What is the best treatment for hollow eyes? (Photo)

Question

I have very hollow eyes and my eyes are really back of my face.Sometimes it feels like my eyes are touching my brain. Just kidding.i have hollowness and darkness in the area as well and i use 4 different concealers each time i do makeup and i am tired of it.I think my under eye area is not very full.I dont want to get injections every year or every 6 months.Is there a possible way you could put a very thin silicone or something? To make it permenant

Jason E. Leedy, MD · Answer

When addressing under eye hollows we need to determine what's causing it.  Is it from lack of fat in the lower portion, is it from too much fat above that accentuates the hollow, or is it from the cheek pulling the lower eyelid tissue down.  If there's simply not enough fat there then fillers or fat grafting work great.  If there's puffiness that makes it worse then removal of the eye bag fat will help.  If the cheeks are sagging a bit, or just not supporting the lower eyelid, then a facelift or fat grafting to the cheeks will help.  Based on the pictures, I would suggest fillers.  There seems to be just lack of volume and I would imagine a small amount injected into the trough would really help.  Fillers can be done a little more precisely than fat because the fat particles are larger.  That area just needs a small amount and filler would likely look best.

Jonathan Kulbersh, MD · Answer

Under eye hollows can be permanently corrected with surgery or temporarily camouflaged with fillers (Restylane, Belotero, Volbella) which can also help nasolabial folds.There are great non-surgical options to fill in under eye depressions and hollowness. Using dermal fillers, a liquid eye-lift can be performed. A dermal filler such as Restylane would be placed in the cheek and tear trough to hide the depression or bag underneath your eye. 
Surgery would require a fat-repositioning lower lid blepharoplasty. In this surgical procedure, fat from the eye area is moved into the tear trough depression filling the actual depression. 
I hope this helps!

Elham Jafari, MD · Answer

Hi and thank you for your question! I understand that you prefer a more lasting solution for hollow under eyes, but hyaluronic acid fillers are really the way to go when it comes to treating dark circles under eyes and I don't recommend doing any other type of fillers there. In my experience, Volbella lasts somewhat longer than Restylane or Belotero under the eyes, so you may want to try that if you are looking for something that can last a bit longer. I hope it helps and good luck!

Mitesh Kapadia, MD, PhD · Answer

In my opinion, fillers are a much better option for the under eye area than fat injections. There is very little margin for error when adding volume under the eyes. Fillers made of hyaluronic acid can be dissolved with an enzyme called hyaluronidase if the results aren't perfect. Once fat is injected, it is very difficult to remove it, even with surgery. Fillers under the eyes often last several years and dissolve slowly. A "permanent" solution can easily become a permanent problem.

Jason Emer, MD · Answer

I don't recommend silicone for this area. A combination approach will give the most improvement. Fillers, lasers, and microneedling/PRP can improve under the eyes. My patients try to get non surgical treatments to avoid surgery. We use PRP and stem cells there often. I suggest consulting with an expert to develop a treatment plan best suited for your short and long term goals. Best, Dr. Emer

Mike Majmundar, MD · Answer

There are several types of fillers that can be used under the eyes to address hollowing.  Though Bellafill is a 5 year filler, and can be used under the eyes, it does carry some risk of nodule formation in the future.  I would try Restylane Lyft first as this tends to last longer and some patients can get about 2 years out of it.  It also allows you to try it out first and see if you like the results before using a permanent product.

Brett S. Kotlus, MD, MS, FACS · Answer

Injectable gel fillers made from hyaluronic acid are still the best options for under eyes in your situation.  There are permanent fillers such as silicone and PMMA but I recommend against these as the thin under-eye skin can be prone to exposing filler lumps which prove difficult to correct with a permanent product.  You should be able to acheive about 1 year of improvement with a filler like Restylane.

Hardik Doshi, MD, FACS · Answer

Nesh,
You are correct in your assessment that you demonstrate hallowness under the eyes that can occur due to progressive aging or, if younger, inherent anatomy (think genetics.) For volume restoration, there are permanent solutions ranging from implants, fat transfer, surgery bringing fat from the cheeks to the under eye, and permanent fillers (silicone, PMMA.) Implants can carry the risk of infection, displacement, extrusion, and increased unnatural visibility through the thin under eye skin. The surgical option can lead to under eyelid pulling, if not carefully performed. Permanent fillers can lead to lumpiness / inflammation due to the body reacting to the product and becomes very difficult to remove. Fat deposition carries a similar risk of lumpiness to thin under eye skin and varying rates of fat absorption. There are long lasting fillers within the hyaluronic acid family on the market that would do well in providing more contour to your face. The filler is made from a compound similar to one naturally occurring in your body with the added benefit that it can easily be dissolved if you are not pleased with the result. A thorough consultation with an experienced aesthetic surgeon is high recommended so that all options can be discussed. Best of luck!

Camille Cash, MD · Answer

Fillers may not be permanent, but they are a great option to have a natural looking result.  Permanent fillers come with risks that can make the result unnatural.  I encourage you to explore various fillers with an experienced injector in your area.  Together you can determine the treatment that is best for you.

Brooke R. Seckel, MD, FACS (retired) · Answer

Thank you for your question.  The only permanent and effective solution to correct Hollow eyes is a procedure called a trans-conjunctival lower eyelid blepharoplasty with arcus marginalis release and fat grafting.  Filler injections can be dangerous and blindness has been reported.

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