Under Eye Hollows

Question

51y/o M. Severe under eye hollows. Body type is thinner/medium, loss of volume is very apparent. Have attempted Restylane and PRP, neither have done the job. Now what? I hate these hollows, they're aging me badly. Are there alternatives? Is blepharoplasty the answer? I'd prefer non-surgical if at all possible.

Anna Chacon, MD, FAAD · Answer

When under-eye hollows are significant and persistent, especially in thinner facial types, we usually step back and reassess why previous treatments didn’t fully work.

You’ve already tried:

Restylane (filler)
PRP

At this stage, a few possibilities:

1. Structural volume loss (most common):
If the hollow is deep and bone-related, filler alone may not fully correct it.

2. Tear trough anatomy complexity:
Some patients have:

Ligament tethering
Midface descent
Fat pad repositioning needs

3. Surgical consideration (blepharoplasty):
In more advanced cases, lower eyelid blepharoplasty (sometimes with fat repositioning) can give the most natural and lasting improvement.

That said, I always try to exhaust non-surgical optimization first, which may include:

Combination filler approaches (midface + tear trough rather than tear trough alone)
Skin tightening modalities depending on skin quality
Careful reassessment of prior filler placement

If non-surgical options haven’t worked well for you so far, then yes—blepharoplasty becomes a very reasonable discussion, especially if the concern is significant and affecting quality of life.

The key is tailoring the plan to whether this is primarily skin, fat, or structural bone loss—because each requires a different approach

Anna Bakeman, MD · Answer

The pronounced under-eye hollows come from a combination of volume loss in the tear trough area protrusion of the orbital fat through the orbital septum which causes the bags you are seeing. Filler to the tear trough area can temporarily mask the hollowing, but for a longer lasting result this is best treated by lower blepharoplasty with fat grafting. This approach allows removal or repositioning of the fat that is causing the bags, restores lost volume with your own fat, smooths the lid–cheek transition for a natural look, and provides long-lasting results.
Non-surgical options like additional filler or skin treatments may offer subtle improvement, but they don't address the underlying problem and carry the risk of looking unnatural

Viva Eve Dermatology - New York · Answer

Hi there!
This is a great question. When under-eye hollows are severe, it’s often not just a “volume loss” issue. Skin thinning, collagen loss, and the way the fat pads and surrounding structures age all play a role.
In cases like yours, a combination approach usually works better than continuing to add more filler. A series of radiofrequency microneedling (RFMN) combined with CO2 laser can help improve skin thickness, texture, crepey quality, and overall support around the eyes by stimulating collagen remodeling.
Then, if needed, very conservatively placed filler can be used afterward to refine the area rather than trying to fully “fill” the hollows. Often the mistake is relying on filler alone for a structural issue.
Blepharoplasty can absolutely be the right answer for some patients, particularly if there is fat pad descent, excess skin, or significant structural hollowing. But if you strongly prefer nonsurgical options, collagen-stimulating treatments plus conservative filler is usually the best next step before considering surgery.
Sincerely,Eleni SgantzosBoard-Certified Dermatology PA-C

Under Eye Hollows

Answers (3)

More Restylane Questions

Restylane vs Skintyte - which is safest for under eye wrinkles? (Photo)

Would Restylane Eyelight help to improve under eye area? (Photos)

Can Restylane skin boosters be effective in the temples?

Asymmetry 1 year after Restylane injection - can this be fixed? (Photos)

Painful late stage nodules from Restylane that has been dissolved 6 times - surgery? (Photo)

What can I do to fix this bulbous spot in my cheek? (Photo)

WE SEND PRETTY
EMAILS