Hollowness- how to correct? (Photo)

Question

40F, I have this hollowness (not exactly under my eyes, but above nose) which makes me look tired and old. Looks worse when I smile. How do I correct this? Thanks

Anna Chacon, MD, FAAD · Answer

Hi there,

Thank you for sharing your photo and concern — what you’re describing is quite common and completely understandable. The hollowness between the eyes and upper nose area, often called the nasojugal groove or upper tear trough, can create a tired or aged appearance, especially when smiling or under certain lighting.

Here’s why this happens:
As we age, we gradually lose volume in the midface — particularly around the cheeks, under-eye area, and upper nasal bridge. The skin also becomes thinner, and the underlying fat pads shift downward, making these hollows more pronounced. Genetics, sun exposure, and natural facial structure can also play a role.

Ways to correct or improve the appearance:

Hyaluronic acid fillers: Expertly placed fillers in the tear trough or upper cheek can restore smoothness and support, softening the hollow appearance. This is the most effective and immediate option when performed conservatively by an experienced injector.

Collagen-stimulating treatments: Biostimulators like Sculptra or Radiesse help gradually rebuild collagen, offering a more natural and long-term improvement.

Skin tightening procedures: Radiofrequency or ultrasound-based devices (like Thermage or Ultherapy) can lift the midface area slightly, reducing shadowing.

Topical care: Using eye creams with peptides, hyaluronic acid, and retinol can help improve skin texture and elasticity, though these won’t replace lost volume.

You’re noticing a very common area of midface volume loss that can be beautifully and safely corrected with the right approach — subtle treatments often make a big difference in restoring a refreshed and natural look.

Monika Kiripolsky, MD · Answer

Hi Jasmine,
You can disguise that by restoring volume (stratigically!) to other areas of your cheek/tear trough that have lost volume. But, that particular area above the sides of your nostrils is a “danger zone”, meaning that there are some major blood vessels there that you don’t want to compromise by putting filler directly into those areas you are pointing to. 
Laser resurfacing can also tighten all of the skin on your face & make those depressions appear less prominent. 
Please see only an MD, preferably a board-certified dermatologist or plastic surgeon for the filler & laser, though, as this correction can go horribly wrong if not performed by someone with an incredible knowledge of anatomy and lots of experience with proper filler selection & placement. 
Hope this helps!
Dr. Kiripolsky

Nelson Lee Novick, MD · Answer

In my experience, this kind of problem is not uncommon. I have had gratitying results using a low viscosity, cohesive, malleable HA filler to elevate and smooth the depression and create a smooth transition between the upper cheek and under-eye regions. This is an advanced injection technique that should not be left to the hands of a novice injector accustomed to using only plain Juvederm or ordinary Restylane for treating smile lines. You would be wise to consult with an experienced, board certified cosmetic dermatologist filler injector. Hope this helps and best of luck.

Michael A. Persky, MD · Answer

Hi Jasmine,
I would recommend an in person examination and then would likely treat you with foundational Sculptra to correct the hollowness.  Feel free to contact my office to schedule either a virtual or in person consultation for further guidance.  The most important aspect of your treatment is to make sure that you choose your expert injecting physician carefully.  Good luck and be well.
Michael A. Persky  MD

Camille Cash, MD · Answer

Dermal fillers can help to improve hollow areas and enhance contours.  You can also consider adding Morpheus8.  This treatment combines RF technology with microneedling to improve overall skin tone and texture.  I've included a video I hope you find helpful.

Eeshara Vithana, MBBS, MSc, MD · Answer

HiFiller would be a good solution for this I use canula to perform this treatment as it is a risk area

Hollowness- how to correct? (Photo)

Answers (6)

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