Safest and Most Effective Treatment for Hollow Eyes?

The safest and most effective treatment for lower eyes is going to vary and patients should look at the following factors:-patient anatomy- thinner skinned patients will look at thinner products and thicker skinned patients may look at alternative products-product longevity- fat transfer or repositioning may offer a better long term solution but an appropriate filler may offer an adequate answer as well-physician training- surgically trained physicians such as facial plastic surgeons and oculoplastic surgeons and plastic surgeons will look at the lower eye area with more potential tools including surgery to offer a broader scope of options for patients

I would love to see a picture of you to help you decide.  Fillers and fat both work well under the eye.  Filler is much more predictable with much less downtime and swelling.  Restylane Lyft is probably the best filler for under the eye.  Of course, it lasts about 1-2 years and then you have to revisit your provider for more.  Bellafill is another great option for filler under the eyes and lasts 5 years or longer.  You want someone very experienced in Bellafill to inject this area since this filler lasts a while and isn't reversible.  Fat is a good option.  However, fat can swell in that area for a few weeks. Occasionally, it can get lumpy because the skin around the eyes can be thinner in some individuals and though it can be treated with steroids to decrease the lumpyness, sometimes the only way to resolve the lumpyness is to cut out the lump.  Fat also is unpredictable in terms of how it survives and if it survives so you may end up using filler anyway to adjust the appearnce of the fat injection.  I like injecting fat in the face and do so often but filler seems to be more predictable with less downtime.  And with Bellafill on the market, you can get good longevity as well (5-10 years).

Alright this is becoming the age old question for 2016. A few key points. # 1 fat is great. It is safer than the synthetic fillers, a portion of it last forever and no there is no scar. It is delivered with a cannula about an 18g size. I place it in two locations, one at 3cm below the eye and one at the lateral canthus essentially. So I am a huge fan of fat. You mentioned longevity, so I think fat is really something you should research. It is by far the best material as far as longevity and it is your own tissue so the risk of infection or allergic reaction is smaller. We do a ton of fat at our practice. I do all the face my partner does the body.   # 2 the most effective treatment for this, at least in my hands, is lower lid blepharoplasty with fat transposition and possible fat transfer. This is also very safe. There is more downtime with swelling and bruising but it is by far the most effective with the most drastic results. I feel most surgeons will agree with me on that. I do a lot of fillers because people are more and more demanding quick results with no downtime but still a blepharoplasty is not surpassed. # 3 I treat a lot of eye bags. It has kind of become our "thing". Many patients have it. A key point is many patients have multiple causes of the bags. So you need to see someone who does a lot that will be able to determine that. Often times fillers are enough if it is only a ligament issue. If fat protrusion and skin are involved then we need multiple modalities such as laser, blepharoplasty or fat transfer. I hope this helps. Best of luck,DrC

Hylauronic acid fillers such as Juvederm, Restylane, and Belotero can work very well to treat dark circles under the eyes in the right candidate. Dark circles can be caused by a number of factors, including pigment and blue veins, which would in turn affect which treatment is right for you. The best thing to do is find a board-certified dermatologist with experience treating dark circles who can evaluate your situation in person and determine the best treatment plan. 

Under eye hollows can be familial, and create a tired look, even after a great nights sleep. This change in the under eye area is due to a combination of factors: fat loss, change in the supporting tissue in the periorbital area, and changes in bone structure. The use of fillers has been proven to be both safe and very effective in correcting this loss of volume. The point I would like to make is that this is not a permanent solution, but it tends to last for 1 year, and you do not have to worry about committing to something that you may not be happy about in the future, such as fat transfer procedures. A Restylane injection can be reversed by a selective enzyme that can dissolve the product, which is a nice option to know is possible. The under eye area is one of the most challenging areas and best left to be injected by a more skilled injector.

Surgery for under eye hollows usually provides the best longest lasting results.  However, if you have good skin laxity and minimal to no fat bulging under the eyes, then fillers like Restylane is a great option.  I would look for an experience injector who is also a board certified plastic surgeon who can help assess your individual needs and discuss the pros/cons of your options.

The vast majority of patients with sunken hollow eyes have
underlying abnormalities of the boney orbit. These patients often have enlarged boney orbits which cause the eyeball
to look small, sunken and hollow. This
condition is known as enophthalmos.Under
these circumstances, injectable fillers would have very little effect on hollow
eyes. In fact in some cases they might
actually make the problem worse by burying the eyeball.Surgical
correction of this problem would involve major work on the facial
skeleton. This type of procedure
wouldn’t be justified because of the risk benefit ratio. In this situation, it’s probably reasonable
to leave well enough alone.

I agree that filler under the eyes is the best route to take.  A hyaluronic acid filler like Restylane or Belotero is the best way to decrease hollowness under the eyes.  If injected properly it will look smooth and softer under the eyes decreasing darkness. I do not recommend fat injections in that area, you can get uneven results.

For hollowness under your eyes, in the tear trough
areas, I would recommend that you have a treatment with Juvederm filler, like
Volbella, which is a very fine product, that can help to soften the hollowness
under your eyes, without leaving lumpiness. In this case, I recommend trying an
injectable treatment with filler before moving to a surgical option. 

Dear Ckone
Under eye filling with Restylane has now become the number one best option for this area. Restylane seems to hold much better than Juevederm for this area. The Restylane is more cohesive than the Juvederm. The Restylane tend to stay in the treated area for about a year. The treatment can easily be adjusted if there are any issues. Fat transfer often appears lumpy in the lower eyelid. In fact, Restylane is often used to improve lower eyelid regularities following fat transfer. I strongly recommend that you see someone with a large body of experience. Dr. Cohen would be a good choice. Alternatively look for a well qualified injector on liquidfacelift.com. Save surgery for when lower eyelid filler options no longer get the job done.