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

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.

There are many causes of eye bags. Some are shadow issues, some are discoloration issues.  

1. Prolapsed orbital fat through the orbital septum: treated with lower lid blepharoplasty and fat re-positioning. Can also be helped with fillers or auto fat transfer to the face but the ideal treatment in my hands is surgery for this issue. In your case I think fat transfer to the face is a real good option.



2. Ezcema: much more common in young people with fair skin. The treatment for this is to hold off on makeup and any manipulation of the lower lid for a few weeks and try some topical anti inflammatory creams. If you have allergies those should be treated also.  A dermatologist is the best person to see for this. We have a multidisciplinary clinic with myself, a plastic surgeon, and my partner, a dermatologist which I think is ideal!



3. Fluid accumulation and/or redundant skin. Could be possible in young patients but would need a good facial analysis and exam to determine. A low salt diet (< 1000mg/day) and a warm compress can help.  I would consider treating with filler/fat transfer, lower lid fractional ablative laser and/or lower lid blepharoplasty.



4. Descent of midface cheek pad. This then causes the nasojugular ligament to become more prominent creating a demarcation and separation of the eye from the cheek subunit. Treated with mid face lift and fat transfer. Again you are young so I think fat transfer is a good option.



It is all about the balance of this transition from the orbit to the cheek. There are many ways to treat this and they vary by the underlying cause. I recommend seeing a surgeon who also does a lot of these treatments. This can make a big difference as most people have a combination of the above that lead to the issue.



Hope this helps.



Best of luck,



DrC

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.

At home peels like cosmelan, enlighten and aerify along with dermarolling (MTS roller with anteage MD ampules) should be started now. There are many things you can do to treat under eye hollows and dark circles. A surgical option to remove skin and/or fat will such as lower eyelid blepharoplasty with or without fat pad repositioning will be the best long term. There are many things you can do to treat under eye hollows and dark circles without surgery. Non invasive less downtime options such as fillers (Belotero, Juvederm Volbella​), lasers (Moxi/Halo/Fraxel/CO2​), Renuvion (J-Plasma), microneedling/PRP, stem cells and microneedling RF like Fractora PiXel8 or Morpheus can all help give some improvement. Accutite can often be used or stronger lasers like erbium or co2 spot treatment can tighten the skin and give very quick improvement in wrinkles and texture. A surgical option to remove skin and/or fat might be the best solution long-term. I suggest you get a formal consultation to see what is best for you and your goals. Best, Dr. Emer.

As an ASOPRS trained surgeon, our practice commonly sees patients with upper eye and under eye hollows, and a proper evaluation should first be performed to rule out any concerning causes.
We can improve these hollows with filler injections, fat injections, or facial implants. 
Each of these treatment options have their risks and benefits, and we review these with our patients in detail. 
We have also helped many patients who have not had satisfactory outcomes elsewhere.

The eyes are perhaps the most important and central feature of ones face. Sunken eyes can give the appearance of fatigue and aging. Certain fillers can be artfully placed in a way to alleviate that sunken appearance and rejuvenate your eyes. These fillers are only temporary and would require repeated treatments to keep the appearance. 

Thank you for supplying your photo with your question. This is a commonly asked question during  consultation. The hollow area ( sometimes with bulging sometimes just hollow, sometimes hollow with dark circles) beneath your eye is not uncommon. It might be in too many forms and combinations. Sometimes only hollow and sometimes hollow and protruding fat pads of the lower eye area. Sometimes  this hollow extends outer part of eye area.  The reason is often both soft tissue and bone related.
There are few options to treat this problem. On elf the best option is mid face lifting with lower eyelid lift. This is a 1 hour procedure. Recovery takes one week . It is not a painful procedure. Sometimes an implant can be added to the procedure. Fillers can be solution only for certain forms and the results of surgery and fillers can not be compared. 
I strongly recommend you visit a board certified plastic surgeon in your neighborhood.

Filler injection around eyes is a very predictable effective option to address hollowness around eyes. Careful placement of the filler and being conservative are important elements.

Hi there! Thank you for your question and pictures. I'm sorry to hear of this effect on your self confidence. You'll be glad to hear that you have some good options here. Personally I specialise and treat a huge number of eye bags / hollowness using tear trough fillers. Small quantities of hyaluronic acid based dermal fillers can be carefully placed in the area to improve the hollow appearance resulting in natural looking and refreshed results. Using a cannula technique, downtime is minimal and expect results to last with the juvederm vycross range around 9-12 months. I hope this is useful and good luck. I do hope you are feeling more confident after treatment. Just make sure you see a practitioner with lots of experience as this is an advanced procedure. Best wishes,Dr Rupert 

A deep-set eye is a common trait, even in young people.  It generally represents a large orbit (bony cup in which the eyeball sits). The most reliable treatment that doesn't have much downtime is injectable filler.  There is no question that right now Restylane is the best injectable gel implant for use around the eyes (albeit off-label).  The results can last for a year or more.  I'd avoid Juvederm and Belotero. Fat grafting is another option that is safe when done by an expert but make sure your surgeon has extensive experience with fat grafting around the eyes (very different from fat grafting elsewhere).You may have some of the "accordion effect" causing a dark area under your eyes which filler can also help with. 

Thank you for your question and i am sorry that you are having such concerns with your eyes. With exams coming, this is something that will be a distraction. 
Firstly, in terms of the area of concern - this can be addressed with fillers that soften the hollowness. i do a number of these in my practice and have some very effective yet subtle results in patients with similar conditions. The key in my mind is where the filler is placed to help soften the hollowness. 
The discoloration is reduced slightly but this darkening is due in part to the hollowness and in part to the skin thickness above. When the skin is thinner, then the underlying muscle is seen and this makes the area look darker. 
Treatments here will include using effective eye serums to improve the skin quality and fillers to add volume to the area to reduce the hollowness. 
good luck with your exams 
Best wishes 
Rohit Seth
Plastic, reconstructive, aesthetic and hair transplant surgery.