Hollow Eye with Dark Circles and Fine Lines? (photo)

I have hollowness around my orbital bone, deep tear troughs. I want to fill them up looked at 2 options, fat graft or transconjunctival blepharoplasty My doctor recommends transconjunctival blepharoplasty to reposition my fat. But my problem is lack of it. I'm afraid that i do not have enough of my own fat under eye to fill up my under eye. My doctor said that it’s not be a problem as there will be fat to reposition but i'm a bit skeptical. Would this be a good option? Thank you.

Doctor Answers 8

Hollow Eye with Dark Circles and Fine Lines?

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    In a young person with little fat and a subtle tear trough, a filler such as Restylane would be a good choice.  Find a plastic surgeon with ELITE credentials who performs hundreds of filler injections each year.                                                                                                                              Kenneth Hughes, MD Los Angeles, CA

Options limited to soft tissue fillers

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I would really consider all non surgical options first. You do not appear to have any bulging fat of the lower lids.  So your options would appear to be limited to a soft tissue fillers such as Juvederm.  

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 20 reviews

Hollowness of lower eyelids without fat herniation is best treated with fillers

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Hollowness with an absence of orbital fat herniation, as in your case, is best treated with fillers.  The filling can be done with autologous fat or with hyaluronic acid.  If you have fat herniation, then a transconjunctival blepharoplasty is also a good option.  Please carefully consider advise you receive on this website based on just a few photos.  Your surgeon had the luxury of actually examining you.  Best might be to consider a second opinion by another surgeon also skilled in all these techiniques in order to give you the best advice based upon your actual examination.  Hope that helps!

Minas Constantinides, MD
Austin Facial Plastic Surgeon

Tear trough correction: transconjuctival bepharoplasty with fat repositioning versus fat grafting.

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For long term correction of the tear trough deformity there are 2 options:  1) orbital fat transposition using a transconjuctival lower blepharoplasty and 2) fat grafting.  These can be used either individually or in combination.  From your photos it appears that the deformity is mild to moderate with little to no orbital fat herniation and therefore fat grafting may be the best option for you.  Periorbital fat grafting to the eyelids needs to be done carefully using microcanula in order to avoid contour irregularities.  Hyaluronic acid fillers are another option but their duration is generally 6 to 12 months. 

Mario J. Imola, MD, DDS
Denver Facial Plastic Surgeon
4.9 out of 5 stars 124 reviews

Tear trough abnormality best treated with fillers to begin with.

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I think surgery of any kind for the problem in the picture is probably a bit too much. I think you be better served by fillers which are safe in reversible if you don't like the effect.

Yes, when there is herniate fat in the lower eyelid, it can be repositioned.

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Thankfully, you have a head on your shoulders and you can see what your potential surgeon apparently can't see-you don't have herniated orbital fat to reposition.  Fat grafting is also an extraordinarily poor choice for managing this subtle under eye circle.   The lack of soft tissue in the under eye circle is very poor at hiding lumps and bumps that are created by the fat grafts.  I strongly advise you to consider finding a highly experienced Restylane injector to fill this area instead.  While this service will need to be refreshed once per year, it can be adjusted as you lower eyelid needs change.  What can be accomplished with the Hyaluronic acid fillers is much more powerful than what we can accomplish with surgery in many cases.  Avoid Juvederm and the new Balotero for this area.  These products drift a bit and are not idea for the under eye area.  This is much better that the tear trough implant which was how we tried to help individuals a generation ago.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Flat or Hollow Lower Eyelid/Upper Cheek Region Benefits from Implant

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You have a concave shape to the skeleton under your eyes.  The most predictable way to change this to a fuller, rounder, convex shape is to place a Tear Trough Implant under the eyes.  This implant is very well suited to your concerns, is permanent (but removable), and can provide far more result than any other form of filling.  Other options such as fat transfer, fat repositioning, or Restylane/other injections simply can not accomplish the amount of correction you would need.  Furthermore, fillers are temporary, and fat procedures frequently end up also being temporary.

The fine lines you refer to in your skin will not be addressed by any method of adding volume to your lower eyelids.  The fine wrinkles, in my opinion, should be treated simply with topical creams and Retin-A.  You are not a good candidate for anything more aggressive than that such as laser resurfacing. 

Louis W. Apostolakis, MD
Austin Facial Plastic Surgeon
4.8 out of 5 stars 36 reviews

Eyelidplasty can treat deep tear troughs

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There is a significant collection of fat under the eyeball that can be repositioned at the orbital rim to fill in the tear trough.  The advantage of this approach is that the fat, still attached to its blood supply, will provide a long-lasting correction over years.  The disadvantage is that this is a surgical treatment with recovery and somewhat more recovery than a simple blepharoplasty.  In order to reposition the fat, the arcus marginalis must be released.  This is the point where the orbital septum attaches to the bony orbital rim.  This is not part of a typical basic transconjunctival blepharoplasty but an additional step.  Off the shelf fillers like Restylane can be used to fill the tear trough non-surgically but the fillers are absorbable, requiring retreatment periodically. 

Lawrence Bass, MD
New York Plastic Surgeon

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.