How to Improve Hollow Below Eye Area and Skin Fold? (photo)

As you can see in my photo my lower eye area is really ugly. How can I fix this area? I have had this fold that runs from the corner of my eye to my nose and therefore makes a hollow valley under my eyes and I always look tired or scary. Please help!

Doctor Answers 5

Tear Trough Improvement

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  In young patients, the tear trough can be improved with hyaluronic acid fillers like Restylane.  I would try this first.  Fat grafting can be done in the future.  Kenneth Hughes, MD Los Angeles, CA

Fat injections under the eyes

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Dear Chashatesherself,

You have 2 options for something like this:

  1. Restylane injections that can last 1-2 years and is non surgical
  2. A fat transfer would be a great option as well, it is permanent and natural looking


Nima Shemirani

Nima Shemirani, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 85 reviews

Tear Trough Correction

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In patients who have developed deep 'tear troughs' at the junction of the lower lid and cheek, adjacent to the side of the nose, the meticulous grafting of fat harvested from the patient's abdomen, hips or thighs can build this area back up and nicely restore a more youthful contour. In some blepharoplasty patients this depression or 'hollow' extends horizontally across the entire junction of the lower lid and cheek, and this must be corrected to obtain the ideal postoperative result.

In select patients, lower lid rejuvenation may consist of conservative reduction (not removal) of the lower lid fat pads or 'bags', in combination with structural fat grafting of the 'tear trough' hollow immediately below. As with all aesthetic surgical procedures, it is absolutely essential to customize the surgical plan to the specific needs of every patient. Fat grafting has been performed by plastic surgeons for decades. There is no question that fat is the ideal material for soft tissue augmentation, and that the results obtained with fat grafting are the most natural-appearing. However, one problem with this procedure in years past has been resorption (breakdown) of the grafted fat, so that the resulting improvement is not permanent. The grafted fat must gain its own blood supply in its new location in order to persist long-term, and this generally is not possible when large amounts are injected at once and when specialized instrumentation and techniques are not employed.

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 123 reviews

Two options

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You have two options:

1. Hyaluronic acid fillers [Restylane, Juvederm, Boletero]

2. Fat grafting


Option 1 is temporary [6-12 months usually] and is an office procedure that is less expensive, but requires repeat injections. It is easily reversible

Option 2 is a more permanent fix, and in experienced hands should last you a long time. Its a greater cost up front, but in the long run probably more cost effective.

Both are great options and you should choose which one is good for you. And both need to be done by experience surgeons/injectors.

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

Under-eye Hollows

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Hi Chas.  Not to worry, you do have options.  You look fairly young so if surgery is out of the question then we would recommend Restylane.  We have had patients as young as 18 and in the same situation as you consider this procedure.  

It's called the tear trough procedure and it helps to provide volume under the eyes where it has been lost due to age or in your situation, where the area is sunken because of your facial anatomy.  

Find a good injector as the results will be very technique dependent and only consider Restylane or Juvederm in this area.  Good luck.

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
4.4 out of 5 stars 7 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.