Droopy Lower Eyelids and Hallow, Sad Under Eye- What Are My Options?

Hello Doctors, I have big eyes however I have no fat under them which in turn makes my eyes look extremely tired. When looking at my profile it's very noticeable and looks very hallow with dark circles due to my veins showing. Also, my lower lids are very low and gives a very sad/round look and shows a lot of my eyeball. I contract/squint/slant my eye muscles throughout the day so that it looks better. Would fat grafting/non surgical help lift my lid or something my drastic like a canthoplasty?

Doctor Answers 5

Where are the photos?

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People, people help us answer your questions please by posting photos.  Even those fuzzy out of focus pictures you take with your phone are often better than nothing. 

Personally, I think fat to the lower eyelids is a disaster.  I cannot recommend this.  Sure some people have had amazing results but was that 1%, 5% or 10% of everyone who has grafted fat?  I see many patients who need fat removed from the lower eyelid. 

Also be very careful with the canthoplasty.  This is truly a reconstructive procedure not a cosmetic procedure.  Generally the analysis upon which this surgery is employed is flawed.  In the type of eyelid you are describing, the issue is not so much weakness in the lower eyelid tendon insertion but rather inadequate orbital rim and zygomatic/maxillary face projection. 

The safest option is hyaluronic acid fillers.  For this you need a lower eyelid filler expert to get the most out of the service.  Treatment can often last 2 years which is pretty good compared to fat transfer results.

Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Eyelid Changes with Maturity

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Gravity and loss of facial volume happen to all of us as we "mature". The hallow appearance you describe can be improved with fat or Restylane. The position of the lower eyelid margin can be raised by injecting small quantities of hyaluronic acid in the deep layers of the lid. Make sure you have this done by a surgeon experienced in eyelid surgery. 

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 43 reviews

Lower Eyelid Rejuvenation

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There are many options for lower eyelid rejuvenation including augmentation of the area with either an off the shelf filler or fat. There are also quite a number of surgical options. Canthoplasty is usually used in conjunction with other procedures for cosmetic purposes. Without good pictures the only advice I can give you is to see a Plastic surgeon who specializes in eyelid rejuvenation. This way you can discuss your desires and the options you have.

Robert T. Buchanan, MD
Highlands Plastic Surgeon

Lower Eyelid Rejuvenation

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It is crucial that you seek out an experienced plastic surgeon. Of course a thorough examination is crucial, but sounds like there are potentially two issues. One is the descent of the soft tissues that were at one time in the upper portion of your cheek. Its is referred to as the "descent of the malar fat pad." This can be addressed with either re-suspension of the fat pad or fat grafting above it. Second issue sounds like there may be a change in the tone of your lower lid. This may be from a previous scar or the development of laxity in the tissues. The treatment will depend on the cause and degree of "drooping" of the lower lid.

Richard Ellenbogen, MD
Los Angeles Plastic Surgeon
4.7 out of 5 stars 30 reviews

Non Surgical Lower Lid Rejuvenation

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It is difficult to comment on your situation without seeing you as a patient or at least viewing photographs.  However, patients with prominent eyes are often disappointed after traditional eyelid surgery because excision of lower lid skin and fat may make their eyes look more prominent.  I agree with Dr. Steinsapir that injection of a hyaluronic acid (such as Restylane) to the tear trough is a great place to start in most cases.

Michael McCracken, MD
Lone Tree Oculoplastic Surgeon

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.