What is the best filler for hollow sub brow, sunken eyes and how long does it last? Will it look as natural as fat?

Hollows in the sub-brow region above the upper eyelid may occur naturally, but are often the consequence, as in this instance, from over aggressive fat removal during blepharoplasty. (A similar, unwanted hollowness can be created for the same reason during lower lid blephs).I would be reluctant to use fat injections since these may leave difficult to manage lumpiness and irergularity in the very thin skin of the region and may, in addition, not give rise to significant longer lasting results than those obtained with traditional fillers. In addition, injectable fat, which taken from the thighs, abdomen or buttocks, retains those areas' potential to enlarge with age related weight changes. Fortunately, a couple of especially good fillers are available for treatment hollowness in the sub-brow region (and under the eyes): Belotero Balance (which I use in my Upper East Side Manhattan practice) and Teosyal Redensity II (which I use in my Israel satellite facility), both of which possess little to no tendency to give rise to the unwanted, bluish Tyndall Effect that can be seen whenr other fillers are injected superficially in the delicate tissues around the eyes.Treating the periorbital region with fillers should not be left to the hands of inexperienced injectors trained in two-day seminars to inject the smile lines. Make sure to seek treatment by a board certified aesthetic core physician with extensive experience and expertise in injecting this very important region and ask to see his/her befores and afters.

I suggest posting photos and seeing someone in person.  Based on what you are looking for you will likely need a combination of fillers, lasers and/or surgical or non surgical approaches.  You will do best by having little procedures done over time to get to a natural result rather than a large amount done at once that has the potential for looking unnatural.  Best, Dr. Emer.

Filler volume augmentation of the sub-brow area is an excellent option. It is safe, predictable, and effective. It also lasts a long time, likely multiple years.  The best fillers would Restylane or Belotero.  Another option would be fat, which is long lasting but not as predictable, meaning not all of the injected fat survives. One can also do fat injection first and then fine tune it later with filler injection.

The best treatment for under eye hollows really depends on your bone structure, skin quality etc.  That being said, in general, most surgeons have gotten away from using fat around the eyes because there are now excellent long lasting fillers that are usually more predictable and safe, for most patients and in most doctors hands then fat.  There is nothing "natural" about injecting fat from one area of the body into another so the issue really is how to get a smooth contour which looks natural, is safe and predictable as well as cost effective and with minimal downtime.  I generally use a thicker filler such as Voluma or Radiesse in the mid cheek for support and Restylane (with added lidocaine to customize it to the patient) around the eyes, if needed.  These are all off label treatments, however, and it's important that you seek out a board certified experienced injector because complications are not uncommon in this delicate region with inexperienced injectors.  The doctor can explain which filler or treatment they prefer in your case and why so you can make an informed decision.  I have seen too many problems with patients having fat injections around the eyes at other practices and discontinued performing those treatments years ago when the current fillers became available.I hope that helps and best of luck!

Hyaluronic acid fillers (juvederm, restylane fillers) are useful in restoring volume to the brow (to soften boney orbital rim and give a brow lift).  A hyaluronic acid that does not absorb a lot of fluid (like restylane fine line) works well in reducing the tear troughs providing a rejuvenated appearance to the eye.  These products can last over a year when injected deep in these sites.  The result is very natural as long as it is not overdone.  Fat survival is variable.  If you are prone to weight gain the transplanted fat can increase in size and may produce eyelid bags.