Under Eye Hollows? (photo)

Hello. I have under eye dark circles and hollows. I was wondering what would be the safest and the most long lasting option for the treatment of under eye hollows. Meanwhile, which kind of personal care (such as creams, or facial exercises) should I use (before getting the treatment) to not make it worse or possibly to improve it? Thank you so much.

Doctor Answers 8

Under Eye Hollows

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Lower lid hollowness can  be improved with structural fat grafting. One must exercise care and caution, as lower lid skin and the underlying soft tissues are usually quite thin, and thus the lower lids are less able to conceal grafted fat. Fat grafting must be preformed conservatively here, with a plan for secondary and occasionally tertiary fat grafting procedures depending on the 'take' of the initial fat grafting surgery.
Please be sure to view many, mnay photos of under eye fat grafting as this s a delicate area and you want to be sure you are pleased with the results your doctor can provide.

Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 123 reviews

Under eye bags vs hollows

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Dark circles will not go away with surgery or creams.  Retin-A will help with fine lines, but must be used for several months to see any changes.  Any puffiness that is in the lower lids caused by fatty deposits can be removed or re-positioned with a lower blepharoplasty.  This will depend on your anatomy.  

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 157 reviews

Safest eyelid bag treatment.

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Options for treating the troughs below the eyelids in increasing order of risk and longevity are

the fillers, Restylane, Radiesse

collagen stimulator and volumizers Scupltra and fat injections

the cellulaze sidelaze laser to flatten the bulges

lower lid blepharoplasty with fat transposition

midface lift

Please consult in person with a Board Certified Plastic Surgeon prior to making treatment decisions.

Luis A. Cenedese, MD, FACS
New York Plastic Surgeon

Lower eyelid bags

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Dear samarehkh,

  • Although you could try Restylane, it may not give a full correction that you are happy with
  • I would do a lower blepharoplasty with fat transfer to remove the fat, then use the fat transfer to sculpt the lower eyelid and cheek
  • Surgery, although more expensive with longer recovery would give you the longest lasting results

Best regards,

Nima Shemirani

Nima Shemirani, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 85 reviews

Dark Bags Under Eyes

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In terms of creams, nothing is effective enough to recommend to you for the darkness and hollowness under the eyes. The fact is, hollowness and darkness is caused by anatomic changes, and that is something that a cream has no bearing on. 

Medically, fillers are a quick and simple option (see the video I posted below), but they are temporary. A lower blepharoplasty could be effective and long-lasting, but it also requires more money and recovery time. You can read about both options extensively on my website, but it really comes down to what you personally are looking for. Both are wonderful options, and you need to decide what works best for your life. 

Hope this helps! 

Cameron Rokhsar, MD, FAAD
New York Dermatologic Surgeon

Lower eyelid puffiness

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You might try a filler from an expert injector.  It looks like you have a degree of volume loss in your upper cheeks and tear trough area that accentuate the appearance of fullness in the lower eyelid.  A hill looks higher if there is a valley next to it.  Fat is the best filler, but requires expertise.  Hyaluronic fillers like restylane and juvederm usually last about a year in this area.

Lower eyelid surgery will provide longer term results.  With your anatomy you will need to address the issue of hollowness in the upper cheek to get a great result, either with a blepharoplasty technique that repositions the fat or with a micro fat transfer.

John Q. Cook, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 12 reviews

Two options

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You have two options:

Surgery  [lower eyelid blepharoplasty with fat repositioning

Fillers  [filling in the hollow region with Restylane or Juvederm]


Surgery is more expensive in the short run, but is a longer lasting option

Fillers are more less expensive in the short run but would need to be repeated every 6-12 months.


A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 42 reviews

Treatments for under eye hollows

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It's difficult to fully evaluate you with just those pictures, but it appears that there may be some fat herniation that is creating some puffiness with the hollowness forming beneath it.  One option to improve it is to surgically remove some of the fat so that the puffiness is reduced, which in turn, reduces the hollowness.  The other option is to inject a filler into the hollow area to improve the appearance.  Both options would be safe, but the surgical option would have longer lasting results.  The filler I would recommend would be Restylane, Juvederm, or Belotero (all hyaluronic acid fillers) and there may be some variation in how long they would last but it could last for a year or longer in that particular area.  

Michael I. Echavez, MD
San Francisco Facial Plastic Surgeon
4.5 out of 5 stars 18 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.