What Are Best Treatment Options for Under Eye Hollowed Areas and Dark Circles?

I had under eye blepharoplasty years ago wherein the surgeon removed all fat compartments. I now have sunken troughs and dark circles. Your expert advice is appreciated. Also, if you could provide doctors names that would be great.

Doctor Answers 7

Fat Grafting for hollow eyes - Look at Photos for evidence

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Many of my eye area structural fat grafting patients have come to my practice for the correction of hollowness created by the over-zealous removal of fat during an upper amd / or lower  blepharoplasty surgery. I am continually amazed at how many cosmetic surgeons practice 1970's-era blepharoplasty surgery in the 21st century. I almost never remove upper lid fat during blepharoplasty surgery, and in many cases I actually add fat at the brow-upper lid junction. Fortunately, essentially all cases of post-blepharoplasty hollowness can be improved dramatically by structural fat grafting. It is a more challenging procedure, as scar tissue must be overcome to create space for the grafted fat, and in many cases it takes more than one fat grafting procedure to restore adequate fullness in these patients.

Lower lid hollowness following an overly aggressive lower blepharoplasty can likewise be improved. One must exercise care and caution, as lower lid skin and the underlying soft tissues are usually quite thin, and thus the lower lids are less able to conceal grafted fat. Fat grafting must be preformed conservatively here, with a plan for secondary and occasionally tertiary fat grafting procedures depending on the 'take' of the initial fat grafting surgery.

Many patients referred to me for treatment of these frustrating and difficult post-blepharoplasty problems have reported more than just a cosmetic improvement. Excessive removal of skin and fat during upper and lower blepharoplasty can impair normal lid function and cause or aggravate dry eye syndrome. In some cases the fat grafting procedure will restore suppleness and flexibility to peri-orbital soft tissues, make eyelid closing easier, and improve the truly irritating and aggravating symptoms of dry eye syndrome.

There are many photographs of before and after fat grafting procedures on Realself and the websites of plastic surgeons with expertise in fat grafting. Take a look to get an idea of what fat grafting can do.

Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 123 reviews

Hollow Eyes and Dark Circles Our Best Treated with Fat Grafting

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Thank you for your question.  I am sorry to hear that you have hollow eyes and dark circles after a prior blepharoplasty. Unfortunately that happens too often when too much fat is removed during blepharoplasty.

My procedure called a trans-conjunctival blepharoplasty with arcus release and fat grafting is the solution I prefer to correct hollow eyes and dark circles.

Please read the links below  provides a detailed discussion of this procedure which I have used for over 10 years  and 100s of patients.

Be sure to consult a plastic surgeon who is certified by the American Board of Plastic Surgery and who is experienced in eyelid surgery.  After your prior experience he want to be certain to get the best result possible.

Lower eyelid blepharoplasty - Los Angeles

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Hollowed areas can be treated with a meticulous fat grafting technique to improve lower eyelid contour. Raffy Karamanoukian Los Angeles

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
4.8 out of 5 stars 95 reviews

Treatments for under eye hollowness

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

In your case,  you may benefit from fat grafting or fillers to restore volume lost with the excessive fat removal.  But you will need a one-on-one evaluation and consultation with an expert.  While I can’t provide you with name of doctors, I can recommend that you choose a board certified plastic surgeon who specializes in cosmetic medicine and more specifically is a member of the Aesthetic Society (the American Society for Aesthetic Plastic Surgery).  Ask your surgeon if eyelid surgery and fat injections are some of their specialties.  You should feel comfortable with your plastic surgeon, and have a sense that you are in good hands of someone who has treated others like you.  Ask to see their before and after photos of others who they have treated.

Steven Yarinsky, MD
Albany Plastic Surgeon
4.9 out of 5 stars 41 reviews

Treatment Options for Dark Circle.

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Treatment options for improving the lower eyelid hollowness (dark circle) include injection of various filler materials and free fat, placement of implants, and lower eyelid surgery. In my opinion and experience, lower eyelid surgery consisting of release of the arcus marginalis (thicken tissue along the orbital rim beneath the dark circle) and redistribution of orbital fat to the hollowed areas gives the best outcome regarding predictability and longevity. 

Eric In Choe, MD
New York Plastic Surgeon
4.6 out of 5 stars 51 reviews

Fillers, Fat or implants

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Hello! I personally find HA fillers such as Restylane or Juvederm to be superior to other options in this delicate area. The softness and smoothness is superior to fat and implants, with the biggest downside being the temporary nature of the treatment. I would recommend looking at the Allergan website for a provider or contact local physician's offices to find an injector experienced in this area of the face. Overall there are less risks, downtime and cost as opposed to surgery. Good luck!

Catherine Winslow, MD
Indianapolis Facial Plastic Surgeon
4.6 out of 5 stars 44 reviews

Photographs would be remarkably helpful in answering your question.

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

What you are describing is a very well recognized phenomena.  So much so, that generally this fat is now conserved with a procedure called an arcus marginalis release.  Fillers have proven to be the treatment of choice for this situation for most.  However, some benefit from more substantial intervention in the form of fat grafting or an orbital rim implant.

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