Dark circles and hollow eyes - is it due to my excessive thinness ? (photos)

Fat grafting to the face is quickly becoming a very popular, and long lasting alternative to fillers and botox. In your case, the careful addition of fat underneath the eyes and in the cheeks would make a dramatic difference. It is very important that you have this procedure done by a board certified plastic surgeon who has experience in this procedure, as it needs to be done very precisely. Generally, the procedure costs around $4500 and can achieve the results that you are looking for in one session, although revision occasionally needs to be done to perfect the results after the healing process. Best wishes. Jaime Perez, MDPlastic Surgery Center of Tampa

This can be improved with fillers, lasers and skin care. I suggest a formal consultation with an expert.  Best, Dr. Emer.

Several factors can contribute to an aged appearance of the lower eyelid -- descent of the cheek fat, prolapse of the fat around the eye, excess skin, etc. In my opinion, based on the photos, your problem is a lack of volume at the lower eyelid/cheek junction.

It appears that you have a combination of findings, a flattened lower lid/cheek complex and descent of the cheek fat. As the fat of the cheek descends it can leave the bony rim of the eye socket more apparent through the relatively thin skin of the lower eyelid, and cause deflation and abnormal shadowing that makes you appear older or tired. In most this occurs with age but it can be genetic (the so-called "negative vector" cheek).

Additionally the thin skin of the lower lid is somewhat translucent to the muscle underneath it, and that's why it appears like dark circles (imagine placing a wet paper towel on a raw steak -- you'd be able to see the darkness of the muscle through the thin paper towel).

Injectable dermal fillers are expensive and temporary but safe. In the lower lid the procedure is technician-dependent so find someone reputable. You can try this approach to see how you like the result, but repeated injections would have to be performed every 9-12 months thereafter so you may wish to consider a technique that lasts longer.

You could consider autologous fat transfer to the problem area. Fat transfer is safe and can be performed under local anesthesia with oral sedation. My chief concern would be potential irregularities of the contour of the skin afterward, and a potential temporary result.

In my opinion the best solution to give you a lasting result is surgery. Through an incision just below the eyelashes, the fat of the upper cheek may be mobilized and sutured into a higher position to add volume to the lower eyelid and help the dark circles fade. Though it should not be considered a permanent solution, this approach should give you a durable improvement over 15 years or more (before you start to see the same issues appear again). You can see photos o patients who had this procedure on my profile page.

Malar (cheek) implants can be considered as well.

Lastly, I have not been impressed with the results from Ulthera in this region.

As always, obtain a consultation with a Board-certified Facial Plastic Surgeon or General Plastic surgeon to get a fully-informed recommendation from a surgeon who is able to examine you. Best wishes!  Harry V. Wright MD, Sarasota, Florida