Have had lower Blepharoplasty -no stitches or skin removal. Left with hollowness making eyes look sunken and darker. (photos)

Blepharoplasty in April 2015. Aug 2016 was given revision surgery as small still remained. My eyes seem to look very sunken, hollow and dark, instead of a youthful look, it's dull, dark and aged. Online info reads that fat shouldn't be removed it should be re positioned to reduce the appearance of dark circles and give a more fuller look. I'm literally in tears, thinking what the hell have I done, gotten rid of fat when It should be kept. I'm not quite sure what to do now....please help! I'm 43.

Doctor Answers 8

Filler injection to lower eyelid

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I am sorry you are so upset. I understand how distressing this can be.  It would be helpful to see the appearance of your eyes prior to blepharoplasty surgery.  From the photos that you have provided you appear to have significant lower eyelid hyperpigmentation and hollowness of the lower eyelids.  If you have had revision surgery I feel that the most effective and safest way to address this issue is with the use of filler to the lower eyelid.  The filler will certainly help with the hollow appearance of your lower eyelids and will decrease the dark circles to some degree as well.  Be certain that you are seeing someone extremely experienced at this procedure as well as very familiar with the anatomy of the lower eyelid in a previously operated eye.  

Lower eyelid hollowness

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The hollowness is currently because of the hyperpigmentation effect.  Think of it this way, if somebody put dark makeup under the eyes the eyes and appear hollow even if they were not hollow.Your best option to minimize the darkness by using good-quality skincare along with gentle exfoliate and in bleaching creams.  Some of the lasers can help reduce it as well.I'll like using the ResurFx laser as it does not have any down time.  You should meet with a good make up artist and learn the techniques of camouflage while you are recovering in treating the hyperpigmentation.


Dr. J

This can beautifully be helped with under eye hyaluronic acid fillers.

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The fillers can last over a year.  While maintenance is needed, this approach is much better that grafting fat into the lower eyelid.  Unfortunately fat causes scaring in a place where things need to slide.  It is essential that you find a surgeon who is very good and placing filler products.  It is a fussy service and how the product is placed makes all the difference.  In my opinion, the only filler for this application is Restylane.  Avoid the so-called smooth fillers in this location such as Juvederm and Belotero.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews


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It is always helpful to see preop photos to compare.  There are many different comments made online. Fat is removed in many cases and in some it is re-positioned.  Fillers may be necessary for sunken areas. Dark circles are pigment that usually will not respond to fillers.  

Injectable fillers may be considered for adding volume to lower eye lid hollowing.

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Depending on your examination, lower eye lid hollows may be improved with microdroplet Silikon-1000, an off-label filler for permanent results. Hope this helps. Dr Joseph

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 430 reviews

Hollowness After Blepharoplasty

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Without seeing the preoperative pictures, it is difficult to say what should or could have been done. At this point, fillers along the infraorbital ridge (lower orbital rim) will improve your appearance. The most common fillers used in this area are hyaluronic acid, poly L lactic acid and fat. Best wishes!

Hollowness after blepharoplasty

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Thanks for reaching out.  I can see what you are describing.  Do you have any photos before your surgery?  Fat repositioning is not something that every surgeon thinks is the right thing to do, so it is hard to determine just from reading online that is what you needed.  Many surgeons think it is better to use a filler to volumize the area of your bony orbit.  At this point that would likely benefit your overall appearance.  Be sure to consult with a board certified plastic surgeon, as this is truly an advanced technique.

I hope this helps :)

Hollowing after lower blepharoplasty

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You have hollowing along the inferior orbital rim and upper cheeks. Filler injections in this area will help reduce the shadowing and give you a more youthful, less tired look. In my mind, rejuvenation of the lower eyelids is often a two step process. Blepharoplasty surgery is used to remove excess fat from the lower eyelids and then fillers are used to add volume along the orbital rim and upper cheeks to complete the treatment. I achieve better, more predictable results with this method than with fat repositioning. You may also have some skin hyperpigmentation under the eyes, but this is easily corrected with concealer. Makeup usually does not work well to cover volume loss in your upper cheeks.

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.