Long-term treatment for under-eye hollows? (photo)

I am so tired of these ugly tear-trough hollows that make me look so much older. My dermatologist recommended Restylane injections. It's cost beneficial for my doctor if I keep getting these injections, but not for me. I would rather pay a lump sum for something that will benefit me longer term. What would you recommend? I am 25 years old, and I have never had any cosmetic surgery or injections. Please see pictures, and thank you!

Doctor Answers 8

Long-term treatment for under-eye hollows?

Most expert experienced artistic plastic surgeons have a variety of procedures at their disposal to produce excellent cosmetic results in the appropriately selected patient: temporary fillers with hyaluronic acid fillers like Restylane which usually last 6 months to 1 year, micro-fat grafts of your own tissue - 30-50% lasts permanently, and blepharoplasties which are more than you would need at this age. There is no one best procedure that would be applicable for everyone. Each has benefits and potential drawbacks. The vast majority of board certified plastic surgeons with extensive experience in eyelid surgery and soft tissue fillers would warn against using a permanent synthetic filler because of the long term complications which can occur even years after injection and are difficult if not almost impossible to correct.

The best option in any particular patient needs to be individualized based on desired outcome and anatomy.

Following the advice of anyone who would presume to tell you exactly what to do based on limited 2 dimensional photos and without taking a full medical history, examining you, feeling and assessing your tissue tone, discussing your desired outcome and fully informing you about the pros and cons of each option would not be in your best interest. Find a plastic surgeon that you are comfortable with and one that you trust and listen to his or her advice. The surgeon should be certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS). You should discuss your concerns with that surgeon in person.

Robert Singer, MD FACS

La Jolla, California

La Jolla Plastic Surgeon
4.6 out of 5 stars 19 reviews

Long-term treatment for under-eye hollows?

Filler is a great option for undereye hollows. I avoid permanent fillers in this area as any problems that are created with the injections are, in fact, permanent and difficult to remedy. In theory fat transfer can be used in this area and many advocate it but I've found the longevity of the fat is unpredictable and you have the risk of lumps and bumps. Dermal fillers like Restylane do need to be repeated about once each year but the results look natural and any bumps or asymmetry can be remedied either with a small amount of additional filler or treatment with Vitrase. 

Stephen Weber MD, FACS

Denver Facial Plastic Surgeon

Stephen Weber, MD, FACS
Denver Facial Plastic Surgeon
4.9 out of 5 stars 129 reviews

Using regenerative skin treatment improve eyelid skin quality for the long-term, along with fillers to add immediate volume

As a cosmetic oculofacial plastic surgeon and boarded with facial cosmetic surgery, I have been doing a lot of facial procedures and I also have a lot of experience with the tear trough area. The hollowing at the tear trough area is due to skin that is very thin. There was a time in my 20 years of being practice where the treatment for the tear trough area was hard to accomplish. We used to select only a small percentage of patients to be a candidate for a permanent silicone implant. Presently, hyaluronic acid has become a very unique benefit to enhance the tear trough area. Hyaluronic acid injected alone can last for 6 months to year. However, the longevity of a hyaluronic acid when injected may be different for each patient.

In our practice, we are combining hyaluronic acid fillers with platelet-rich plasma. Being very active with the regenerative medicine field, I have been using platelet-rich plasma combined with extracellular matrix for hair loss and I also use it for volume correction for acne scars. For the tear trough area, I use platelet-rich plasma because it stimulates the body’s own vascular endothelial growth factors and collagen. Platelets are cells in the blood that are necessary for healing. So we draw your blood, spin it and concentrate the platelets and the plasma that is carrying it so that we can mimic the healing response to restore quality of the skin and volume. There is a more long-term permanence to this type of procedure because it has a real improvement in the skin quality.

Since you’re skin is naturally very thin and you’re only 25 years old, you don’t have as of yet, age related changes. I think that the combination of platelet-rich plasma and hyaluronic acid rather than just hyaluronic acid alone would be a good option for you. I suggest that you find a doctor that you trust and feel is not driven by a purely financial incentive. You should understand what the risks and benefits are. I hope the information about the platelet-rich plasma was helpful in your educational process. I wish you the best of luck, and thank you for your question.

Amiya Prasad, MD
New York Oculoplastic Surgeon
4.3 out of 5 stars 72 reviews

Solution to hollow eyes

There are many treatment options. At a young age like yourself I would avoid a surgical procedure for now. Temporary fillers would be the lowest risk procedure for you. See a surgeon who performs all types of lower eyelid surgery and fillers to get an objective assessment.

Thomas Buonassisi, MD
Vancouver Facial Plastic Surgeon
4.9 out of 5 stars 108 reviews

Under Eye Hollow Treatments

The actual bone structure responsible for the hallows one sees, is constantly changing. Therefore, a permanent solution is difficult. If the hallows are in part caused by volume loss, I prefer using a hyaluronic acid filler. If it is skin changes accounting for crepiness under the eye, I like to use a fractionated CO2 treatment. Ultimately it is a combination approach, addressing the different signs of facial aging that give a natural and enhanced result.

Sabrina Fabi, MD
San Diego Dermatologic Surgeon
5.0 out of 5 stars 85 reviews

Hollow tear troughs

Hello and thank you for your question.
I routinely perform fat transfer to this area for patients in your position, who don't want to have routine injections with filler. The fat graft lives and is potentially permanent. I recommend that you see a board certified plastic surgeon in consultation to get more specific answers to your questions which can best be addressed after a thorough history and examination is performed.

Best of luck to you!

David L. Cangello, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 15 reviews

Well-performed Silikon-1000 injections may work well for permanent correction of under eye hollowing.

Based on your photos, you may be a candidate for lower eye lid filling. Our experience is strictly with Silikon-1000, an off-label filler for permanent results. The skill of your doctor is imperative when filling your delicate under eye area.

Hope this helps you.

Dr. Joseph

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 421 reviews

Cost effective or not for your dermatologist, Restylane is the safest and best solution for this.

It would be great if the surgery was as good or better than the under eye filling with Restylane.  The reality is that when properly done ( and it does take a fussy injector) under eye Restylane filling is the best treatment we have for the under eye circles.  The treatment is far better than any surgery we have.  You look like you would do well with the a small volume of under eye filler.  In someone your age, treatment can last well over a year.

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