What is the Best Procedure to Fix Hollow Eyes?

I recently had juvederm injected under my eyes as an attempt to fix my hollow eyes.The procedure only seemed to make them worse. Is there any other procedure that could fix my hallow eyes.

Doctor Answers 13

Fat Grafting to Correct Hollow Eyes - Look at Photos to see Evidence of Surgical Expertise

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Structural fat grafting is a procedure in which small amounts (less than 0.1 cc at a time) of fat are carefully introduced in a series of discrete layers to gradually 'build' new soft tissue structure. As there is space between each micrograft, new blood vessels are able to grow into the grafted fat, allowing it to persist indefinitely. If this process of blood vessel ingrowth (neovascularization) does not occur, then the transferred fat cannot truly be considered a 'graft' and is instead just another temporary 'soft tissue filler' that is broken down and reabsorbed over several weeks.  Fat grafting requires specialized training and specialized surgical instruments, as well as patience and meticulous attention to detail on the part of the surgeon. When performed properly, permanent and natural-appearing aesthetic enhancements can be achieved.
Because the lower lid tissues tend to be quite thin, a conservative approach is an absolute necessity for fat grafting of this area.  If one overfills the lower lid  /cheek junction, and most of the fat persists, then the patient ends up with unnatural fullness that needs to be corrected.  I tell patients that our plan will be to add fat until an ideal contour is achieved and then we have to let it heal and see how much persists.  Because the amount of fat that survives is variable, some patients require a second and rarely even a third fat grafting procedure to reach the desired endpoint of improvement.  As fat grafting can be performed as an office procedure under mild oral sedation, and fat grafting recoveries are brief compared to traditional lower blepharoplasty surgery, supplemental fat grafting procedures are easily accomplished.

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

Hollow Eyes are Best Treated with Fat Grafting, Be Cautious of Fillers

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Thank you for your important question.  Your experience is common as I see many patients who have had Filler Injections to treat Dark Circles or Hollow Eyes and who have felt that the injections make the problem worse.

Problems with Filler Injections around the eyes:

  • Poor technique-many doctors doing filler injections do not have experience in eyelid surgery and knowledge of the anatomy. There are a few expert plastic surgeons who can successfully use this technique-you must find an expert
  • Fillers are not permanent, thus repeated injections are required-I am concerned about repeated injections into the eyelid damaging important structures
  • If fillers are not placed properly the action of the eyelid muscle pushes the filler down out of the hollow or depression and make the dark circle worse
  • There is a potential for injection into a blood vessel which can cause blindness-cases have been reported

I use a technique called Open Composite Fat Grafting in which I surgically place a fat graft under direct vision into the proper position to plump the Hollow Eye or Dark Circle. This is NOT Fat Injection or Fat Transfer.

The benefits of Open Composite Fat Grafting to the Eyelid are:

  • Accuracy
  • The Fat Graft is a permanent fix
  • The Fat Graft is your own tissue and better accepted by the body
  • The Fat Graft has a beneficial effect on the overlying skin
  • The Fat Graft reconstructs the actual problem

For more detailed information check the link below.

Options to Fix Hollows Under Eyes

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Dermal fillers is typically the best option for hollows under the eyes if the treatment is performed by an experienced and expert physician injector and utilizes a product such as restylane or belotero.

If dermal fillers are not a good option for you, then fat transfer to the hollows under the eyes is a good alternative for the appropriate patient.

Consult with 3 experienced and expert board certified plastic surgeons who are master injectors to understand your options.

Kris M. Reddy, MD, FACS
West Palm Beach Plastic Surgeon
4.5 out of 5 stars 56 reviews

Best Treatment for Eye Hollows....Restylane by an Experienced Physician

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Hi Onlyone,

First of all, Juvederm is a bit too hydrophillic (attracts too much water) to be used in the lower lid hollows.  Restylane is the only filler that I use in this unforgiving and delicate area.  Secondly,"it is not the filler, it's the filler", in other words, your results are due to the person who injected you, not the filler.   Good luck and be well.

Dr. P

Michael A. Persky, MD
Encino Facial Plastic Surgeon
4.8 out of 5 stars 39 reviews

Hollowness of eyelids

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Fat grafting can be done by experts and this may help. See a plastic surgeon or oculoplastic surgeon.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 39 reviews

Fixing Hollow Eyes

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There is no easy way to fix hollowness of the orbits. Such hollowing is caused by the age-related loss of fat inside the eye socket which causes sinking in of the eye ball into the orbit. This is made worse by a sagging of the cheek exposing the rim of the orbit creating the Tear Trough. While the Tear Trough can be covered with several fillers, increasing volume INSIDE the eye socket is a challenge and can only be accomplished by either bone grafting or placing a plate along the floor of the orbit. These operations are usually done in severe trauma reconstruction cases and not in cosmetic cases.

Dr. Aldea

Peter A. Aldea, MD
Memphis Plastic Surgeon

Hollow eyes

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Thank you so much for your question. Body fat can be transferred to the under eye area to reduce the appearance of hollowing related to volume loss. With structural fat grafting, small amounts of fat are introduced as micrografts and new blood vessel growth allows it to persist indefinitely. I would recommend a consultation with a Board Certified Fellowship Trained Facial Plastic Surgery Specialist.

All my best, Dr. Elizabeth.

"This answer has been solicited without seeing this patient and cannot be held as true medical advice, but only opinion. Seek in-person treatment with a trained medical professional for appropriate care."

Fat Graft Hollow Eyes

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Soft tissue fillers when injected in the right tissue plane and in the right hands can have dramatic results.  Using your own fat to fill the hollow eyes can potentially be a long term solution.  Fat needs to be injected in small aliquots and layer smoothly underneath the thin eyelid skin/muscle to prevent lumps and bumps which may be difficult to repair.

Johnny Mao, MD, FACS
Orange Facial Plastic Surgeon
4.9 out of 5 stars 59 reviews

Blepharoplasty, eyelid surgery

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Instead of removing fat under the eyes with a eye procedure, I have been repositioning it. This could also help with your hollow eyes.

Edward J. Domanskis, MD
Newport Beach Plastic Surgeon
4.5 out of 5 stars 28 reviews

Balancing the lower eyelid with the cheek

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Treating the lower eyelid hollow is one of the most technically challenging areas to treat!!  It is the person treating you not the product that you should be most concerned.  I recommend you consider surgery vs. non surgery. Surgery can include moving the fat around to fill the hollow, with an outpatient procedure that requires a week or two of cosmetic recovery time. Extreme caution for fat injection to this area, as it is very easy to overdo.  Non surgical is the off label use of injectable fillers, several options exist depending on the injector preference.  Remember, if you feel the injection you had made things worse, there is a product that can be injected to erase the effect, called Hyaluronidase.  Go to your nearby expert, ideally a member of the coalition for injectable safety, to make you better!

Julius W. Few, MD
Chicago Plastic Surgeon

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.