Dark and hollow under eyes - would a lower blepharoplasty or fat transfer fix this? (Photos)

Question

I’ve been dark and hollow my whole life, purely genetics. Would a lower bleph or fat transfer work? Or make problems worse? I’ve seen migration/Malar bags come from some. The tear trough is so deep and dark and prominent. They drive me nuts! One is longer than the other. What else can I do to take them away?

Carl Truesdale, MD · Answer

Thank you for your photos and question. Based on your concerns with hollowing and darkness under the eyes, facial fat transfer can be an excellent rejuvenation option. This procedure uses your own natural fat, typically harvested from an area such as the thighs, which is then carefully purified and strategically injected into areas of volume loss under the eyes. The goal is to restore soft tissue support in the tear trough and surrounding midface, which helps reduce the shadowing that often contributes to a tired or dark appearance.
Fat transfer works not only as a volumizing treatment but also as a regenerative one, as the fat contains living cells and growth factors that can improve overall skin quality over time. Once placed, it integrates into the tissue and provides long-lasting, natural-looking correction without the need for synthetic fillers. This approach is especially beneficial under the eyes, where thin skin and delicate anatomy make traditional fillers more prone to irregularities or swelling.
Overall, fat transfer helps smooth the transition between the lower eyelid and cheek, restores youthful fullness, and improves the brightness and rested appearance of the under-eye area in a very natural way.

Edward Buckingham, MD · Answer

It looks like the hollowness and shadowing that you see are primarily due to volume loss along the infraorbital rim and cheek. Fat transfer will help build up this region and provide fullness to the hollows. A major thing to note about fat transfer is that any future weight fluctuations may cause the transferred cells to shrink or hypertrophy so maintaining a stable weight is essential after this procedure. You might also consider filler if looking for a non-surgical option. Good luck!

M. Mark Mofid, MD, FACS · Answer

Hi there,Thank you for your question. If the hollowing is genetic, a lower blepharoplasty alone usually won’t help and can sometimes worsen hollowness unless there is fat to reposition.Fat transfer can improve volume, but it must be done conservatively&mdash;overfilling can lead to issues like migration or malar fullness. A common first step is careful filler, which is precise and adjustable. Combination treatments are often used for best results.Please consult with a board-certified plastic surgeon.

Dark and hollow under eyes - would a lower blepharoplasty or fat transfer fix this? (Photos)

Answers (3)

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