Hollow Under Eyes - Fillers or Fat Grafting?

Fat is a type of filler!! If you need fillers on cheeks , or other ares , fat would probably be a good option. It depends on your dermatologist, or plastic surgeon experience what kind of filler he or she would recommend. All fillers should give excellent results, if done properly.

Thank you for your question. My answer is likely controversial as many physicians are using filler injection around the eyes today. A perfectly placed filler injection can correct the depression beneath the lower eyelid called the dark circle or nasojugal fold which is different from the Hollow Eye which is caused by lack of orbital fat. The problems with filler injection in this area are:


Many physicians with no training or experience in eyelid surgery are using this technique-often the filler is placed incorrectly or the eyelid muscle pushes the filler out of the depression and makes the dark circle worse-I also do not like the idea of repeated injections with a needle into a very delicate important functional area

A true hollow eye-depressed eyelid caused by lack of fat requires volume replacement into the orbit where very vital structures are located-I would not blindly place a needle and inject into this area-blindness following filler injection into the eyelid has been reported in England-the filler was injected into a blood vessel

Fillers are temporary and must be repeated-repeated injections into the eyelid can cause scarring and possibly damage to the eyelid


I use Composite Fat Grafting NOT Fat Injection or Fat Transfer. Composite Fat Grafting utilizes a whole piece of fat which is harvested from the pubic area and transplanted into the depression beneath the puffy lower eyelid or dark circle. My reasons are:


A composite Fat Graft survives better than injected fat

If the graft takes or survives-about 80-90% of the time-the correction is permanent unlike fillers

Injections into the eyelid are avoided

The fat can be accurately surgically placed into the proper position

Transconjunctival incision for graft placement allows for release of the Arcus Marginalis which allows proper placement where volume is needed

For a true Hollow Eye, fat can safely be placed into the orbit to add volume


I hope this helps