Under Eye Hollows and Wrinkles Under Eyes? (photo)

At home peels like cosmelan, enlighten and aerify along with dermarolling (MTS roller with anteage MD ampules) should be started now. There are many things you can do to treat under eye hollows and dark circles. A surgical option to remove skin and/or fat will such as lower eyelid blepharoplasty with or without fat pad repositioning will be the best long term. There are many things you can do to treat under eye hollows and dark circles without surgery. Non invasive less downtime options such as fillers (Belotero, Juvederm Volbella​), lasers (Moxi/Halo/Fraxel/CO2​), Renuvion (J-Plasma), microneedling/PRP, stem cells and microneedling RF like Fractora PiXel8 or Morpheus can all help give some improvement. Accutite can often be used or stronger lasers like erbium or co2 spot treatment can tighten the skin and give very quick improvement in wrinkles and texture. A surgical option to remove skin and/or fat might be the best solution long-term. I suggest you get a formal consultation to see what is best for you and your goals. Best, Dr. Emer.

You are noticing loss of volume in your lower eyelids.  As we age, we lose volume in our soft tissues, muscles, as well as bone.  The orbital rims (bone that surrounds the eyes) actually get larger since the bone is gradually deteriorating, while the skin is getting thinner.  You have several options.  First, you need to be on good skin care and a good eye cream such as Neocutis Lumiere Riche or SKin Ceuticals - AGE complex.  You may choose to have a filler.  I would recommend Restylane or Belotero for lower eyelids.  It is of the utmost importance that the person who injects has experience in this area of injection.  Also lasering or chemical peels wil help tighten the skin.  

Thank you

I do not use fillers in the lower lids or for tear trough areas. Fat grafting with a skilled and experienced surgeon can be an ideal treatment for lower lid hollowness. One must exercise care and caution, as lower lid skin and the underlying soft tissues are usually quite thin, and thus the lower lids are less able to conceal grafted fat.

In patients who have developed deep 'tear troughs' at the junction of the lower lid and cheek, adjacent to the side of the nose, the meticulous grafting of fat harvested from the patient's abdomen, hips or thighs can build this area back up and nicely restore a more youthful contour. In some blepharoplasty patients this depression or 'hollow' extends horizontally across the entire junction of the lower lid and cheek, and this must be corrected to obtain the ideal postoperative result.

Hello 'mart1765', thanks for your question.  As we get older, our skin gets thinner, and facial fat tends to shrink as well as sag due to the effects of gravity.  This can lead to unwanted prominence of various parts of the face, including the nasojugal fold/ tear trough deformity that you are concerned with.  Skin laxity with repeated sun exposure can also lead to significant fine lines and wrinkles around the eyes, especially in patients with fair skin as in your case.  There are procedures that can be done to address all of these factors.  A small amount of filler can be used to smooth and camouflage the under-eye hollow you mention, which is due to descent of the midface/ cheek fat pads with prominence of the inferior orbital rim, ie. tear trough deformity.  The fine wrinkles are best addressed with a CO2 laser procedure, or repeated maintenance chemical peels, all of which can be done in the office setting.  Lower lid lift/ blepharoplasty surgery can give the most dramatic results, but that is usually reserved for patients with more severe signs of aging with herniated ocular fat pads and significant loose eyelid skin, which it does not look like you have, yet.  I recommend seeking consultation with a board-certified plastic surgeon who will be able to perform a thorough examination and go through the options in more detail with you.  Hope that helps!

-Dr.92660