Under Eye Hollowing and Wrinkles - Recommendations? (photo)

I would love to do my whole face but by eyes are what bother me the most especially when I smile. Not sure wether eyelid surgery, fillers or laser? Any recommendations would be greatly appreciated!

Doctor Answers 15

Lower bleph and cheek lift

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I would perform lower blepharoplasty and cheek lift to correct the lid-cheek junction. and flattened midface. You might also benefit from endoscopic browlift. The sagging of your midface could be improved by Sculptra to repair the deflation.

Edison Oculoplastic Surgeon
5.0 out of 5 stars 12 reviews

Best treatment for puffy lower lids, bags and wrinkles

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Thanks for submitting photos, they are helpful.  In order for you to obtain the best results possible, you need to look at 'before' and 'after' photos of patients with problems similar to yours.  If you are pleased with that aesthetic result, you have probably found the ideal surgeon for you!  In fact, there are many approached that will yield expert and natural results.  In your case, I would reposition the fat that is bulging into the lower lid.  That means to move it from where it is bulging, to areas where there are depressions.  It is likely that you will need to add some fat (which can easily be harvested from areas in your body where you think you may have excess!) into the area around the lower lid, in order to provide a uniform depth and smooth transition between the area of the lower eyelid, and the adjacent areas of the cheeks, temples and nose.  You may need some minor skin excision from the lower lid to get rid of the wrinkles between the lashes and the cheek.  



Michelle R. Yagoda, MD
New York Facial Plastic Surgeon

Blepharoplasty Not Fillers Best For Puffy Eyes, Dark Circles and Hollow Eyes

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Thank you for your question. From your photographs it appears that you have excess eyelid skin, puffiness caused by excess fat beneath the eyelids, and a depression or dark circles or hollow area below the lower eyelid.

The trans-conjunctival blepharoplasty with fat grafting and a skin apinch blepharoplasty to remove excess skin would be my choice to treat your lower eyelids. This procedure is further described in the link below.

If your eyelid has good tone meaning that your "snap test" is normal, which is done by pulling the eyelid down releasing it and watching if the lid snaps back quickly against the eyeball, another option would be to do a trans-conjunctival blepharoplasty to remove the puffiness, using the fat as a graft to plump the depression or hollow area beneath the eyelid and do fractional erbium ablative laser resurfacing to remove wrinkles and tighten the lower eyelid skin.

You must understand however that when you smile wrinkling will always be present because the wrinkling is caused by the contraction of your eyelid muscles. Botox can be used to minimize the wrinkling in the crows feet and outside one third of the lower eyelid but the middle and inside portions of your eyelid cannot be treated with Botox and there will always be some wrinkling with smiling.

Be sure to consult a plastic surgeon who is certified by the American Board of Plastic Surgery or the American Board of Ophthalmology with specialized training an oculoplastic surgery and who has a good reputation in your community.

Treating under eye hollowness

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In your individual case, it appears you would most benefit from fixing the issue with your eyes surgically.  You have pseudoherniation (outpouching) of fat from the eyelid. As individuals age, skin tends to thin and the normal fat pads in the eyelids herniate from their normal positions and become more prominent.  This prominence can appear as bags under the eyes.  To fix the issue, fat repositioning and fat grafting lateral to the area can yield a great result.  I would recommend a consultation with a board certified surgeon who has a great deal of experience performing procedures to the eyes.  Thank you and I hope this helps.

Paul S. Nassif, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 49 reviews

The Eyes Have It

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When evaluating the orbital region, we must consider your underlying Bone, Muscle, Fat, Connective Tissue and overlying Skin.  Each component of your mid-face/orbital area needs to be carefully addressed and understood.  There are lots of different procedures that will benefit your cosmetic beauty.  Therefore, please evaluate your best options for a multilayer rejuvenation! 

Robert Shumway, MD
San Diego Facial Plastic Surgeon
5.0 out of 5 stars 12 reviews

How to deal with bags under the eyes.

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Certainly your eyes are a big problem with your looking aged. Tjhe problem actually does involve your entire face in that you have lost elasticity, but equally important is your loss of volume. I think you can get just so much correction around your eyelids and you will have addressed less than you will desire when all done. I say this with 39 years of experience and seeing people's responses to various corrections.

With that in mind, your eyes have several problems:

1. Pseudo-herniation of the fat causing the "bags,"

2. Deficient fat along the bony rim of the lower lid causing the hollowing and shadows

3. Loose skin of the lower lids and possibly mild festoons (skin overhanging the cheek)

4. What appears to be a loose lower lid with some sagging of the lid margin itself

Ideally you would get the best result from addressign all of these issues;

1. Removing the excess fat in the bags, either through an incision inside the lid or in the skin, the former would be called a transconjunctival incision.

2. Fat transfer to the lower lid. Or you could start with an injectable such as Restylane. Either must be done very tediously.

3. I expect some skin should be removed, but you must be careful because of # 4. Excess removal of skin will cause the lid to droop more, called an ectropion -- something you do not want. Also a Fraxel laser could be used to tighten the skin, and this would definitely help.

4. If needed, this would require a canthopexy -- tightening of the tendon at the outer corner of the eyelid where the uppedr and lower lids come together.

Note that when you smile, you look so much younger becasue your cheek is pulled upward filling the hollows and giving you the youthful cheek mound. This is an easy example of what a proper facelift could do for you. Plus, enthusiastic, smiling people look younger.

Thank you for the interesting question and photos,and good luck.


Eyelid issues

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Your eyes certainly show signs of aging. A blepharoplasty can be performed to treat the lower eyelid skin and fat.  Remember to be checked for lower lid laxity(most have it after a certain age) and a canthopexy is usually recommended.  Good luck.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Under eye wrinkles and hollows

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I consider myself an expert in lower eyes and have written chapters in major textbooks. All plastic surgeons have different skills and experience . My answer will be different than most but who else has 36 years of experience and cose to 3500 blepharoplasties.

Yo have fairly substantial hernation of the fat pockets. Filler is useless in this case and will only make the margins of the puffiness less distinct.

In order to get a smooth non puffy non hollow undereye tou must have the herniated fat removed from inside the eye. At the same operation you must have your own fat injected by a careful controlled technique to fill the bagless hollows. Thelax skin will adjust by itself with no necessity for a scar or excision. The entire operation will take 45 minutes.

 Other plastic surgeons wont agree with this but they dont have my experience.

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

Under Eye Hollowing and Wrinkles - Recommendations? (photo)

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You are probably better off having surgery than fillers in your case.  Laser resurfacing of your eyelids at the same time would be beneficial as well. 

Sam Goldberger, MD
Beverly Hills Oculoplastic Surgeon

Under eye hollowing and wrinkles

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Thank you for your question.  Your best options to correct the problems that you are concerned with would be lower eyelid surgery. This would remove the excessive skin and redistribute the lower eyelid fat which is causing the fullness and depressions (tear troughs) below your eyes.  Fillers may help hide your fat beneath your eyes but will need to be repeated on a consistent basis.  Laser will tighten the skin but will not address the problem with the excessive fat.  I would suggest seeking a consultation with a board certified plastic surgeon to review your options.

Donald M. Brown, MD (retired)
San Francisco Plastic 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.