Treatment for Sunken Areas Around Eyes and Nose?

I have sunken eyes, especially on the inset of my nose. I have had my "tear troughs" filled with Restylane, but I still get asked if I have a black eye! I have consulted with a plastic surgeon about this and she said that if I were to get filler in that area, that I risk blocking my tear ducts. Any advice? What other treatments would you recommend?

Doctor Answers 10

Arcus marginalis release and fat grafting can correct sunken or hollow eyes

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A specific operation called a transconjunctival arcus marginalis release and composite fat grafting can be done through a tiny laser incision on the inside of your lower eyelid to correct dark circles, and the sunken or hollow eye look.

Do not have fillers or fat injections into the eyelid area--permanent lumps and discoloration as well as eye injury can occur.

In the procedure I am discussing, a whole piece of fat is surgically transplanted into the proper position under direct vision.

Tear trough implants for sunken eyes

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There are tear trough implants that are specifically made to improve and augment that area of the cheek. They are inserted through underneath the upper lip and placed over the cheekbone to try to fill in the area of the tear troughs when fillers have failed. They are also totally removable in case patients do not like them.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 157 reviews

Treatment of black areas underneath the eyes

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If you're tried fillers and they haven't worked out for you, implants may be a good option. These are usually made of silicone or plastic and are placed via incisions in the lower eyelid skin. They are permanent, so make sure it's something that you really want to do. In the meantime, however, you may need more that the usual amount of filler to get the results that you want. Good luck!

Restylane for sunken eyes

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Soft tissue fillers such as Restylane and Juvederm, when placed appropriately, can make a huge difference in the under eye area. I agree with the other physicians that this should only be done by a very experienced injector as risks such as lumpiness of the product, overfilling, pigmentation concerns, or rarely blindness have occurred. I prefer these hyaluronic acid fillers in this area because if the result is not satisfactory it can usually be removed quite easily through the use of an injection of hyaluronidase.

If there is significant darkness under the eyes then other causes should also be sought - i.e. is it blood vessel related from allergies for example? A pulsed dye laser may be a consideration in this area if the darkness is more vascular or lightening agents may be used for true pigmentation.

Good luck.

Jason R. Lupton, MD
San Diego Dermatologic Surgeon

Under eye Restylane-No question about it.

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Dear Black Eyes

I was just quoted in the September Harpers Bazaar regarding the use of Restylane to fill the under eye circles. I told them that there is almost no reason to do lower eyelid surgery. Even if you do have a little fullness from lower eyelid fat, the circles can be filled in until the areas are smoothed. The average patient needs more than 1 ml of Restylane under each eye. Recognize that the skin is thin here and placing filler in this area is an advanced technique.

It is not true that treating this area with filler with Restylane will affect your tearing mechanism. This is just your Plastic Surgeon's way of saying "I have no idea how to accomplish what you are asking (and I want you to do surgery anyway)." Don't make someone do something they are not comfortable doing. My advice is to look at the liquidfacelift website for a highly qualified injector in your area who does these treatments. However, please recognize that not only is this an advance technique but it also is a bit of an art form.

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

Tear trough injections

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Tear trough injections using fillers can improve the sunken appearance.  This has to be done very carefully because lumps can develop from over injection. Even blindness has been reported.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Sunken Eyes around Nose

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You can get a filler that builds up your own collagen such as Sculptra. Make sure the dilution is correct.

The tear duct injection would happen by wrong placement of the material.


Tanveer Janjua, MD
Bedminster Facial Plastic Surgeon
5.0 out of 5 stars 126 reviews

Fillers or Surgery

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There are several things to consider when treating the under eye or tear trough area. If there is a definite hollowing then filling it with restylane, juvederm or radiesse is a great option. An evaluation to see if you have any extra fat pushing through the lower eyelid that is creating or worsening this depression should also be considered because it may require some surgery to remove the bulge that is creating the deeper trough. If surgery is indicated then often times the extra fat can be moved into the deep trough and used to treat both issues.

Darkness could either be genetic, thin skin or extra blood vessels or could be worsened by the hyaluronic acid filler being placed too superficially. Vessels, can often be lasered using a pulsed dye laser, filler will fade or can be removed using an enzyme. Genetics and thin skin are tough and usually make up to cover gives the best result.

Edgar Franklin Fincher, MD, PhD
Beverly Hills Dermatologic Surgeon

Fillers and surgery

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You should be carefull with filler injection around the eyes. The skin is very thin in this area and it is easy to create a hyperpigmentation. For the tear trough,the injection need to be deep with 0.3 to 0.5cc of a hyaluronic acid filler. Surgery remains the best option for significant eye lid bags or deformity.

Hisham Seify, MD, PhD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 19 reviews

Treatment for sunken eyes

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Treatment of dark circles of the lower eyelids is difficult. There is no predictability in the results for coloration. Sunken eyes often look darker and fillers in the tear trough may help. If the Restylane is placed under the muscle the cosmetic result may be better than if it is placed above the muscle because sometimes the filler can cause a bluish tint if it is seen under the thin skin. Laser resurfacing may help induce more collagen production and the dermis may become slightly thicker thereby decreasing the darker color that is seen from the underlying tissues. Some advocate the use of different creams that may help diminish the dark color. One of these creams uses vitamin K, such as Illume. A few patients see improvement and others do not. Fat transposition can be done by a surgeon to help fill the area.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 39 reviews

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.