Would filler, bleph, or mid-face lift address my under eye hollowness? (Photo)

Hello and thank you for your question. A formal evaluation would be needed to determine the best treatment. There are both surgical and non-surgical options to correct this, depending on your specific situation.

For less significant puffiness and sagging UNDER the eyes, or more mild improvement, there are nonsurgical treatment options: we often use Renuvion helium plasma radiofrequency (RF) energy to achieve incredible results and take years off of your appearance. Combining RF energy and cool helium plasma, the signs of aging (wrinkles, pigmentation, skin laxity) are improved in a ‘Nonsurgical Lower Eyelid Lift.' The focused heating tightens and peels the outer skin layer with extreme precision, leaving the surrounding area undamaged, smoothing and tightening the periorbital skin, and improving the overall skin quality around the eyes. It's an aggressive treatment, and the recovery time is longer than with other nonsurgical procedures, but the results can be life-changing.​

Surgery (a lower blepharoplasty with or without canthopexy/canthoplasty or orbicularis muscle suspension) is a great option for more significant improvement- for example if there are more severe lower eyelid bags / bulging present. Sometimes the surgery can also be used to intentionally adjust the shape and/or size of your eyes, or correct any asymmetries!

Dr. Donald Groves is an expert facial plastic surgeon that I work with, who specializes in these types of procedures. It is important that if you are considering surgery that you go to someone who is well trained and very experienced with these delicate operations to get the best results. I suggest getting a consultation with an experienced cosmetic dermatologist and facial sculpting expert, or an aesthetic facial plastic surgeon like Dr. Groves; we are both located right here in Los Angeles.

Best,
Dr. Emer

Thank you for your question and for sharing your photographs. Based on the images, I can see that you have under-eye hollowness, particularly towards the outer edges, with relatively strong visibility of the tear trough and prominence of the orbital fat in the lower eyelids.

Given your concerns and the previous experience with filler injections, I would suggest considering a lower eyelid blepharoplasty. This procedure involves repositioning the orbital fat over the lower rim of the orbit, which can effectively address the hollowness and improve the overall contour of the under-eye area.

Why Lower Eyelid Blepharoplasty:

1. Repositioning Orbital Fat: By repositioning the orbital fat over the lower rim of the orbit, the hollowness and visibility of the tear trough can be significantly reduced. This technique smooths out the contour and creates a more natural transition between the lower eyelid and the cheek.
2. Option of Fillers and Mid-Face Lift: The above approach most likely eliminates the need for additional filler injections or a mid-face lift. It directly addresses the root cause of the issue and typically provides a long-lasting solution.

I recommend consulting with a qualified plastic surgeon who specializes in eyelid surgery to discuss this option in detail. They can evaluate your specific case and develop a personalized treatment plan to achieve the best possible results.

An in-person examination that allows for palpation and manipulation of the skin would be helpful for better formulating an appropriate treatment plan. However, from what can be determined from the photos, the use an appropriate HA Filler injected with the proper technique can help to diminish the under-eye Hollows and create a smoother, more gradual and natural transition between the upper cheeks and the lower lid regions. You would be wise to consult with an experienced, board certified cosmetic dermatologist filler expert and best of luck.