Undereye Hollowness & Thin Skin?

I'm a 52 year old man with undereye hollowness. I've been treated with restylane w/ mixed results. The hollowness was minimized but my doctor explained that the reason why the restylane treatment results in my skin looking slightly bumpy and/or more wrinkled is because of my extreme undereye thin skin. The doctor's suggestion was that I have an undereye peel. Do you agree? And if yes, what kind of peel do you recommend? Big thanks! Jackson M.

Doctor Answers 13

Treatments for under eye hollowness

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A chemical peel can smooth out wrinkles, but in general will not correct hollowness.  Sometimes surgical intervention with a lower lid blepharoplasty to rearrange the fat is necessary. I have found that fat grafting gives a smoother result than fillers, and so I would consider consulting a surgeon with extensive experience with eyelid fat grafting.  Lumpiness is always a risk, but that risk is very low in experienced hands.

Undereye Hollowness & Thin Skin?

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     If there is wrinkling, then a peel or conservative excision may be the appropriate recommendation.  Pictures or an exam would be helpful in your case.  Kenneth Hughes, MD Los Angeles, CA

Thin Lower Eyelid Skin

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It is difficult to comment without a picture.  In general peels can be effective as well as fat grafting.  

Dr. ES

Treatment of Under-eye Hollowness and Thin Skin

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The problem you describe is generally not amenable to a peel. In fact, peels in thin skin are fraught with danger. WIthout an exam, it is impossible to make specific recommendations. However, if you got somewhat reasonable results with Restylane, then you should get good results with fat grafting to the area. This can fill the area and actually improve the skin. Depending on your findings, other treatment options may be available. See a plastic surgeon with significant experience in eye rejuvenation and the ability to use all options. 

Robert T. Buchanan, MD
Highlands Plastic Surgeon

Under eye issues

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Fillers can provide nice results in the lower lid tear trough region if done carefully. As for loose skin this is unrelated and may need to be conservatively excised. An exam is important to be properly evaluated.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Undereye Hollowness & Thin Skin?

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i would not be in favor of a peel or even fillers at this point other than fat grafting. But it is quite likely you have enough fat either in your orbit (around the eyeball) or in your upper cheek that could be rearranged to give you the added volume you need. These are very tricky procedures and it is unlikely your current Dr. does them or he would have already recommended that. See someone with a lot of experience in eyelid rejuvenation surgery.

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 29 reviews

Hollows under lower eyelids

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As gravity pulls on the cheek fat pads, and they begin to separate from the lower lid structures, a circular hollow under the eyes may begin to intensify.  This is best treated with structural rearrangement (surgery known as blepharoplasty and midface lifting) to get the fat pads supported and overlapping as a more youthful condition.  The non-invasive and minimally invasive techniques such as fillers and skin treatments will not correct the early "bag" formations.

Undereye hollowness

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For undereye hollowness in patients with very thin skin, the fillers need to be injected very carefully as every lump/bump will be visible.  Having a skilled injector who is very knowledgeable about the facial anatomy is paramount!  Undereye peels will help improve wrinkles but not the hollowness.  Please consult with your board certified specialist who can assist you in achieving the results you seek.

Kimberly Lee, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 13 reviews

Hollowness vs wrinkles

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First and foremost, it would be very beneficial for us to see your photos so that we can give you a personalized recommendation rather than generalizations.

However, when we treat hollowness, whether with fillers or with fat injection, the overlying skin wrinkles should improve a bit. Think of a deflated balloon and then add air to it.

If skin wrinkling is what is bothering you right now, a skin peel can help, but if you are saying that there is bumpiness to the overlying skin, maybe its the placement of the fillers that is the problem. Post a photo, if possible, and we should be able to give you a better answer.

A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 42 reviews

Hollowness under eyes

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Hollowness under the eyes is a common feature during aging. In fact, essentially all of us loose the fat under the eyes which makes the eyes appear hollow, bony and darker.  In our practice I treat this problem regularly with fat transfer to replace the lost volume and often combine a skin pinch to tighten the loose skin if needed.  I personally would not recommend a chemical peel for the problem you are describing but to be fair to your surgeon, I haven't seen the condition.  The best advice is to make sure you see lots of before and afters and make sure you like the way your surgeon handles the problem. Moreover, that this is something he/she does often (several times/week). 

Good luck.

Amir M. Karam, MD
San Diego Facial Plastic Surgeon
4.7 out of 5 stars 124 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.