What would be a good treatment for under eye hollows? (Photos)

Question

My primary concern is the lack of volume in the inner sides of under eye area. Is filler the only solution? I read that fat grafting can be tricky in that area, and since the skin under my eyes is very thin, I don't think it's worth the risk to for fat grafting. Lastly, can lasers and other skin tightening treatments help? I know that results from such treat are subtle, but if they're long-lasting, it'd be worth it.

Nima Shemirani, MD · Answer

Hi @danaverno! The upper cheek is a major support for the under eyes. I would first begin with addressing the volume loss in the cheeks followed by addressing the tear trough area. Another option would be PRP injections.  PRP which stands for Platelet Rich Plasma is a natural and non-surgical solution to treat under eye circles and bags. PRP is highly effective for restoring sunken eyes.  Generally, two vials of blood will be collected from the patient and placed into a centrifuge. The centrifuge spins and separates the platelets from the rest of the blood components. The plasma contains the valuable collagen and growth factors from the rest of the blood's components. The plasma is then drawn up into a syringe and injected in the tear trough area. Typically, 3 sessions is adequate for optimal results.

Jason Emer, MD · Answer

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.

Jonathan Kulbersh, MD · Answer

Hello, and thank you for your question. There are several procedure options to treat the under-eye area. Small amounts of filler injected into the tear trough via a microcannula will add subtle volume to reduce lines and discoloration. Facial fat transfer uses fat from other areas of your body to treat the sunken area under the eye to create a more youthful facial appearance. An experienced, board-certified facial plastic surgeon will know just how to perform this treatment to achieve a natural result.

Lasers, Profound RF (microneedling combined with RF energy), and other procedures that help collagen production can also be very effective in tightening and refreshing the skin around the eyes.  A combination of procedures can provide you with optimal results. To determine the best treatment for you, I recommend scheduling an in-person consultation with a reputable board-certified facial plastic surgeon. Your surgeon can do a proper evaluation, customize the best treatment plan, and ensure the best possible results.

Harold J. Kaplan, MD · Answer

Hello Dana.  You are a perfect candidate for under eye injections with Restylane.  The fact that the skin and tissue is very firm under the eyes makes Restylane a great option.  Yes, fat grafting is a potential solution but not one we would advise in a patient your age with your anatomy.  Dermal fillers are just too straightforward and have much less risk with the same or greater potential benefit (link below).  Find an experienced injector near you for best results.  Look for before and after photos on their website.

Nelson Lee Novick, MD · Answer

The kind of problem seen in the photos is a rather common esthetic issue for which patients come just about every day in an active cosmetic dermatology practice. There appears to be considerable volume deficit in the upper cheek region that supports the under eyes. If a robust HA filler is used for this region not only is the overall cheek contour improved, but there is typically a significant lessening of the hollows and tear troughs. Fat transfer has its problems, as you correctly state, and expensive "bells and whilstles" lasers and other tightening devices have not only potential safety issues, but, to date, are far more backed and promoted by marketing hype than true hard science. Make sure to consult and experienced, board certified cosmetic dermatologist. An experienced injector should be able to achieve the above in about fifteen minutes with results that typically engender an immediate "Wow!" response. Best of luck.

Marc Polacco, MD · Answer

Thank you for your question. This is usually the first area to show signs of aging. While filler is certainly the most common treatment, fat grafting is also a great option, although more invasive due to harvesting and a little less predictable. Fat however can give a result that's more permanent, while filler will break down over time. So really there isn't a right or wrong answer, it's whatever sounds more appealing to you based on risk profile. Lasers are helpful for tightening the skin surface and addressing fine lines, but they won't add volume, which is needed to address hollowing. I hope this is helpful, and all the best to you.
-Dr. P

Anshul Gambhir, MD · Answer

Hello, thank you for your question! Undereye filler can help your tear troughs (the hollowness where a tear would fall). In our office we use Volbella(.55cc), you could use one syringe per undereye. Other options would be: Co2 laser resurfacing which can help tighten the skin and any texture issues. PRP is another option to help build collagen in the area, it can also help with darkness. I hope this helps! Thanks!

Harish Kumar Kabilan, MBBS · Answer

Hi Danaverno, 
Under eye hollows are most commonly caused by lifestyle issues such as dehydration, lack of sleep, stress, imbalanced diet, so on. However, in some cases it can also be due to genetics, sun exposure, allergies, etc. 
In the former case, lifestyle modification such as good sleep, hydration, a balanced diet does wonders to the skin and therefore the under-eye hollows. 
In the latter case, such as genetics or sun exposed skin, provided you do not have any other conditions which need to be treated, hyaluronic acid fillers does wonders and masks the shadows cast by the hollows. The decision to treat using fillers is taken only after a visit to your plastic surgeon. Hope this answer helps. 
Cheers, Dr. Harish Kumar KabilanKalp aesthetics

Camille Cash, MD · Answer

Fillers are often used to improve hollows under the eyes.  This gives results that last approximately one year.  Adding volume can help bring this area into better harmony with the surrounding contours.  Fat grafting is another option which would be more permanent.

Onir Spiegel, DDS, PhD · Answer

If you are in your 20s and 30s and seeing under-eye hollowness your best bet is trying tear trough fillers as a first treatment. Young skin does very well with under-eye fillers which will last for years to come. As your skin ages, you may require other modalities to tighten the under-eye skin such as microneedling and/or radiofrequency. Don't give up, this is simple to correct.

What would be a good treatment for under eye hollows? (Photos)

Answers (12)

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