Hollowed bulging eyes - what procedure?

Question

I have always had bulging eyes with deep hollows under . Would fat transfer be better or I should consider eye implants or Blepharoplasty? Thank you

Nelson Lee Novick, MD · Answer

At least from the photos provided, the kind of under eye hollowing shown can often be easily and quickly treated with fillers. In general, a supportive volumizing filler, such as Voluma XC, can be used to restore or in some cases to create a sufficient supportive foundation for the under eye region, which alone typically makes a secondary improvement in the appearance of hollowed under eyes. The use of less robust, filler, if still needed, such as Belotero Balance or Teosyal Redensity II, may be used to create a smooth  transition between the upper cheek and lower lid regions. Fat injections, despite the allure, have a number of drawbacks, which is why I gave up using this approach many years ago. For one thing, fat severed from its original blood supply, seldom lasts more than traditional fillers in the transpanted locations. What's more fat transfer is a relatively expensive two-step minimally invasive process that engenders some real downtime. (removing the fat with large cannulas from the belly, buttocks or thighs and reinjecting it with large cannulas into the new location). Moreover, the fat from say the belly retains, wherever it is relocated to, the belly fat's propensity to put on a "midriff bulge" with age, which can be quite displeasing and difficult to deal with it later on. Surgery, with all its expense and downtime, is of course does remain an option. But it would seem reasonable to explore a noninvasive approach first that typically results in an immediate "Wow!" reaction and has a surprisingly protracted durability of response. Be sure of course to consult with a board certified aesthetic physician injector and make sure to ask to see his/her personal befores and afters before agreeing to proceed. Best of luck.

Mehryar (Ray) Taban, MD, FACS · Answer

There are various treatment options including filler, fat, implant, and lower blepharoplasty. The latter (lower blepharoplasty) is usually the best where the existing under eye fat bags are shifted/repositioned to the hollow area. See an expert.

Megan Dreveskracht, MD · Answer

Based on your submitted photographs, you have what’s called a Tear Trough deformity. A Tear Trough deformity is created when the retaining-wall like layer which holds the lower eyelid fat in place weakens from aging or due to genetics. As a result, the fat pad bulges out, giving a full appearance to the lower lid while simultaneously accentuating the hollow area just beneath it. There are both surgical and non-surgical options for correction. If you wanted to try a non-surgical option, fillers can be great for filling the tear trough. They effectively fill the hollow area and smooth the lid-cheek junction. Unfortunately, fillers are only a temporary solution and will require periodic re-injections to maintain results.The surgical procedure most appropriate in this scenario would be a lower eyelid blepharoplasty. An incision is made on the inside of the eyelid, through which extra fat can be removed and repositioned to fill the hollow area. Unlike fillers, this would be a more permanent solution, though the area will continue to change and age over time.

Hollowed bulging eyes - what procedure?

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Hollowed bulging eyes - what procedure?

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