How to fix my hollowed eyes and bags under eyes? (Photos)

Doctor Answers 9

The height of eye bags can cause hollowness to look deeper, but they can be treated to look completely natural

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Thank you for your question. You submitted several photos and ask about fixing hollow eyes and under eye bags. Your photos were taken in different environments, which are very helpful for me in guiding you in what I would do for someone like yourself in our practice.

A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I’ve been in practice in Manhattan and Long Island for over 20 years.  One of the most popular issues we provide solutions for is under eye bags and hollows. I’ll give you some understanding to the approaches based on the underlying cause, which appears from the photos is a large bulge of puffiness under your eyes, and right below it appears to be hollow.

You are dealing with lower eyelid fat prolapse, which means the fat pockets around the eyes pushed forward and created this large bulge under the eyes. Your eyes can look puffy and simultaneously hollow because of bone structure and the contrast between the puffiness causing an elevation, and hollowness right below looking like a valley.

The strategy that I generally recommend for a significant amount of puffiness is a more definitive surgical procedure called a transconjunctival blepharoplasty. This is a procedure where we go from the inside of the eyelid to address the fat pockets by reducing, sculpting, and repositioning the fat so they no longer prolapse forward. This eliminates a large amount of both the puffiness and the hollowness by contrast, and you get a more definitive, long-term benefit. This procedure is performed under local anesthesia with LITE™ sedation in our office operating facilities, which are certified by the Joint Commission for safety standards and personnel requirements so they are no different than any major hospital.

For people with lighter skin who’ve had sun exposure contributing to an aged appearance of the skin and discolorations, we’ll do a combination of the use of platelet-rich plasma (PRP) and a laser procedure. Platelet-rich plasma (PRP) is derived from your own blood and is a concentration of the healing and growth factors that help stimulate collagen and blood supply, and creates a foundation for healthier better-looking skin. A laser procedure improves the outer surface of the skin, the epidermis, and the dermis or the backbone of the skin so the skin is tighter, and has a smoother  fresher look because it’s new, fresh skin. When lasers are used in combination with platelet-rich plasma (PRP), it’s a very powerful benefit overall.

There are situations in our practice where people first want to try treating eye bags non-invasively. Non-invasively is a bit of a misnomer because they are referring to the use of fillers, which I use a lot of fillers in our practice to help people with under eye hollows and mild to moderate puffiness. The thing to understand is once you enter the skin, it is an invasive procedure. It is less of an issue compared to surgery because you just go to an exam room and have the filler placed, but you are still getting a local anesthetic, so it is a procedure. We use the most minimally invasive approach, such as blunt cannulas to minimize bruising and swelling, but filler placement in the hollow is something can consider as a first line treatment, or to confirm for yourself the benefit of a surgical procedure. Sometimes patients come to us who wanted to do the surgery in a few months, but have important events coming up they want to look good for, so we’ll do a filler as a bridge procedure. You do have different options, and sometimes the filler can be combined with platelet-rich plasma (PRP) for a synergistic benefit.

That said, based on you photos, I think surgery will be more definitive for you long-term. I recommend you meet with qualified, experienced cosmetic surgeons who do a lot of eyelid procedures, and have a lot of experience with both surgical and non-surgical solutions to help the under eye area. Once you are comfortable with the doctor, you may move forward and start helping yourself look your best. I hope that was helpful, I wish you the best of luck and thank you for your question.

This personalized video answer to your question is posted on RealSelf and on YouTube. To provide you with a personal and expert response, we use the image(s) you submitted on RealSelf in the video, but with respect to your privacy, we only show the body feature in question so you are not personally identifiable. If you prefer not to have your video question visible on YouTube, please contact us.


New York Oculoplastic Surgeon
4.4 out of 5 stars 80 reviews

"hollow" eyes and bags under eyes

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Dear Courtney,

It appears from your photos that you have fullness before lower eyelid fat pads pushing through the skin in the lower eyelid region.

This can happen with age or sometimes at birth. 

Options could include surgical removal or transposition of the lower eyelid fat pads for a more definitive correction.

Fillers can be used but often look unnatural in the lower eyelid region.

I hope this was helpful.

Adam Scheiner, MD
Tampa Oculoplastic Surgeon
4.4 out of 5 stars 39 reviews

Filler

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
I WOULD TRY FILLERS BEFORE GOING IN AND DOING SURGERY , THE DIFFERENCE BETWEEN FAT TRANSFER AND FILLERS ARE FILLER ARE LESS INVASIVE AND CAN LAST 6-9 MONTHS SOMETIMES UP TO A YEAR DEPENDING ON WHICH ONES. FAT TRANSFERS ARE USUALLY SURGICALLY DONE WITH LIPO AND TRANSFERRED TO ANOTHER AREA OF THE BODY. A FAT TRANSFER CAN ALSO BE DONE THROUGH A LOCAL AFTER SURGERY FOR A REPEAT FAT INJECTION. FAT INJECTIONS OR TRANSFERS ARE USUALLY MORE PERMANENT. THIS IS SOMETHING THAT YOU MAY WANT TO SPEAK TO YOUR DOCTOR ABOUT IN A CONSULTATION AND SEE WHAT YOUR OPTIONS ARE.

Elliot M. Heller, MD
New York Facial Plastic Surgeon
4.5 out of 5 stars 96 reviews

Hollowed eyes and bags under eyes

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Thank you for your question Courtney.  Based on the pictures provided, you would likely be an excellent candidate for lower eyelid blepharoplasty to remove the lower eyelid bulges.  The "hollow" area between the upper cheek and lower eyelid, such as the tear trough, may also be addressed using a hyalurinic acid dermal filler to "soften" the area resulting in a natural and smooth contour.  Good luck!

Paul Nazemi, MD
Newport Beach Oculoplastic Surgeon

Dark Circles, Eyelid Wrinkles/Bags Treatment -- Restylane or Belotero with Cannulas, Clear+Brilliant, Eclipse Micropen, Viva

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Circles can be treated with lasers, fillers, microneedling/PRP and skin care. Please see an expert.  Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 207 reviews

The current state of the art treatment for this is under eye fillers by an expert injector.

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Put you finger on top of your "bag".  What you are feeling is your bony orbital rim.  You do not have herniated orbital fat which is the stuff we operate on when we do lower eyelid surgery.  Trust me, we do not chip out the bone.  Problem is that many, many surgeons who should know better do not understand that fat is not the only thing that can look like a "bag".  When you are a hammer, the world looks like a nail.  For many years, under eye fillers will beautifully fill in this circle.  Treatment it very technique dependent and finding an expert injector can be challenging.  I know because I have patients who fly from London, New York, and Dubai to have this treatment with me and I assure you if they could find good treatment locally, they would not be flying to Los Angeles for my care.  Don't talk yourself into surgery.  I believe that will be a decision you regret.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Eyelid Surgery

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Thank you for your question. Eeyelid surgery is common for removing under-eye bags that can develop while fillers are suitable for increasing the volume in hollowed eyes. Please consult with a board certified facial plastic surgeon during an in-person appointment. Best wishes,

Ross A. Clevens, MD
Melbourne Facial Plastic Surgeon
4.7 out of 5 stars 124 reviews

How to fix my hollowed eyes and bags under eyes?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Hello CourtneyMcCann,There is naturally fat found around the eye.  In some patients, the membrane that holds them back is weaker than in others as a result of genetics or age.  This allows those bags to show through more.  This then accentuates the area below the bags, known as the tear trough, and makes it look deeper and more hollow.  There are several options to help.  The first option is simply using makeup to help camouflage the area.  With time, more is needed and it starts to cake.  The next option is to camouflage it.  The hollow below the bag draws more attention because of the shadow cast by the bag above.  By using fillers (I like Restylane) to elevate the tear trough, it softens the shadow and makes the bag less noticeable.  The third option is to go at the root cause of the bag.  This involves surgically removing the fat.  Based on your photos, I would imagine the approach through the pink part of the eye (called transconjunctival) would work for you.  This does not have any external incisions and can address the fat bags below the eye.I'd recommend you consult with a facial plastic surgeon to go over your options, learn the pros and cons, and determine which is right for you.I hope this helps and good luck.    

William Marshall Guy, MD
The Woodlands Facial Plastic Surgeon
5.0 out of 5 stars 31 reviews

Lower eyelid bags

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

From your pictures, it appears you have mild prominence of the lower eyelid fat compartments, which is what causes the lower eyelids to look a little full and "puffy." It appears the skin texture/tone of the lower eyelids is good. You may be a good candidate for a transconjunctival (incision from within the inside of the lower eyelid) blepharoplasty with removal of some of the prominent fat. This will result in a much smoother appearance of the lower eyelid. If you have some hollowing under the eyelids ("tear troughs"), this can be addressed at the time of surgery by re-positioning some fat into the area. This can also be managed post-operatively with hyaluronic acid fillers like Belotero and Restylane. 

Katherine Zamecki, MD, FACS
Danbury Oculoplastic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.