How to address genetically bagggy/hollow undereyes/mid face area? (Photos)

Question

I’m 27 years old and have always struggled with genetically bagggy/hollow undereyes. I’ve gotten dermal fillers since the age of 18 and recently got them dissolved a few days ago. I am looking for advice on procedures to address this area, and given my age, if I should stick with fillers again or move to surgery. I am getting a functional rhinoplasty soon and am also wondering how soon after the rhinoplasty I can address this area. Thank you

Michael A. Persky, MD · Answer

Hello P,
Your photos look like you still have the effect of filler.  I would recommend dissolving the filler completely and then re-evaluating your anatomy.  If you have bulging lower eyelid fat pads (which is unusal in young people) then I would recommend a fat transposition lower eyelid blepharolplasty.  I would not recommend any further standard hyaluronic acid filler treatments.  The only injection I would recommend under your eyes would be EZ gel which is 100% natural, made from your own blood, a combination of platelet rich fibrin (prf) and albumin.  Good luck with your rhinoplasty, happy,healthy New Year, and be well.  
Michael Persky, MD
Encino, CA

Nelson Lee Novick, MD · Answer

Since the upper cheeks are a major support for the undereyes, when there is volume deficit in this region, the inevitable result for the under-eyes are the development of hollows and tear troughs. The appropriate use of a robust HA volumizing filler properly injected for the cheeks  therefore, can not only establish a more desirable feminine Ogee Curve for the cheeks, but help to smooth the transition between the upper cheeks and the under-eyes, thereby diminishing the bags and hollows. You would be wise to make sure to consult with an experienced, board certified cosmetic dermatologist filler injection expert and best of luck.

Anna Chacon, MD, FAAD · Answer

Thank you for sharing your history so thoughtfully. Genetically hollow or “baggy” under-eyes are very common, and the fact that this has been present from a young age strongly suggests that anatomy—not aging alone—is the main driver here.

Since you recently had your tear trough filler dissolved, it’s important to allow the area to fully settle before making any next decisions. After dissolution, the skin can temporarily look thinner, looser, or more hollow than baseline. This does not mean permanent damage—it reflects inflammation, enzymatic effects, and the absence of volume your tissues had become accustomed to. This phase can last several weeks.

Fillers vs surgery at your age

At 27, surgery is not automatically the better option, even with long-standing hollowness.

Fillers can still be appropriate when used very conservatively and in the correct plane (deep, structural support rather than superficial filling). For genetically hollow under-eyes, the goal is subtle contour support—not chasing complete smoothness. Overfilling is what often leads to long-term issues like puffiness, discoloration, or dependency on repeat treatments.

Surgery (lower blepharoplasty) is generally reserved for cases with significant fat herniation, true skin laxity, or when fillers have repeatedly caused problems. In someone your age, surgery carries a higher risk of looking overcorrected or altering the natural shape of the eyes if done prematurely.

Many patients in your situation do best with a hybrid approach over time—periods without filler, then very minimal correction only if truly needed.

Other non-filler options to consider

Before jumping back into filler or surgery, there are treatments that can improve the appearance of the area without adding volume:

Energy-based skin tightening (radiofrequency or ultrasound) to improve skin quality and firmness

PRF/PRP to support skin thickness and vascular tone

Laser treatments (chosen carefully) to improve texture and pigmentation rather than volume

These won’t “fill” hollows, but they can make the area look healthier and less shadowed.

Timing with your upcoming rhinoplasty

It’s wise to separate facial procedures. After a functional rhinoplasty, swelling and lymphatic changes can affect the midface and under-eye area.

In general:

Allow at least 3 months after rhinoplasty before reassessing the under-eyes

Ideally wait 3–6 months before any filler or surgical intervention in that area so everything has stabilized and your facial balance is clear

This also gives your recently dissolved under-eye tissue time to fully recover.

The big picture

Your instincts are good—you’re right to pause and reassess rather than rushing back into filler. At your age, the priority is preserving natural anatomy, minimizing long-term risk, and choosing treatments that age well with you. Subtlety and timing matter far more than the specific procedure.

With patience and a measured approach, this area can absolutely be improved without sacrificing harmony or creating new problems down the line.

Citrus Aesthetics - San Diego · Answer

Genetically baggy or hollow under-eyes are very common, and at 27, the goal should be support, not replacement. This is exactly where a multi-modality approach becomes so important.
First, it’s great that you dissolved previous filler. That gives the tissue a clean baseline and allows a provider to reassess what’s truly anatomy versus product. In many young patients, under-eye concerns are not just about volume loss, they’re often a combination of genetics, midface structure, skin quality, lymphatic drainage, and light shadowing.
In most cases at your age, surgery is not the first step unless there is a significant structural fat pad issue that cannot be addressed conservatively. Instead, I typically recommend a thoughtful, staged plan that may include:
Midface support first: Strategically supporting the midface (cheek) can often soften the appearance of under-eye hollows without placing filler directly in the tear trough, which reduces long-term risk.
Very conservative filler use (if appropriate): If filler is reintroduced, it should be minimal, placed deeply, and only after the surrounding anatomy is supported. Under-eye filler is not something that should be repeated frequently or layered over time.
Skin-focused treatments: Laser, radiofrequency, or regenerative treatments can improve skin thickness, texture, and color, which often plays a larger role than volume alone.
Lifestyle and anatomy review: Allergies, sinus issues, sleep, and facial muscle dynamics all matter and are often overlooked.
Because you’re undergoing a functional rhinoplasty, I would strongly recommend waiting until you are fully healed before treating the under-eye or midface area. Swelling, fluid shifts, and facial balance change after nasal surgery, and treating too soon can lead to overcorrection or misjudgment. Most providers recommend waiting at least 3–6 months, depending on your healing and your surgeon’s guidance.
The most important takeaway: this area should never be treated with a one-size-fits-all solution. A conservative, multi-modality plan, guided by an experienced, anatomy-focused provider, will always give you the most natural and safest long-term outcome.
Aesthetic treatments should always be discussed with and performed by a trained, licensed, and medically certified aesthetic provider. The recommendations above are for educational purposes only and do not replace an in-person consultation, examination, or personalized medical advice.

Vikram Mookerjee, MD · Answer

There are multiple anatomic factors that can contribute to eye bags and a hollow midface. These include the orbital vector (projection of the eyeball relative to the facial bones), the presence and size of lower eyelid fat bags, weakening of the lower eyelid septum that can cause fat bags to appear more prominent, and a lack of bony prominence of the midface facial bones. 
A treatment plan may involve a combination of procedures to address each of these factors. The projection of the eyeball cannot be changed, but lower eyelid fat bags can be reduced or repositioned, and the projection of the midface facial bones can be augmented to reduce hollowness. Augmentation of this area can be performed with fillers, fat grafts, or implants. 
You should consult with your local plastic surgeon to understand what option may be best for you. In addition, your rhinoplasty surgeon can counsel you on how soon after your rhinoplasty surgery would be safe to undergo any procedures to the lower eyelid and midface. Best of luck and I hope you find this information to be helpful.

How to address genetically bagggy/hollow undereyes/mid face area? (Photos)

Answers (5)

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