Do I have a negative orbital vector? What solution could make my eyes and cheek area more supported? (Photos)

Question

My cheeks are very flat and my eyes look very unsupported on the bottom unless I manually add support with my hand. My left eyelid corner also seems to be retracted causing it to look bulgier and feel drier, what can be done for that?

Anil R. Shah, MD · Answer

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin - Winnetka & Chicago. This is a great question. When the mid-face looks flat and the lower eyelids feel unsupported, I recommend cheek filler to help restore structural support to the under-eye area and create a smoother transition between the lid and cheek; this can sometimes reduce the appearance of hollowness or “bulging” from the lower eyelid.

Nelson Lee Novick, MD · Answer

The cheeks not only provide appropriate projection of the mid-face, but are a major support to the under-eye regions. So, the use of a robust HA  volumizing filler, appropriately injected can both restore the cheek projection and improve the under-eyes. You would be wise to make sure to consult with an experienced, board certified cosmetic dermatologist filler injector expert, since it is important that the injections not be given cookbook style, but in such a way as to preserve a masculine face and not inadvertently feminize it. In experienced hands, the procedure should take about ten to fifteen minutes to perform with typically immediate results and little to no significant post-treatment downtime. Hope this helps and best of luck.

Anna Chacon, MD, FAAD · Answer

Hi, thank you for providing details and photos—it really helps to understand your concerns. From what you’re describing, it sounds like your midface and periorbital area have minimal projection, which can contribute to the appearance of unsupported eyes and subtle hollows under the eyes. This is often related to a negative or flat orbital vector, where the eyeball sits slightly ahead of the cheekbone.
For support and improved contour in this area, several approaches can help:

Deep midface filler: Placing filler in the cheeks and along the orbital rim can provide structural support, lift the cheek, and indirectly improve under-eye appearance. This can reduce the hollowed or “unsupported” look.

Tear trough filler: Carefully placed under the eye, this can soften shadows and improve smoothness, though it should be done conservatively to avoid puffiness or Tyndall effect.

Eyelid concerns: The slight retraction of your left eyelid corner and dryness could be related to a combination of aging, orbital anatomy, or even prior subtle tissue changes. In some cases, addressing the periorbital support with filler or, in more advanced cases, a targeted surgical approach may help improve eyelid positioning and comfort.

The key is restoring midface support first, which can improve both aesthetics and function, rather than directly manipulating the eyelid. Each area is delicate, so treatments should be personalized for symmetry, safety, and natural results.

Do I have a negative orbital vector? What solution could make my eyes and cheek area more supported? (Photos)

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