Why Are Pre-blepharoplasty Pts Not Told It Causes Hollowness?

My eyes are hollow and sunken in their orbits.I had beautiful almond shaped eyes with some "bags" prior to blepharoplasty. I would NEVER have signed up for a surgery that I knew caused 1)Hollowness 2)Changed the shape of my eye from almond to round. 3)Would cause my eyes to sink down into their orbits.How can this information not be given pre-op when it is documented fact & noted in medical journals dating back to the 1990's & earlier,that by removing the orbital fat, you will get these outcomes

Doctor Answers 9

Post Blepharoplasty Hollowness

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You are correct that the literature has contained information about the problems that you mention. In spite of this, there are still a very large number of practitioners doing blepharoplasties that do not believe this. They see relatively good results with the techniques that they were taught and do not follow their patients long enough to see these changes commonly. The problems are correctable with fat grafting to restore the hollowness and a canthoplasty to correct the roundness. See a plastic surgeon who specializes in eye rejuvenation and has significant experience in correcting previous problems.

Highlands Plastic Surgeon

Hollowness after Blepharoplasty

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Eyelid lift surgery should improve and enhance the eyes but not make them hollow. I entirely agree with your observation. The question is one of communication between you and your blepharoplasty surgeon. We like to perform eyelid lifts, and I assume you are referring to the lower lids, with minimal or sometimes no fat removal in order to prevent the outcomes you are describing. I would discuss with your surgeon - filling of the under eye region may be a solution for you.

Frank P. Fechner, MD
Worcester Facial Plastic Surgeon
4.6 out of 5 stars 48 reviews

Hollow eyes after blepharoplasty

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It can occur and should be part of the informed consent process.  If its not on your consent that you should have a copy of, you should talk to your doctor about it, assuming your assessment of your eyes are true (you may have had hollow eyes already as it is a normal process of aging) and see what your surgeon can do to resolve your concerns.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews

Hollowness after eyelid surgery can be fixed!

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Older techniques of eyelid surgery did indeed cause hollowness. However, newer techniques have been developed that either reposition the fat or transfer abdominal fat to the lids which will reduce the chance of hollowness. If you have a little hollowness of the upper and lower lids, you might be a candidate for filler to augment the lost volume. Filler will last for a year or more in this region. You might also want to consider fat augmentation (see Dr. Glasgold's comment!)

Theda C. Kontis, MD
Baltimore Facial Plastic Surgeon
5.0 out of 5 stars 42 reviews

Why Are Pre-blepharoplasty Pts Not Told It Causes Hollowness?

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I'm sorry to hear about your postoperative issues. As surgeons we try and discuss all of the potential negatives with patients prior to the procedure so they are well informed. Bad outcomes are always possible but hopefully that is an infrequent occurence. I hope you will be in contact with your surgeon to express your concerns and see what he can do to help correct them.

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 29 reviews

Hollow look after lower eyelid surgery

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Many patients have fullness or “bags” under the eyes, particularly right under the eye and laterally.  In some patients, even if they have “bags,” a hollow area is seen toward the nose (sometimes called the “tear trough” region).  Lastly, there may be extra skin or redundant lower eyelid muscle as well.  In many cases, surgeons recommend removal of the fat from the lower eyelid region from inside the eyelid (transconjunctival approach).  This is sometimes paired with a trim of a tiny amount of skin under the lashes, or, in some cases, addition of fat taken from elsewhere on the body.  In the former case, removing the fat from the lower eyelid region can actually make the eyes look older and more hollow.  In the latter case, addition of fat from other parts of the body is unpredictable – it can lead to undertreatment, overtreatment, unevenness between sides, or no results at all.

In my practice, I recommend a lower eyelid procedure that uses the fat pads already present under the eye to fill in the tear trough.  This fat is guaranteed to survive, since it remains attached to its blood supply; plus, it’s almost always just the right amount.  Next, I lift the skin of the lower eyelid and upper cheek region, removing the excess by the outer corner of the eye.  This helps to improve the lower eyelid contour, gets rids of folds and wrinkles, and avoids the hollow look that can happen with other approaches.  Most importantly, the results look natural.

Hollowness after blepharoplasty

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I have been lecturing on this topic at national plastic surgery meetings for almost 15 years and it is only in the past few years that there has been a growing acceptance by most plastic surgeons, however the majority of plastic surgeons have not developed an expertise in volume rejuvenation.  While it is unfortunate that you are hollowed out, we commonly treat and correct this result with fat transfers.  As you research this topic you will find a lot of controversy about success rates and potential problems.  These issues are related to a doctors experience with the procedure and our patients have been extremely satisfied with the results.

Mark Glasgold, MD
Highland Park Facial Plastic Surgeon
4.5 out of 5 stars 47 reviews

Hollow eyes after eyelid surgery

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Thank you for your question.

Plastic surgery has inherent risks, such as bleeding, scarring, and infection, just to name a few. Hollow eyes, as well as persistent bulges and bags, can also occur after blepharoplasty surgery. Too much or too little tissue can be modified. Fortunately, plastic surgeons can now reverse a sunken appearance by fat injections or facial filler treatments as appropriate.

Speak with your plastic surgeon regarding any concerns. Only after a comprehensive evaluation can an eyelid surgeon help determine appropriate options for you. Best of luck.

Dr. Chaboki


Houtan Chaboki, MD
Washington DC Facial Plastic Surgeon
4.9 out of 5 stars 89 reviews

Why Are Pre-blepharoplasty Pts Not Told It Causes Hollowness?

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           The procedure as an entity does not cause hollowness rather the execution of the procedure with aggressive fat removal can cause these issues.  This is largely technique and surgeon dependent and is not the goal of surgery.


Kenneth Hughes, MD Los Angeles, CA

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.