Surgery for hollow under eyes? How can I get rid of the sunkenness in the inner corners? (Photos)

Question

Hi :) I had tear trough filler for hollowing & shadows but I’m not satisfied with the results. The inner corner still looks hollow. I asked for more filler but the injector said no as it might affect lymphatic drainage. How can I get rid of the sunkenness in the inner corners?

Thomas A. Mustoe, MD, FACS · Answer

I agree that filler underneath the eyes can cause chronic swelling occasionally that doesn’t always resolve even after dissolving the filler.  The sunken area is cause by the orbicularis muscle being tightly adherent to the underlying bone.  A transconjuctoval approach to lifting g the muscle off the bone and then doing a small fat transfer can nicely soften that area.

Zoran Potparic, MD · Answer

Based on these photos you seem to be good candidate for upper and lower eyelid surgery and cheek and periorbital rejuvenation, volume augmentation with fat grafting. It would be in your best interest to have in person or teleconference consultation with a board certified plastic surgeon with experience in these procedures. Good luck.

Eric M. Joseph, MD · Answer

We utilize microdroplet Silikon-1000 for permanently filling congenital lower eyelid grooves. This may be a welcome alternative to blepharoplasty surgery for many people. Since the under eyes skin is so delicate, it is important that you choose your physician carefully. Thank you for this question, and I hope it's helpful. Sincerely, Dr Joseph

Mustafa Aydinol, MD · Answer

The result looks OK, but it can be better. You can get biostimulant filler injections specially designed for delicate parts. Nano fat injection is also a solution. You can also try mesotherapy with vitamins, aminoacids and non cross-linked hyaluronic acids

Pawel Szychta, MD, PhD, DSc · Answer

Hi.I'm sorry to hear that you're not fully satisfied with your tear trough filler results. Under-eye hollowness, especially in the inner corners, can be particularly challenging to treat. If your injector is concerned about adding more filler due to the risk of affecting lymphatic drainage, there are several alternative approaches you might consider:
1. Consult with another board-certified dermatologist or plastic surgeon who specializes in under-eye treatments. They can provide a fresh perspective and may suggest different techniques or treatments suited to your specific anatomy.
2.Different injection techniques or using a filler with different properties might yield better results. For example, a softer, more flexible filler could better integrate with the delicate tissue in the inner corner without impeding lymphatic flow.
3. A lower eyelid blepharoplasty is a surgical procedure that can address under-eye hollowness by repositioning fat or adding a small amount of fat grafting to the area. This option provides a more permanent solution compared to fillers.
4. This procedure involves transferring fat from another part of your body to the under-eye area. It can provide a natural-looking and long-lasting correction for hollowness.
5.Laser: - Stimulates collagen production, which can thicken the skin and reduce the appearance of hollows. - Fractional lasers can improve skin texture and stimulate collagen. - Tighten skin and promote collagen synthesis.
6. While they won't fill in hollows, products containing retinol or peptides can improve skin firmness over time, making hollowness less noticeable.
7. Ensure you're well-hydrated, get adequate sleep, and maintain a balanced diet rich in vitamins and minerals that support skin health.
8. Skillful use of concealer and highlighting can temporarily reduce the appearance of under-eye hollows and shadows.
9. Gentle massage can promote lymphatic drainage and reduce any puffiness that might be accentuating the hollowness.

Mats Hagstrom, MD (license on probation) · Answer

Improving this area can be tricky.
Midface volume can be enhanced using fillers, fat grafting, with implants, or a mid-facelift.
Each procedure has advantages and disadvantages.
Fillers are probably the gold standard.
Finding providers who are exceptional at facial enhancement with fillers is not always easier or straightforward.
The numbers of providers who are truly excellent at this kind of work is in reality.
 to get an idea of what can be achieved using only fillers consider looking at the results of Dr. David Mabrie MD in San Francisco.David, it’s a facial plastic surgeon whose career is devoted exclusively to facial volume augmentation using fillers spread.
Real self will not allow me to include a link to outside websites so you’ll have to look up his website on your own.
His website has a very impressive collection of before and after pictures.
I’m not suggesting people fly to San Francisco to get facial fillers.
I do think that reviewing his results can be a powerful tool to educate people to what can be achieved using only fillers in the hands of the right provider.
Best,
Mats Hagstrom MD

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