Hollow under eyes at 21 - what treatment options will help? (Photos)

You would be a candidate for lower lid surgery with volume replacement (fat grafting). Best to see an eyelid specialist.

It's hard to tell from these angles but it's possible you have a retrusive maxilla. You could consider advancement surgery for that if it's something that really bothers you. Otherwise, volume (filler vs fat).

Relax. At least from the photos provided, the use of an appropriate, robust HA volumizing filler properly injected can typically yield immediate results and engender little to no significant downtime. The upper cheeks are a major support for the under-eye region. Hence, the layering of a robust HA filler in that region can restore a smooth transition between the upper cheeks and lower eyelids, I.e. elevating the hollow and smoothing the transition to the under-eyes. In experienced hands, treatment should take no more than ten to fifteen minutes. You would be wise to consult with an experienced, board certified cosmetic dermatologist filler injection expert. Best of luck.

Based on these images it appears that you have a mild malar hypoplasia, small cheek bones, which is the reason your condition started very early. Augmentation of cheek bones with implants or fat grafting as well as transconjuctival lower blepharoplasty are good options for improvement. Good luck.

Under eye hollows can be genetic or age related, but there are solutions. A common approach is injection a hyaluronic acid filler to add volume. This lasts 6-9 months. There can be bruising after the injections, so I recommend finding an experienced injector that uses cannulas instead of needles. Some products can lead to a bluish discoloration under the skin, but we have a lot of success with Restylane in that area.

If you want something more natural, you can have far grafting, which involves using liposuction to remove a small amount of fat from the abdomen, hips, or thighs and transferring it under the eyes. That is a fairly permanent solution. There is also PRP (platelet rich plasma), which involves drawing blood, spinning it down in a centrifuge, and then injecting it. This doesn’t provide as much volume, and it’s temporary, but it has very few risks or side effects and could give you an idea if you like the look of more volume in that area. There is also a commercially available product called PDGF which is a lab version of the PRP that’s even more concentrated with growth factors that can add volume to the area.

The appearance will get worse as you age, so eventually under eye surgery could be indicated in your 50s or 60s as under eye bags accentuate the hollow underneath, but there are plenty of options before then. Best wishes.

Midface volume restoration or enhancement can be done multiple ways.
Treatments include volume augmentation with fillers comma fat transfer using implants or a mid face lift.
The primary etiology is lack of projection of your maxilla which isn't giving sufficient support for the soft tissues.
Each of the above treatment options has advantages and disadvantages.
I suggest having a few in-person consultations with plastic surgeons in your community.
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 who had similar facial characteristics for whatever procedure they are recommending.
Bring pictures of yourself to use as reference during the consultation.This is really helpful when reviewing before and after pictures.
You may need to consult with several providers before you find the right surgeon to be working with.Of the treatments listed my recommendation would be fillers or a mid-faced lift. Fillers are ideal but finding a provider who has this sufficient skill and experience may be challenging.
I noticed you live in San Francisco. Consider checking the website of Dr David Mabrie MD in SF. His practice is devoted exclusively to injecting fillers. David's work with facial volume enhancement using fillers is the best I've ever seen. His website has an impressive collection of good before and after pictures of his work.
Good luck,
Mats Hagstrom MD