How to Repairs my Hallow/sunken Eyes? (photo)

my eyes are so hollowed. i've turn 20 and look like in my 40s. i hate this look. i've got exam coming up and i can't focus on it due to my look. i am so embarrassed to go outside or even face my friend. i hate my face. people tell me to be happy but i can't even after trying so hard because i keep worrying. i tried all home rem ides to solve it. i do have 7.5 to 8 hours sleep. i drink lots water. i think this could be genetic but i really want way out of this problem. please give me some advice.

Doctor Answers 11

Possible Treatment for Hollowed / Deep Set Eyes

From the photographs, it appears that your eyelids are slightly hollowed / deep set. This may be improved with fat injections, other fillers or silicone cheek implants. It also looks like you have darkness to your eyelid skin. A bleaching cream and some lasers may help with the discoloration. The results can vary, so you should have an evaluation with an Oculoplastic Surgeon who can better judge your issue and provide you with an individualized treatment plan. I hope you find this helpful.

Under eye hollowness

This is a great question, and one that is commonly asked and sought out in consultation. That hollow area beneath your eye, near your nose, is called a nasojugal groove or a "tear trough." They can often extend laterally, toward your temples and the outside of your eye, as an orbitomalar groove. This can become more prominent with age, but often do exist in younger patients with a genetic predisposition. The underlying cause is often both soft tissue and bone related.

Fortunately, there are good options for correction. In the past, implants in this area had been very popular, but the current trend in cosmetics is that implants are being replaced with fillers that have significantly longer durations and better outcomes. Fillers have the main benefits of very little risk when compared with the surgical procedure of an implant and the long-term complications that all too often force those implants to get removed. Fillers also cost a fraction as much.

You may hear a debate from some surgeons about fat transfer versus fillers, but the reality is that fat transfer is unpredictable, even in the best hands. Hyaluronic acid fillers provide a very consistent volume and result. Newer fillers last significantly longer, with very high patient satisfaction when used in this area.

Seek out a consultation from somebody with experience. Read: beware, not everybody has the knowledge and skill set necessary to deal with this area. All too often I am dissolving filler from other injectors who have chosen the wrong product or the wrong patient to inject in the periorbital area. The ability to be dissolved is another benefit of filler in this area, as it can often be sculpted and corrected to achieve the natural appearance desired.

To ensure you are receiving the highest level of care, seek out a dermatologic surgeon, oculoplastic surgeon, facial plastic surgeon or plastic surgeon who is board certified and fellowship trained in one of these "core four" cosmetic specialties.

Cameron Chesnut, MD, FAAD, FACMS, FASDS
Spokane Dermatologic Surgeon
5.0 out of 5 stars 24 reviews

What can I do for the dark sunken circles under my eyes?

This is a very common question in my practice. The area under the eyes provides a very unique challenge. Your hollow sunken look is coming from several different factors. Primarily, you have fat loss on the upper and lower lids (on the side closest to your nose). This is causing contour irregularity and shadowing. Also, you have a "purple" color to the skin around the lids. The cause for this is complex and is usually inherited.  For the hollowing and fat loss, I recommend hyaluronic acid filler. It's important to see an experienced injector with a very good understanding of both the product being used and the anatomy. I routinely use Restylane and Belotero under the eyes. Rarely I will also use Juvederm Voluma, but only in rare cases. The discoloration is more difficult to treat, but adding a layer of filler just underneath the skin (usually a thin filler like Belotero) as well as treating the skin (certain lasers have shown some benefit) can improve this issue.

Jeffrey M. Joseph, MD
Newport Beach Oculoplastic Surgeon
5.0 out of 5 stars 4 reviews

Facial Implants to Correct Hollow/Sunken Eyes

Your eyes are deep set, but you also have what is known as a tear trough deformity.  This can be corrected by one of two mechanisms.  You also have flat Malar eminences (cheek bones).  A combination of silicone cheek implants and silicone tear trough implants could change your hollow eyes to haunting eyes.  

As an alternative, injectable fillers can accomplish the same correction.  This is much cheaper and gives you the idea of what can be done. 

A Board Certified Plastic  Surgeon experienced in facial implants and tissue fillers would be the correct person to see to start you on your road to greater self esteem.

Undereye bag treatments for young patients

Thank you for the question and the photo. In younger patients, it is best to try non-surgical treatments first. Typically this involves fillers (Restylane or Belotero in my practice), in addition to medical grade skin care. That said, there are some patients who have significant under eye fat, and techniques to camouflage just make it look worse. In these cases, a conservative amount of fat removal can be performed via an incision inside the eyelid. For patients with a tear trough deformity, the fat closest to the nose can be transposed to (i.e., used to fill in) the hollow area.

Evan Ransom, MD
Bay Area Facial Plastic Surgeon
5.0 out of 5 stars 76 reviews

Hollow under eyes

Great question and one that is commonly asked. you appear to have volume loss under your eyes in the tear trough area- so my common treatment approach to this area is fillers. 

You have two options for fillers, one is a temporary injectable- I commonly use Belotero injections in this area (please see my before and after pictures under belotero)- which gives natural results lasting 3-6 months. 

Your other option is fat transfer to the area, which also produces natural long lasting results when done well. (Refer to my before and after pictures for fat transfer). Hope this helps. 

Dilip D. Madnani, MD, FACS
New York Facial Plastic Surgeon
5.0 out of 5 stars 53 reviews

Filler or implants.

OK, this is difficult. You only have two real choices that work. Sunken eyes can be genetic, and worsened with age as the orbital rim recesses and bone structures change with age. 

The best solution to give dramatic changes are implants suited to your contours. Hands down for this procedure. 

The second solution are fillers to both the tear troughs and beyond *malar areas/ cheek areas. Fillers in this area are tricky to perform as the filler need to lay on your bone (safety), additionally cheek fillers can blend in the fillers from your troughs. Technically challenging but possible. Expect only a 40-50% correction with fillers. They last 9-14 months. 

Davin Lim, MBBS, FACD
Brisbane Dermatologist
5.0 out of 5 stars 31 reviews

How to improve dark circles under the eyes due to hollowness?

There are multiple causes for dark circles under the eyes. I agree with the review of Dr. Gordon below.
You have the rather unique case of true hollowing due to lack of any normal fullness in the lower eyelid space. This likely has its origin in the orbital septum being set back slightly inside the orbital rim.

Many people with lower lid bags have used filler to help to camouflage them. I personally feel that this isn't a great use of fillers in the lower lids and see more problems there than successes.

I have helped others  with a condition like yourself with hyaluronic acid fillers in the tear trough region and this has has been successful in helping to improve the appearance in this area.

Fat has been used here as well but fat can be permanent and I've seen more problems with using fat here that successes.

In addition as Dr. Gordon expresses, there are some pigment issues in the skin here as well and medical skin care products  along with certain light treatments (Broad Based Light) could help improve this as well.

I hope you found this explanation helpful. 

Adam Scheiner, MD
Tampa Oculoplastic Surgeon
4.5 out of 5 stars 22 reviews

Sunken eyes

I have had great success in using fillers. It takes 2 sessions 2 weeks apart. I use Voluma which lasts a good year before re-injection is necessary. Minimal bruising

David A. F. Ellis, MD
Toronto Facial Plastic Surgeon
4.5 out of 5 stars 4 reviews

Hollow Lower Eyelids - Do NOT Use Fillers or Implants! Look at Photos for Evidence

The ONLY treatment for hollow lower eyelids is fat grafting.  A Link to my fat grafting before and after gallery is attached.Fat grafting of the lower lid area requires experience and meticulous technique. As the area is covered by a very thin layer of skin and muscle, overcorrection must be absolutely avoided. My approach is to graft fat to the point that the area looks aesthetically ideal, then stop and wait 3 months to assess fat survival. As fat survival is variable, additional fat grafting procedures may be performed based on the results of the first. Take a look at the many examples of fat grafting to the upper and lower eyelids on my website (link below) When prformed expertly, fat grafting can provide very beautiful and very natural looking results. 

Some physicians recommend fillers. I would ask them to share dozens of before and after images of patients weeks and months after treatment. I have not seen anyone with consistently beautiful and natural looking results using injectable fillers. 

It can be very confusing to patients who hear varying opinions from physicians. Look at many, many photos that can provide evidence of the experience and expertise of a physician.

The following are a few things that can distinguish some surgeons from others.

1) Graduating from a top tier medical school at the top of their class.

2) Membership in Alpha Omega Alpha. This is the medical honors society. Alpha Omega Alpha is to medicine what Phi Beta Kappa is to undergraduate universities

3) Formal surgical training from prestigious medical universities. The minimum number of years of surgical training for plastic surgeons to be board certified is five years. Some physicians have as many as ten years of formal surgical training. There simply is no substitute for stelar academic and practical surgical training.

4) Very experienced surgeons with meticulous surgical technique and natural looking outcomes will have photgraphic evidence of their work. Patients should be able to view many photos of the surgery of interest, photgraphed from three different perspectives all with similar lighting, distance from the camera and cropping

The elite experience extends beyond the surgeon to the facility, and the surgical team. You should be able to see the surgical theater and know who else will be in the OR with you during surgery. The Joint Commission (JCAHO) is an organization that provides certification to hospital OR's. The Joint Commission and AAAASF are two of the organizations that can provide certification to surgical suites. Some plastic surgeons elect to have their surgery centers dually certified.

The anesthesia experience is critical to a safe and comfortable surgical experience. A board certified anesthesiologist can administer general or MAC anesthesia. My preference is to have a board-certified anesthesiologist at the bedside of my patients for the duration of surgery.

Plastic surgeons who cater to high profile individuals who place a high value on privacy will have a private first floor entrance and exit so patients never need to be in a public lobby or elevator for pre-operative or post operative visits.

Michael Law, MD
Raleigh-Durham Plastic Surgeon
5.0 out of 5 stars 86 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.