What options are available for hollow, sunken eyes? (Photo)

Question

I am a 39 man who in the last ten years has experienced rather severe hollowing of my eyes. I am not underweight (or overweight) and do not know what has caused this issue. I am wondering what my options are, surgical and non-surgical, to improve this problem. Thank you.

Mansher Singh, MD, FACS · Answer

Hey It's hard to tell from the pictures but facial fat transfer would be a good option for hollowness in your under eyes or cheek area. You should get a virtual or in person consult with a plastic surgeon who does these procedures on a regular basis

William Portuese, MD · Answer

More information is needed, such as any surgical history for a blepharoplasty or eyebrow lift. Fat grafting may be of some benefit to give more fullness to your upper lids.

Mats Hagstrom, MD (license on probation) · Answer

Entire text books have been written, addressing the question you pose.
The answer to your question is not simple and opinions will vary substantially depending on who you ask.
There are excellent surgical and non-surgical approaches they can give both satisfactory and unsatisfactory outcomes.
One of the best ways to treat facial volume, depletion is with the use of fillers. While the treatment is temporary, the treatment has many strong advantages. Perhaps the greatest advantage of using fillers is when results don’t turn out the way you had hoped. Using temporary treatment options allows you to go back to page one and start over. If the results have room for improvement and this can be addressed during follow up treatments. This allows both patient and providers to fine-tune treatments until quality outcomes have been achieved, including the ability to change providers and start over.
A popular alternative is the use of fat transfer or fat grafting. Fat grafting is not an equivalent, long-term solution to the use of fillers. The treatment is inherently different, and while there are advantages to the permanence of fat grafting, there are also major disadvantages that need to be taken into consideration.
Eyelid surgery can also be considered generally referred to as blepharoplasty. This can include the upper, lower, or both upper and lower eyelids. With a proper assessment, the eyebrow position should be addressed as well. For some individuals brow lift can be an appropriate treatment.
For volume restoration alone I suggest you consider checking out the webpage of Dr. David Mabrie in San Francisco. I like to use his website as a reference point of what can be achieved using Fillers alone. In my opinion, Dr. Mabrie represents the gold standard in what can be achieved with this non-surgical treatment option.
Facial aging is complex, and a quality assessment should be fairly comprehensive. One part of the face typically does not age alone. Some of the best providers in surgical aesthetics take them more overall view a facial aging generally assessing the entire face rather than its separate components. A combination of less dramatic treatments covering a range of different signs of aging can give very dramatic results without being overly done.
My best suggestion is to get the most comprehensive assessment possible, including all treatment options for your entire face. From there on, you can make decisions regarding treatment options that coincide with what you’re willing to go through, what you’re trying to achieve for your individual needs.
The approach to this type of work requires respecting the individual since people vary in what they’re hoping to achieve and what they’re willing to go through in regards to having procedures, financial expenses, etc. etc.
What works for one person may not be appropriate for another despite having similar underlying issues.
More than anything I want to emphasize that the approach, including outcomes of this type of work varies, quite dramatically from provider to provider, despite possibly having similar credentials.
In the end, the two most important variables are understanding your own candidacy for any particular treatment option, and secondly, finding the right provider. There isn’t all that much patients can do regarding their own candidacy, but what they do have control over is provider selection.
I recommend patient schedule more consultations and they may feel necessary. The best way to find the right provider as many in person consultations as possible. With is increased permanence calms increased importance of provider selection.
During each consultation, ask each provider to open up their portfolio and show you their entire collection of before, and after pictures of previous patients with similar characteristics to your own(especially true for surgical intervention). An experienced provider should have no difficulty showing you the before, and after pictures of at least 50 previous patients. Being shown a handful of pre-selected images, representing the best results of a providers career is insufficient to get a clear understanding of an average results look like in the hands of each provider. For non-surgical options provider selection has great depth in regards to background training. Rules and regulations regarding who can and cannot do cosmetic medical treatments vary from state to state.
Insisting on board certification in plastic surgery, facial plastic surgery, or ocular plastic surgery may or may not be recommended. Being board-certified in plastic surgery is certainly no guarantee of competence or skill it does means somebody has gone through quite rigorous training.
Whenever you present a question in an area that is inherently complex, you should expect to get some different opinions. Simplistic problems typically have more monolithic solutions.
Facial aesthetics, including understanding the aging process is inherently complex in mastering this type of work requires a lifetime commitment.
In the hands of the best providers results can be truly stunning and life-changing. Without careful selection process results can unfortunately be devastating and regretful. 
When in doubt, slow down and schedule more consultations. Focus your efforts and understanding your candidacy for various procedures and provider selection. 
Good luck,
Mats Hagstrom, MD

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