Hollowed Eyes and Other Facial Wasting. Was Told That Fat Graft From Another Location Not Ideal. Move Fat From Outer Eye? (photo

I'm a 37 year old male with upper orbital hollowness. I'd like to get it fixed but do not want lumps, cysts or damage. One surgeon said that it is not ideal to graft fat from another location. Instead, he wanted to "move" the fat from the outermost of my eye, inward. However my hollowing is so bad that I do not see or feel fat in the outermost areas. I'm attaching a picture of a woman with comparable hollowing. I live in the Southwest.

Doctor Answers 9

Fat grafting would give you a good result if done properly

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Your pictures would help. Your surgeon was correct in being concerned about the fat. This are has very thin skin and will show minimal imperfection. Fat grafting can be a great tool for this area if done conservatively. 

New Orleans Plastic Surgeon
4.7 out of 5 stars 153 reviews

Treatment of hollow eyes.

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I have used fat for 35 years and it works well for me but I do NOT use it in uupper lids. I see so many patients with lumps when their surgeon use this. Gradual injection of Juviderm is better and can be rreversed if needed.  The disadvantage is it lasts 1 year but iny opinion this iis minor when view from relative lack of problems.  Patients come to sees for improvement NOT PROBLEMS!

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 38 reviews

Lower Eyelid Hollows, Use a Tear-Trough Implant

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I highly recommend a tear-trough implant combined with fat repositioning for this issue.  The procedure serves to augment the volume in the area by using an implant that effectively rounds out the skeletal shape, not the soft tissue shape.  Then in combination with the orbital fat reposition and blending, you get a smooth and full lower eyelid/cheek transition area that looks youthful.  It doesn't crowd or bunch with smiling, it doesn't get bigger and smaller with weight change, it is always even, it doesn't fail to take, it is low risk, it is a scar-less, it is reversible, and it is likely that it will continue to look good for decades.

I agree that fat is not a good filler for the area around the eyes.  40 to 50% of all patients who have fat transfer to the face require at least one additional procedure in the first year, and then many of them fail yet again.  Furthermore, should you have too much fat successfully take or have it take unevenly, there is no good way to correct that.  And yet a further issue would be that should the fat take, it will gain and lose volume according to the donor location as you gain and lose weight overall.

You will notice if you examine a young person by pressing on the area just under the eyes that they do not have thick squishy soft tissue.  They have a thin layer of soft tissue overlying bone.  The implant serves to replicate this shape.

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

Adding Volume to Hollow Eyes

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A photo of your own face might help better to determine a suggested method for you. At my practice in New York, we offer solutions for Hollowed Eyes treatment. There are certain treatments for hollowing eyes that are less invasive and beneficial for adding volume to the eye area. I have seen many people who need my help after having injectables done incorrectly and end up looking "lumpy" with many irregularities, so it is important you get the help of a qualified professional. Hyaluronic acid fillers (such as Restylane) can be injected along the orbital rim of eye as well as under brow. Platelet Rich Plasma (PRP) and Platelet Rich Fibrin Matrix (PRFM) are also very helpful for hollow eyes. PRP or PRFM, often referred to as the Vampire Facelift, which I offer in New York uses platelets and growth factors extracted from your own blood and used as injectable filler to the eye area with volume loss. The advantages of the The Vampire Facelift or PRP injections is that there is some of your body's natural collagen being generated, so when the sunken appearance becomes more pronounced, this method helps to build collagen and thicken the skin. By can enhancing skin quality (with lasers or chemical peels) and add volume around the eyes (with Vampire Facelift PRP or Restylane), you may be able to improve your appearance.

Amiya Prasad, MD
New York Oculoplastic Surgeon
4.4 out of 5 stars 80 reviews

Posting your own photo is appropriate

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You will get many different responses to your question as there are many different techniques available to address your stated problem. Fat grafting can be helpful, done by an experienced surgeon. Fillers are less risky and can also improve the hollowing.

The photo posted here definitely has eyelid ptosis, but it is NOT your photo, so its hard to make a recommendation based on someone else's photo.

A consultation with an Oculoplastics surgeon would be helpful. Find one close to you on the ASOPRS dot org site.

Good luck

A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 42 reviews

Hollow eyes filled in easily

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I laugh to myself at what some surgeons say who are uninformed.I have done this technique of filling hollow eyes over 100 times and have presented a lecture to the Los Angeles plastic surgery society on this technique. It is a transfer of fat from your flank to this area. It is extraordinarily successful and takes less tha 15 minutes. Not all plastic surgeons can do all things well. This is a very specialized technique

Richard Ellenbogen, MD
Los Angeles Plastic Surgeon
4.7 out of 5 stars 30 reviews

Pick your surgeon carefully for this type of work.

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You have levator dehiscence upper eyelid ptosis and this is a factor in the hollow upper eyelid sulcus.  There is only on specialty with the depth of experience needed to help you address these issues and that is oculoplastic surgery.  These are board certified ophthalmologists who complete a two year fellowship in eyelid, orbital and facial plastic surgery.  The depth of experience possessed by oculoplastic surgeons for these issues far exceeds that of any other specialty.  The American Society for Ophthalmic Plastic and Reconstructive Surgery maintains a geographic directory on their website that can help you find a well qualified surgeon in your area.  I do agree that sub brow fillers are an excellent option for volume and last well over a year, perhaps two years in some individuals.  Grafted fat in this area is very unsatisfactory.  Ptosis surgery can bring fullness to the upper eyelid sulcus in some.  A personal consultation can be very helpful here.

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

Can my eyelids be improved? (photo)

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Dr. Windle is referring to treatment of lower eyelids, but your question asks about upper eyelid hollowness.  Your picture is not shown, and examination for diagnosis must precede advice about treatment.  Although hyaluronic acid (and perhaps other fillers) can augment this area well, they are temporary.  I release post-septal fat and secure it above a lowered orbito-palpebral crease to permanently fill upper lid hollows.  Levator dehiscence, if present, must be concomitantly treated.

Some examples are among the thirty or so cases posted on our blepharoplasty gallery.

Steve Laverson, MD
San Diego Plastic Surgeon
4.9 out of 5 stars 50 reviews

Filler for under the eye hollows

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Considering your concerns about surgery, I would recommend a filler.  I regularly use fillers for this problem and my patients are thriled.  Dermal fillers in the lower eyelid area take a little longer to look good and you usually get some bruising but after three weeks it looks great.  There are lots of potential problems with injections in this area so you must seek out a Board Certified Plastic Surgeon or Dermatologist who has extensive experience with fillers under the eyes. 

Brian Windle, MD
Kirkland Plastic Surgeon
4.9 out of 5 stars 64 reviews

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.