey skin is a skin-quality issue: it improves with CO2 laser resurfacing or a series of microneedling treatments, plus a small pinch blepharoplasty if there is true excess skin. Filler alone under very thin skin can look bluish or lumpy, so with skin like you describe I lean toward fat-based or surgical correction for the hollow and laser for the skin itself. An in-person exam separates how much of what you see is hollow, how much is bulge, and how much is skin. In my practice, lower eyelid surgery and facial fat grafting are done awake under local anesthesia with IV sedation.

Hollow, thin, wrinkly under eye area - what are the best treatment options? (Photos)

Answers (4)

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