Hereditary Hollow Lower Lids and Thin Skin. Is Restylane the Best Treatment?

I am a white female. Almost 22 yrs old. I have always had hollow eyes, but over the past 3 years, they have gotten worse. I had 1cc of Radiesse injections into the tear troughs in March of 2010. The Radiesse didn't even last 3 months. I have heard Radiesse is not recommended for that area anyway. I am considering Restylane at the end of this month. Is that my best option?

Doctor Answers 12

Restylane for lower eyelid hollowness

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Restylane can help augment this area but I find less risk of lumpiness when it injected below the muscle rather than immediately under the skin. Many of the patients who are dissatisfied with their results and complain of lumpiness appear to have had Restylane, or Juvederm, injected superficially above the muscle. The thin skin here shows the lumpiness.

Manhattan Dermatologic Surgeon
4.9 out of 5 stars 39 reviews

Best filler for under eye area might be fat

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The problem with thin skin and a hollow area under the eyes is that the color of any filler might shown through. Any of the HA fillers such as Restyane or Juvederm can present a bluish color called the Tyndall effect, whereas Radiesse does not, so it may not have been a terrible choice. In my view the best answer is often fat injections, which can be permanent and look very natural if done skillfully.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 59 reviews

Lower lid hollows

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Restylane is a great filler for the nasojaugal groove of the lower lid hollows as you mentioned.  I would not put radiesse there myself.

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

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Radiesse versus Restylane in lower eyelid area

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I prefer Restylane over Radiesse for many reasons. However, in reading your question , it sounds as if you were disappointed in the duration of effect for the Radiesse you received. Regardless, in terms of duration only, more often than not Radiesse lasts longer.

Steven Hacker, MD
West Palm Beach Dermatologic Surgeon

Restylane and other HA fillers can improve undereye hollowness

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A hollow lower lid can create shadowing and darkness leading to a tired look.  Injecting a hyaluronic acid filler such as Restylane can do wonders toward improving that hollow look.  The filler must be injected at the orbital rim and placed deeply, slipped under the orbicularis muscle.  Restylane can be expected to last 6-9 months. 

Pamela Carr, MD
Sugar Land Dermatologic Surgeon

Lower eyelid hollows

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The Radiesse should have lasted longer!    Having said that, Restylane is the best nonsurgical option for lower eyelid hollows for many reasons.  The lower eyelid skin is thin and so need to put something there that won't show.  Moreover, Restylane is reversible if there are any problems.  You are also young to have surgery.  Good luck.

Dr T

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 91 reviews

Filler treatment of under eye hollows (tear troughs)

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My approach to treating under eye hollows depends on the individual patient.  For patients with mild hollows I often use Restylane, as in my experience it more forgiving (produces fewer lumps) than Juvederm.  For patients that have lost a lot of volume in the high cheeks, in addition to the hollows, I often inject a deep foundation of Radiesse or Perlane, and later add more volume with Restylane on top of that foundation.  The use of these fillers in this area is "Off Label"  meaning that these fillers are not officially approved by the FDA for use in this area. 

Of all the areas I use fillers, this area is the most gratifying to me as the results can be very dramatic and in some cases take 10 to 20 years off a patient's appearance.  The results also tend to last longer in this area, compared to the lips and smile lines.  Patients that require larger volume correction should realize that it is best to have the correction done in stages.  I usually separate the treatment sessions by at least monthly intervals (can be longer).  A staged correction allows for a better result and also helps large volume requiring patients be more discreet about their treatment.  Because full correction can produce a very dramatic improvement, friends will be less aware of a gradual correction as opposed to an "Overnight" full correction.  Once a patient has achieved a full correction, a "touch-up" treatment is usually required every 6 to 12 months to maintain the effects. 

Daniel McCauliffe, MD
Killington Dermatologist

Hereditary Hollow Lower Lids and Thin Skin

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This is a great question! The tear trough hollows are a very tedious areas to treat correctly and even harder to obtain GGREAT results. I recommend first try Restylane injections at a very low dose deeper into the tissues. Followede by a week check up to see if more is needed. Than wait until the Restylane resorbs, usually within in 3 months. If the patient is happy, I will either continue with the Restylane protocol or use a Selphyle PRFM injection as a more permament solutions. This is also called the "Vampire" regenerating filler. It does work very well. Seel in person opinions. 

More than one Option

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Tear troughs can be tricky. Many filler options may be used in addition to fat, which has been very well studied in that area. The problem with fat is that it requires a skilled surgeon to prevent any problems especially rippling and lumpiness in the skin. Radiesse should be avoided since it can harden up and will look unnatural there. Radiesse is great however, since its white and prevents the Tyndal effect or the blue colored hue that occurs with the injection of HA fillers in the area. The best way to approach the tear troughs is to see a reputable board certified dermasurgeon, plastic surgeon or oculoplastic surgeon and have them assess the situation and recommend the right treatment for you.

Hassan Galadari, MD
Dubai Dermatologist

Micro-Fat Transfer to Lower Lids

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For a more permanent correction you might want to consider micro-fat transfer to your cheek/lower lid junction. Fat transfer procedures are performed using a local anesthetic, with or without IV sedation or general anesthesia, depending on the extent of the procedure and recommendations of your surgeon.
 This is highly technique specific so pick someone with extensive experience in this technique.



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.