Hollow eyes - what options do I have?
Doctor Answers 12
Fillers for Tear Trough Correction
Hope that helps
Hollow eyes can be corrected by Restylane or Juvederm, but it is important to see if puffiness may be accentuating hollowness
Thank you for your question. You stated you’re going for routine Juvederm injections and you’re interested in options for under eye hollow treatment, and you understand Restylane is popular. You say you have very slight hollows.
I can give you some idea of how I approach people with these types of concerns in my practice. A little background - I’m Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon specializing in cosmetic and reconstructive procedures of the eye area.
With many different options for under eye hollowing, we have to define the cause of the hollowing. For example, it is very common for people to feel they have a hollow when they also happen to have puffiness. There’s a difference between puffiness and hollowing you need to understand before treatment so you make an informed decision. Under eye hollowing alone, in the absence of puffiness, is a loss of volume in the area of the tear trough and the eyelid-cheek junction. In this area, it is routine for me to place Restylane which is a softer hyaluronic acid filler. I often combine it with platelet-rich plasma (PRP) to help the skin quality because very often, people with under eye hollowing are also concerned about the dark and thin quality of the skin, and often there’s sun damage and other issues. The filler can be placed very strategically to improve the under eye hollowing.
Now what happens when you have puffiness? If it’s a minimal amount of puffiness, you can still get away with placing a bit of filler. Often, people overinterpret what they consider a small amount of puffiness. We have patients who have very large bags under the eyes, who come to the office and say, “Can you put filler to deal with the hollows?” Now when I show them the puffiness is lower eyelid fat prolapse, which means the fat around the eyes pushed forward and created a bulge, that bulge acts like a mountain which makes the adjacent area look hollow. So they learn that if the puffiness is too big, then the under eye hollow can’t be improved with filler. As a specialist in oculofacial cosmetic surgery, patients come to me from all over the world with filler issues related to trying to hide under eye puffiness and address under eye hollows. We end up using enzymes like hyaluronidase to melt away this material to get rid-off this excess volume, so you have to be careful with deciding on filler. Less should be just enough, but if you’re putting a lot more filler, you have to ask yourself what you are really addressing: are you dealing with a deep under eye hollow, or cheek volume loss, or with puffy under eye bags?
In addition to hollowness and skin quality from a thickness issue, we also help people with discolorations under the eyes. Sometimes, a little laser, whether it’s a fractional laser, an ablative laser or even a light peel, or even something minimal like topical retinols can help the under eye hollow appearance.
Speak to your doctor who you’re going to for routine Juvederm and ask about these options. Learn about what makes sense for you. Make sure you distinguish what is hollow and what is puffy, and then move forward. I think that Restylane is a very good option for this type of situation because we have a lot of experience with that. We use blunt cannulas, and place the material in a way to minimize the trauma and improve the area in an interesting way so the material can last a lot longer than it does in the dermis, but that’s a separate discussion. I hope that was helpful, I wish you the best of luck and thank you for your question.
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Thank you for your question. For under eye hollowness I typically prefer Restylane however it does depend on individual anatomy so I would recommend an in person exam to determine candidacy.
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