Removal of under eye hollowness? (Photo)

The #1 pic shows my under eyes when I'm not smiling. #2 pic shows severe under eye hallowness when I smile. I hate it and it makes my undereyes look dark with the hallowness. I feel like I have a frog eye appearance and my eyes bulged out. I consulted my doctor who injects my Botox and dermal lip fillers about my under eye hallowness and he basically says that filler will do minimal to decrease the appearance of my under eye hallowness. Is this true? Is there any other procedure that can be done?

Doctor Answers 16

Under Eye Hollowness

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It is difficult to evaluate from the photos but I believe your physician is correct. From the photo it looks like there is more darkness than hollowness. Botox to this area can perhaps worsen the bags under your eyes. Regrettably, fillers won’t help because this only happens when you smile. 

Summit Emergency Medicine Physician

Undereye hollowness

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Thank you for your question. The problem seems to be with the obicularis oculi musscle oculi muscle, which is strong in your case. I would recommend trying Botox to relax the muscle and I like to inject fat below the eye to re-create a more normal convexity. Fat is easily harvested from another área of your body then re-injected below the eye. Since it is your own fat, there is little to no swelling, and when performed with a cannula, minimal bruising. Also, there is no potential for rejection since this is your own fat. Lastly, there is much information about the benefits of fat and associated stem cells. Best of luck.

Michael P. Morrissette, DDS
Ventura Oral & Maxillofacial Surgeon
5.0 out of 5 stars 4 reviews

Under eye hollowness

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Thank you for your question.  At the most, I would consider a dermal hyaluronic acid filler to the area to help create a more smooth contour between the lower eyelid and upper cheek, and especially when you smile.  Best of luck!

Paul Nazemi, MD
Newport Beach Oculoplastic Surgeon

Under eye hollowness

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Thank you for the photos. You definitely do not need to jump into surgical treatments at your age to achieve a more refreshed look. A quick and simple solution would be to have the appropriate hyaluronic acid filler to your lower eyelid area to blend the area between your lower eyelid and cheek. The majority of your appearance is due to your orbicularis oculi, the muscle around your eye that helps you blink and squint. A small amount of Botox injected into the muscles within the eyelid will prevent them from bunching up and giving you a thick eyelid appearance when you smile. But be careful! Too much can make your eyelid look worse. For the best treatment options, it is important to visit an expert for an in-person examination. Hope this helps!

Johnson C. Lee MD, Plastic Surgery

Johnson C. Lee, MD
Beverly Hills Physician
5.0 out of 5 stars 17 reviews

Removal of under eye hollowness?

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Best to get in person consultation with an oculoplastic specialist. There are nonsurgical and surgical options that can improve your problem. 

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 91 reviews

Removal of Under Eye Hollowness?

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I would consider a small amount of Botox injected into the lower lid to try to reduce bunching of the lower eyelid muscle when you smile.  In my hands this is a quick, safe, inexpensive, and non-invasive treatment.  It wears off over time and should be repeated if you like the results.


Dr. Ort

Richard Ort, MD
Lone Tree Dermatologic Surgeon
5.0 out of 5 stars 28 reviews

Removal of under eye hollowness?

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In your photos I do not see much if any hollowing of your lower lid I just see prominence of contraction of the orbicularis muscle with smile.  It would be best to be assessed in a face-to-face exam and if these findings were seen in my office I would be discussing a very conservative test trial of Botox to weaken the contraction of the lower lid and possibly but not very likely use of some tear trough fillers.  This is such a dynamic area that is also affected by lighting that it is nearly impossible to give you accurate advice based only on a photograph.  The Botox might serve to slightly weaken the contraction of your orbicularis muscle which may help somewhat.  There could be side effects from it however so it would need to be done extremely cautiously and conservatively.  You can always add Botox or Xeomin but you cannot take it away!

Jon A. Perlman, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 33 reviews

Under eye hollows?

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I see a roll of the orbicularis oculi during smiling and this can be improved with Botox in this area. It is a small amount and needs to be properly placed. The no smiling photo shows a bit of hollowing and Restylane can be placed there using cannulas. Other treatments in link.

Steven F. Weiner, MD
Panama City Facial Plastic Surgeon
4.9 out of 5 stars 75 reviews

Under Eye Rejuvenation with fillers, lasers, microneedling/prp

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A combination approach would be best. Fillers, lasers, and microneedling/PRP can improve under eye hollows. My patients try to get non surgical treatments to avoid surgery. We use PRP and stem cells there often. I suggest consulting with an expert to develop a treatment plan best suited for your short and long term goals. Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 207 reviews

Lower eyelid hollow

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I would avoid injecting fillers in the lower eyellids as it is associated with prolonged discoloration almost universally; and the blue coloration can last up to 5 years. I would consider a laser of the lower eyelids or just a lower eyelid blepharoplasty.

Arian Mowlavi, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 106 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.