Permanent Solutions for Low Cheek Bones, Tear Troughs and Facial Hollowness?

I'm barely 20 years old and all my life I've had shadowing under the eyes and a gaunt face. What especially bothers me is the inner-upper corner of my eyes; it always looks bruised, and from that corner I have a crescent that becomes the tear trough/bag. I've learned how to hide it, but I really want a solution that I don't have to repeat twice or more a year.

Doctor Answers 8

Facial Hollowness

The areas you desire fullness for can be addressed.  I would caution you against anything permanent at this point.  I think the fillers can address these hollow areas well and even out the depressions to create a smooth surface and eliminate the shadow effect.  I would only seek a permanent option after you've tried the fillers to see what it will look like to ensure that you are satisfied with the results.

Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 13 reviews

Please be very careful what you wish for.

There is no reason for you to have cheek implants because they are not designed to put volume in the correct place in the face.  The gold standard for treating the under eye hollow in 2011 is Restylane along the orbital rim.  The results of this procedure is better than any surgical procedure we have.  Fat grafting can create permanent volume but it can also create permanent lumps, bumps and scaring in planes that should glide over each other.  The loss of this glide plane will generally be unacceptable for someone as young as you are.  Restylane filler does not stimulate scaring.  Regarding the hollow in the upper eyelid, this is a very high risk area for fillers.  I would only venture an opinion on treatment options for this after a detailed consultation.

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

Best Treatment for Low Cheek Bones, Tear Troughs, and Facial Hollowness...Sculptra

Hi Chan,

I understand how you are bothered by the hollow.  I would strongly advise you against any type of permanent implant.  I would also not ever use Juvederm in your eye hollow area; the only injectable filler that should be used in that delicate and unforgiving area is Restylane.  I would treat you with a small amount of Sculptra to support the mid cheek trough, that in turn will help your lower lid hollow.  When used properly, Sculptra can correct your problems.  This is the advise that I would give to my patients. I can only speak for my own results.  Treatments such as yours are not a commodity, rather they require artistic vision, skill, and experience.  Choose your treating physician most carefully.  Good luck and be well.

Dr. P

Michael A. Persky, MD
Encino Facial Plastic Surgeon
4.8 out of 5 stars 36 reviews

Face hollows

At your age you should limit ypourself to fillers at firs and see if you like the result. If so then consider fat injections. Stay away from invasive procedures or implants at this time.

Michael L. Schwartz, MD
West Palm Beach Facial Plastic Surgeon
4.8 out of 5 stars 12 reviews

Fat transfer gives you permanent correction of hollow mid face.


1)  In my opinion, cheekbone implants are almost obsolete, because they often have complications and deformities.  If you are really ready for surgery, skilfully done fat transfer (tiny blunt cannula, multiple deposits of "string of pearls" fat fragments) can give great natural enhancement.

2)  I recommend correcting the problems with a filler like Juvederm (this is just an office visit under local anesthesia), and then if you like the result, you can move on to fat transfer.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
4.8 out of 5 stars 9 reviews

Permanent solution for "low cheeks", etc.

The permanent solution for your cheeks would be cheek implants to give you fullness. The eye hollowness can be treated with Juviderm for the depression but you may have excess fat of the lower lid that can be used to fill the depression permanently. I would need to see more photos of your eyes from the front.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 34 reviews

Hollowness under the eyes.

The best treatment at your age is still soft tissue fillers.  I would avoid surgery at this point. 

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 19 reviews


You are very young to be entering the world of facial surgery. However, all of your issues can be served by facial plastic surgery or injestion, I would do fillers first to see if you like the results before moving on to permanent implants

David A. Bray, Sr., MD
Los Angeles Facial Plastic Surgeon
4.4 out of 5 stars 7 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.