Best Treatment for Hollowing and Herniation of the Lower Lid Fat Compartments?

When some fat compartments in the lower lid have atrophied with age, but other compartments remain and therefore appear herniated, what is the best surgical or non-surgical treatment to address this? Remove the herniated portion or tighten the lid? Is it wiser to seek an experienced eyelid injector that can add filler to hollow areas to "level out the playing field" instead? (if filler in this part of the orbit is even an option at all). Sorry for so many questions!

Doctor Answers 6

Best Treatment for Hollowed Lower Lids

The answer is yes, but by using new approaches such as fat transposition, micro-fat transfer, mid-face or cheek lift techniques, and use of fillers. . Make sure you select your plastic surgeon wisely, one that is well trained and experienced in these techniques.


Orange County Plastic Surgeon
4.9 out of 5 stars 157 reviews

Lower Eyelid Aging Options

As we age, the tissues around the lower eyelid move downward. This frequently causes the orbital rim to become uncovered. With significant fat in the medial fat compartment, this may not be as noticeable. The lateral fat pocket, however, will generally become well demarcated and visible. The best way to correct this is with a full Blepharoplasty where the medial and lateral fat is rolled over the orbital rim and the muscle and skin are tightened. A filler or fat injection by someone very experienced in this is another option. While it may not be a permanent solution, it, certainly, can be a temporizing one. See a Plastic surgeon experienced with eyelid rejuvenation and discuss your options.

Robert T. Buchanan, MD
Highlands Plastic Surgeon
5.0 out of 5 stars 6 reviews

Best Options for Eyelid Hollowing and Eyelid Fat Herniation

Dear Jane A-

In general, eyelid hollowing is best adressed by some type of filler.  The filler can be from a syringe, or your own fat, or ever repositioning of the structures under the eyelid, but the best option would be what your inidividual face would look best with.

Regarding eyelid fat herniation, typically you will want to have just the excess fat that's bulging out removed.  That can be done with some type of blepharoplasty- eyelid lift surgery.

Of course, photos would be helpful to give you more specific advice, but the best way to figure out your best strategy is to have a consultation with a plastic surgeon. 


Best Wishes,


Roy Kim, MD
San Francisco Plastic Surgeon
4.2 out of 5 stars 6 reviews

Lower lid irregularities

You have so many appropriate questions because there are so many anatomical irregularities as you describe. Each anatomical entity has to be addressed individually and then the whole procedure "packaged" so that it fits anatomically and physiologically. In essence, every patients requires this analysis that will lead to a customized "best-fit" solution.

Robin T.W. Yuan, M. D.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 11 reviews

Fillers vs. blepharoplasty for aging eyes.

I would need to see photos to properly answer your question.  In general, we do a blepharoplasty and tighten the skin, rmove the excess skin and fat, and place the excess fat in the hollow and suture it in place. Juviderm may be an alternative.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 34 reviews

Lower Eyelid Blepharoplasty

You may want to approach the situation with a transconjunctival removal of the protruding fat pads of the lower eyelid, with an additional skin pinch removal of skin just below the eyelashes.  In addition, I would also recommend that you have either a hyaluronic acid filler (Restylane) or fat injections done to the hollows below the eyelids (tear trough region).  This way you improve the eyelid contour without creating or exacerbating the hollow appearance.

Jenifer L. Henderson, MD
Silverdale Facial Plastic Surgeon
5.0 out of 5 stars 13 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.