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

I recently got a filler done in the lips and asked if I would be a suitable candidate for any under the eye. The nurse told me because of my high cheekbones I wouldn't be a good candidate for this procedure, she also said my hollows were due to a lack of fat under the eyes. Is there a good alternative? I've heard of non invasive laser therapy and under eye lifts as potential procedures, though I'm not sure of their safety/reputability as it's hard to find much information on them.

Doctor Answers 14

Lower Eyelid Dark Hollows

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In most cases the  lack of volume in you lower eyelid  can be compensated  by filling it in with hyaluronic acid gels like Restylane or Belotero( not Juvederm-which causes too much swelling).If you want to see if this procedure can make a real difference ask the Physician to inject sterile saline in to the dark hollow. The saline will dissipate without harming you and you will be able to visualize the result of a future injection of Restylane or Belotero.Both of these products can be easily be reversed with an enzyme if you do not like the result.In contrast fat grafting has the potential to form granulomas and nodules that may be easily seen therefore I do not advocate for fat grafts in this particular location.Fat cannot be easily reversed. I agree with other commenters that lasers will not remedy the problem/ 

Ridgewood Oculoplastic Surgeon

Fat grafting or Belotero not laser treatments are best for under eye hollows

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Thank you for your question and photographs. Personally I do not use fillers to correct depressions beneath the eye lid. From your photographs it appears that you have some excess fat causing puffiness which creates a shadow beneath the eyelid. In my experience a blepharoplasty procedure called arcus marginalis release with fat grafting is the most successful permanent solution. Fillers can be used but only if done by an expert eyelid surgeon and only if Restylane or Beletero is used.

Choose your Dr. very carefully and insist on seeing a board certified plastic surgeon or oculoplastic surgeon. I have seen many patients who had filler injections beneath the eyelid who had visible gray lumps and were very unhappy with the results.

TearTrough Deformity Management

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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.

Fat Grafting or Blepharoplasty May Help

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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.

What is the best treatment for under eye hollows without using a filler?

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 The photographs demonstrate herniated fat and lower lids creating the puffy look. It is best to seek evaluation by a physician, not a nurse for any surgical treatments on the lower lids. A trans conjunctival approach lower blepharoplasty can accomplish removal of those fat pads creating the puffy look and getting rid of the double bubble appearance. For many examples, please see the link and the video below

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

Filler for under eye hollowing

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Filler is the best treatment for under eye hollowing and from your photos I feel that you are a good candidate. Common fillers used under the eye include Restylane and Belotero. Volbella is a new filler on the market and I have had excellent results using it for the lower and upper lids.

Jeffrey M. Joseph, MD
Newport Beach Oculoplastic Surgeon
5.0 out of 5 stars 17 reviews

Laser, Fat or blepharoplasty

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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,


Benjamin Caughlin, MD
Chicago Facial Plastic Surgeon
5.0 out of 5 stars 13 reviews

Fat Grafting for under eye hollows

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Thank you for your photos. I would need more photos to determine whether or not you would be an ideal for fat grafting under the eyes. But, fat grafting under the eyes, when performed by a very well trained plastic surgeon with expertise in fat grafting can provide a beautiful, smooth and natural looking result. Be sure to view many, many photos and carefully check the credentials of a plastic surgeon

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 123 reviews

Best Way to Deal with Eye Hollows

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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.

Options for under eye hollows

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Hi there,
You should see a surgeon who has experience in both eyelid surgery and filler treatments to the eyelid/cheek area in order to determine what options are best fit for you. Cosmetic eyelid surgery (blepharoplasty) can help remove under eye bags by either removal and/or repositioning of the the excess fat pockets. Filers to the eyelid/cheek can help improve the under eye hollows and dark circles. Both are options that can provide excellent results in the correctly selected patient.  Good luck.  

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.