Hollow eyes - what are the best treatment options? (Photo)

Question

Hi! I have these slight indents under my eyes. I was told that retinol and caffeine can work to improve the look but I was wondering what other treatments can I get results from to smooth out these lines. I don't want to do under eye filler.

Anna Chacon, MD, FAAD · Answer

Those slight indents under the eyes are often related to the tear trough, where the natural transition between the lower eyelid and cheek creates a shadow. Genetics, skin thickness, collagen loss, and changes in facial volume can all make this area more noticeable.

Retinol can help over time by improving collagen production and skin texture, while caffeine may temporarily reduce puffiness and make the area look a little smoother. However, neither will actually replace lost volume, so the improvement may be limited if the indentation is primarily structural.

Since you don't want under-eye filler, there are several other options to consider:

RF microneedling: Can stimulate collagen and tighten the skin, which may soften fine lines and improve the overall texture of the under-eye area.
Fractional laser resurfacing: Depending on your skin type and the specific laser used, this can improve fine lines, texture, and collagen production. It needs to be performed carefully around the eyes.
PRP/PRF: These treatments use your own blood-derived growth factors and may gradually improve skin thickness and texture. Results tend to be subtle and develop over several treatments.
Collagen-stimulating injectables: Certain biostimulatory treatments can improve skin quality and support collagen production without directly filling the tear trough. These require careful product selection and placement around the eyes.
Lower eyelid surgery (blepharoplasty): If there is significant hollowing, fat displacement, or skin laxity, a surgical approach can address the underlying anatomy rather than simply adding volume.

One important point is that under-eye “lines” and hollowness aren't always the same thing. If the indentation is caused primarily by the natural anatomy of the tear trough, topical products can improve the quality of the skin, but they generally won't completely eliminate the hollow itself.

Also, I would avoid aggressively applying strong retinoids directly too close to the lash line because the skin in this area is very thin and easily irritated. A gentle formulation used carefully can be a better approach.

Nelson Lee Novick, MD · Answer

The use of retinol (hardly the most effective retinoid) and caffeine products may be of value for under-eye dark circles, but really can do little for under-eye hollows, which result from volume loss. Since the upper cheeks are a major support for the under-eyes, often the proper injection of a robust HA volumizing filler for the upper cheek can secondarily improve the hollowness under the eyes. In experienced hands, this should take no more than about ten minutes to perform and the results are immediate.  If necessary, there are now a number of HA fillers that are approved for use directly under the eyes for this purpose. Since this is not an area to be left to the hands of novice, inexperienced injectors accustomed to injecting simple Restylane or plain Juvederm for smile folds, you would be wise to make sure to consult an experienced, board certified cosmetic dermatologist filler expert. Hope this helps and best of luck.

Camille Cash, MD · Answer

An in person consultation is recommended.  You may be a candidate for Morpheus8.  This treatment combines RF technology with microneedling to improve overall skin tone and texture.  Three treatment sessions are recommended for optimal results.  We also recommend using medical grade skin care products like Transform MD and wearing sunscreen every day.  You can find out more by visiting my website or a provider near you.

Hollow eyes - what are the best treatment options? (Photo)

Answers (3)

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