What can be done for hollow ring around the eyes (under eyes and outer corners)? (Photos)

Question

I'm in my 20s and overweight with a lot of facial fat EXCEPT my eyes, my under eyes are hollow and purple (very sick looking) and also the outer corners of my eyes are dented, which also looks purple from the side and looks very sickly. I look extremely ill. I have a lot of weight to loose so it will look worse. I don't know what to do for this. I have read a lot that fillers in this area is risky. I don't even know if fillers on the outer eye corners is possible. I'm also worried about filler migrating into cheeks as I already have a malar bag forming which I don't want to have look worse. What can I possibly do to improve this area?

Anna Chacon, MD, FAAD · Answer

I completely understand why this is frustrating, especially when you feel that the hollowness and purple discoloration make you look much more tired or unwell than you actually are. The area around the eyes can be particularly challenging because several different things can create a similar appearance: naturally thin skin, visible blood vessels or pigmentation, a lack of soft-tissue volume, the shape of the orbital bones, and shadows created by the transition between the lower eyelid and cheek.

Because you are concerned about both the under-eye hollowing and the indentation toward the outer corners, I would not automatically recommend simply placing filler directly into every hollow area. Under-eye filler can help carefully selected patients with true volume loss, but this is an anatomically sensitive area. Too much filler can create persistent puffiness or make existing malar bags more noticeable, and filler can occasionally migrate.

Your concern about safety is also valid. Although serious complications are uncommon, accidental injection of filler into a blood vessel can cause tissue injury and, very rarely, vision loss or blindness. In addition, the FDA notes that filler injections in the periorbital area are not FDA-approved uses, which is another reason this area should be approached very conservatively by an experienced injector.

The purple coloration is important as well. Filler will not necessarily correct discoloration caused by thin skin, visible vessels, or pigmentation. In some people, the appearance can actually be more noticeable if filler causes swelling or a bluish discoloration known as the Tyndall effect.

Depending on what is actually creating the contour abnormality, possibilities can include very conservative hyaluronic-acid filler in carefully selected areas, treatment of the surrounding cheek rather than injecting directly under the eye, skin treatments to improve texture or pigmentation, or—when there is a true structural contour problem—surgical options such as lower blepharoplasty or fat repositioning/grafting. These procedures are generally considered when the anatomy calls for them rather than simply because someone has dark circles.

I would also be cautious about making major changes while you are actively planning substantial weight loss. Changes in facial volume during weight loss can alter the appearance of the cheeks and under-eye area, so the best treatment strategy may change as your face changes.

Most importantly, you do not necessarily need more volume everywhere to make this area look healthier. In the under-eye region, restraint is often much better than trying to completely fill every indentation. The goal is to improve the transition between the eyelid and cheek while preserving a natural contour and avoiding additional puffiness.

What can be done for hollow ring around the eyes (under eyes and outer corners)? (Photos)

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