Hollow eyes - what options do I have?

Going in for my routine Juverderm Injections and was curious on what options I have for under eye treatment. I believe Restylne is most popular. I just have a bit of hollowness. Thanks.

Doctor Answers 12

Fillers for Tear Trough Correction

Hi, thanks for you question. Correcting tear trough (this is what we call the under eye area when we are talking about dark circles) volume loss with fillers is one of my procedures and one that I have been performing daily in my clinic for 12 years. I like it because it is painless, quick, involves minimal risk and patients look 10 years younger and much less tired in 5 to 15 minutes. I like to use Juvederm that is specially prepared for the tear trough area by my office staff according to my specifications. I have seen that prepared Juvederm lasts anywhere from 2 to 6 years in the tear trough, depending on the patient. It is also easily reversible with a simple injection of an enzyme.
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.

Amiya Prasad, MD
New York Oculoplastic Surgeon
4.3 out of 5 stars 62 reviews

Hollow Eyes

Hollow eyes can be improved by the use of fillers and/or Nano fat. However, if you have redundant skin you may need a blepharoplasty (eyelid surgery) Restylane is an excellent hyaluronic acid filler that is great for filling under the eyes (tear troughs). This should be done in the hands of a Board Certified Plastic Surgeon with expertise in Oculoplastic surgery. #drrodrohrich#plasticsurgery#fillers

Rod J. Rohrich, MD
Dallas Plastic Surgeon
4.9 out of 5 stars 51 reviews

Under Eye Hollowness

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.

Kathleen Morno, MD
Highland Park Physician
5.0 out of 5 stars 1 review

Solution for hollow eyes

When treating under eye hollows, injecting the mid-face cheek eyelid junction can lift the cheek and improve the appearance of the under eye area.  This does not work on every patient and some patient’s injections are actually done under the eyelid skin to treat a hollow.  Your facial architecture really determines the location and placement of the filler as well as the type of filler used, such as Restylane, Juvederm or Radiesse.  It would be helpful to at least see your pictures.

Joseph A. Eviatar, MD, FACS
New York Oculoplastic Surgeon
4.7 out of 5 stars 64 reviews

Options for tear troughs

Treating the under eye with filler is a beautiful area to treat and in the right hands yields a fresh and natural results that takes years off the face.  Make sure you visit a reputable clinician when considering this area.

Martin Jugenburg, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 427 reviews

Filler for Hollow Eyes

Dear Nicky, Thank you for posting your interesting question. Restylane and Belotero are both hyaluronic acid fillers that are used to correct lower eyelid hollowness. These products produce natural results that last up to 1 year. I recommend that you find an a Board Certified Plastic Surgeon who is experienced with this procedure, because the results are technique dependent. Best wishes, Dr. Richard Swift

Hollow eyes - what options do I have?

Thank you for your question.  I would recommend sticking with one of the hyaluronic acid based dermal fillers such as Restylane or Belotero for the undereye area.  Juvederm can also be used but must be carefully placed to minimize swelling and contour irregularities.  See a board certified plastic surgeon in consultation.

Nelson Castillo, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 43 reviews

Under Eye Hollows

I like both Belotero and Restylane for the under eye hollows.  It depends on the depth of the hollow and your anatomy as to which filler I choose for the patient.  Please be certain to consult an expert for the best cosmetic results.  Best, Dr. Green

Under eye hollows

Yes, I prefer using restylane diluted for the tear troughs. I find the diluted form is a bit smoother and less likely to cause lumps.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

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.