What's the best treatment for under eye hollows without using a filler? (photo)

Under-eye hollows are indeed
due in part to a lack of fat, and also to the muscle surrounding the eye (responsible
for closing the eye or squinting) attaching to the bone with no intervening
tissue. Fillers can run the risk of unevenness or irregularities. Fat grafting
can often yield very nice results but must be done very carefully to ensure the
fat does not resorb, and any overcorrection can be very hard to deal with. It
is best to carefully inquire about your surgeon's experience.

A lower lid blepharoplasty
(eye lift) can surgically release the muscle from the bone. If there is enough
fat, it can be rearranged, but in your case adding some fat under direct vision
during the blepharoplasty could be very beneficial. You need to see your
surgeon to discuss these issues. Best wishes.

Fillers would certainly be an option for your under-eye region. It needs to be done by someone who really is a highly specialized expert in the area to get a good result and avoid complication.The other option would be to have fat grafting performed in the same region for a more permanent result.

At home peels like cosmelan, enlighten and aerify along with dermarolling (MTS roller with anteage MD ampules) should be started now. There are many things you can do to treat under eye hollows and dark circles. A surgical option to remove skin and/or fat will such as lower eyelid blepharoplasty with or without fat pad repositioning will be the best long term. There are many things you can do to treat under eye hollows and dark circles without surgery. Non invasive less downtime options such as fillers (Belotero, Juvederm Volbella​), lasers (Moxi/Halo/Fraxel/CO2​), Renuvion (J-Plasma), microneedling/PRP, stem cells and microneedling RF like Fractora PiXel8 or Morpheus can all help give some improvement. Accutite can often be used or stronger lasers like erbium or co2 spot treatment can tighten the skin and give very quick improvement in wrinkles and texture. A surgical option to remove skin and/or fat might be the best solution long-term. I suggest you get a formal consultation to see what is best for you and your goals. Best, Dr. Emer.

Thank you for sharing your photos. Relative hollowing below your eyes, although often associated with ageing or tiredness, can often be seen in younger people as a result of genetics. Anatomically a flatter cheek can result in hollowing below the eyes and this can be treated by adding volume, this can be achieved both non-surgically and surgically. With non-surgical treatments, a filler (hyaluronic acid) can be added to this area to improve the appearance, particularly if the changes are relatively mild. Filler treatments to the lower eyelid are more challenging than adding fillers elsewhere in the face, and not all practionners are comfortable treating this area. Care is required in the technique to add fillers to your lower eyelid as some serious risks can occur if due care is not taken with the filler choice or technique. With surgery, more can be achieved, the lower eyelid area is treated with lower blepharoplasty (fat preservation or fat transposition technique in medical jargon) and the addition of volume such as fat transfer. In my experience, the lower eyelid is an intricate area and your specific characteristics need an assessment in person to identify the most suitable treatment for you, to give the most natural looking results. Fillers are temporary, but blepharoplasty offers a long-term solution, however the recovery is longer. By visiting a facial cosmetic and plastic surgeon that specializes in blepharoplasty, you will gain a better understanding of the ideal aesthetic outcome from surgery.

When there is your own eye fat bags present, the best treatment would transconjunctival lower blepharoplasty with repositioning of the fat bags to the hollow area to give long lasting improvement.

Great question. I disagree with your nurse. I think fillers can help. That being said fat is even a better grafting material. In my hands the best results are with a combination of lower lid blepharoplasty with fat transposition and fat grafting.

I also like laser for this problem but the results are modest. To make most patients and myself completely happy with the results, a combination of procedures is often required. I have done fat and laser only on patients adverse to surgery. The results are good. You volumize with the fat and then tighten the skin with the laser. Depends on age, skin type and exam to see whether or not you have prominent fat pads etc. 

Hope this helps.

Best of luck,

DrC

It's not unusual for patients with tear trough deformities to request plastic surgical consultation. When this situation arises, a variety of treatment options exist to treat this condition. These include surgical procedures that release the arcus marginalis and reposition fat, fat injections and hyaluronic acid filler injections. Each of these approaches offers advantages and disadvantages.It's extremely important to individualize the treatment of tear troughs. For this reason, the specific procedure chosen will depend upon the patients anatomic findings and aesthetic goals. It's note worthy that your pictures demonstrate the presence of fat pads.It's important to realize that lower eyelid filler injections are very effective for treating tear trough deformities, but don't provide a permanent solution to this problem. When a permanent solution is desired, fat injections may be an acceptable alternative.In someone like yourself with prominent fat pads, arcus marginalis release with fat re-positioning is probably the best treatment option. The procedure is associated with excellent clinical results.It's important for patients with tear trough deformities to consult a board certified plastic surgeon with experience in this area. This surgeon should be able to formulate a treatment plan that addresses your anatomic findings and achieves your aesthetic goals.

One must carefully assess patients when dealing with the
under-eye area. With light-skinned or thin-skinned patients, certain
hyaluronic fillers can show through and appear as a silvery-blue color, which
is why it is extremely important to be conservative in one’s approach.
Other fillers can cause lumps and bumps if not administered carefully by
qualified and skilled injectors. However, if the patient is properly
assessed and the proper filler or autologous fat (one’s own fat) used, the
results can be natural, understated, and attractive.

You do have some prolapsed fat, so you will notice the hollowing in the tear trough just below this.  If you fill in the tear trough with some hyaluronic acid, you should be able to improve the contour and color in this area. 

I do not see any reason why you could not have a filler used to help with the hollowness under your eyes.  You appear to have a bit of protruding fat causing a bit of bagginess.  This could be improved surgically with lower blepharoplasty but a filler can also help when injected below the bags.  If you had the filler done, I would recommend one of the hyaluronic acid products.