What treatment would you recommend for under eye hollows? (photos)

I'd like some help with what I can do with my under eye area, I saw a plastic surgeon the other day and he said my under eye hollows are due to naturally hollow cheek bones so my under eye area isn't supported, also thin under eye skin and prominent brow. He said in his opinion I would need number of surgery to correct this including cheek implants, fat transfer,brow and nose shaved too...couldn't I just have a lower bleph to correct? To bring up the lower area an so they isn't so much thin skin

Doctor Answers 7

Treating the puffiness below your eyes and the hollowness/discoloration/thin skin with two separate treaments

Puffiness is mostly because of lower eyelid fat prolapse, which means the fat that is normally below your eyes pushes forward and creates a visible bulge. May people with the problem also have skin discoloration.

To address lower eyelid fat prolapse and skin discoloration, we do a combination approach. One procedure is called transconjunctival blepharoplasty to reduce the fat pockets from the inside of the eyelid. By doing that, we are able to reduce, reposition and do whatever is necessary to restore the contour. When it comes to the discoloration of the skin, we routinely help people with a material called platelet-rich plasma (PRP). Platelet-rich plasma is derived from your own blood. It is essentially a concentration of the growth and healing factors that are necessary for wound healing. PRP improves skin quality significantly.

By doing these types of procedures, we’re taking away the negative that dominates the face that draws attention. In the field of cosmetic surgery, we look at things both in the close-up view as well as the holistic view. When I look at the patient, I just think what the dominant feature that is drawing the attention and is that dominant feature taking away from the face. For example when someone has bags under their eyes and they always look tired, it just affects everything in their whole face.

In terms of what the doctor was talking about in the cheeks, it may be a negative vector. It means that the cheekbone is relatively less projected compared to the eyeball or front of the cornea. That is a set-up in certain patients for issues related to cosmetic eyelid surgery such as lower eyelid retraction. We have seen a lot of patients all over the world that unfortunately had surgeries done from an external approach called transcutaneous blepharoplasty. The skin was removed and nothing was done to support and control the position of the lower eyelid. What eventually happened in the healing process is that the lower eyelid was pulled down and created retraction. In some cases, it actually everts and causes ectropion - the eyelid being exposed from the inside.

Your doctor made a very valid assessment of your anatomy. In our practice, we are very sensitive to this and we manage to avoid these types of issues 99% of the time. You may start by first dealing with the issue on your face that is dominantly negative which is the puffiness under the eyes. After that procedure is complete, if you still feel that you want more cheek projection or you want other things dealing with your nose, then you can pursue those things.

I think a lot of plastic surgeons are biased because when they look at a patient, they want to address everything. Since they do everything under general anesthesia, they want to try to do as much as they can for that patient during that one general anesthesia session. In our practice, we don’t do general anesthesia. We do everything from eyelids, facelift, breast augmentation, liposuction and tummy tucks under local anesthesia with sedation. We are able to give our patients a lot of flexibility from that perspective.

At this point, meet with other cosmetic surgeons and get some other opinions. Find a doctor that you resonate with and get a realistic sense of your outcome. Once you do that, make the decision and move forward. I hope that was helpful, I wish you the best of luck, and thank you for your question.

This personalized video answer to your question is posted on RealSelf and on YouTube. To provide you with a personal and expert response, we use the image(s) you submitted on RealSelf in the video, but with respect to your privacy, we only show the body feature in question so you are not personally identifiable. If you prefer not to have your video question visible on YouTube, please contact us.

New York Oculoplastic Surgeon
4.3 out of 5 stars 70 reviews

Under Eye Rejuvenation

In researching surgical options to improve the appearance of your under eye area, you’ve likely noticed a recurring theme in the information provided by both patients and the medical community on this site—successful surgeries begin with successful consultations.I commend you on taking this crucial step, even though it seems your consultation has left you with more questions than answers.

There are a wide range of options available for under-eye rejuvenation.Some patients looking to achieve a subtly refreshed appearance can easily achieve their goals with the use of dermal fillers such as RestylaneÒ to hollow tear-troughs to reduce the appearance of shadows and fatigue.Other patients require a lower blepharoplasty to meet this same goal.For others still, reshaping neighboring facial structures in addition to targeting the under-eye area is the best approach.While modifying additionalfeatures that border the eye area may seem counterintuitive to the goal of a subtle and natural look, a combination of procedures is often the key to avoiding obvious signs of cosmetic enhancement because it maintains or restores a natural looking and aesthetically pleasing balance to the face.

Without a physical assessment and evaluation of your unique facial structure, skin and tissue tone, medical history or the opportunity to comprehensively discuss your desired goals, I cannot advise you on pros and cons of the different options available to you.The best recommendation I can offeris to set up another consultation.If you were comfortable with the doctor you met with, by all means schedule a follow-up appointment to further discuss any new questions that may have arisen after your initial consultation (typically follow-up consultations are complimentary.)If you left your consultation feeling a lack of rapport with the surgeon, then I suggest that you research board-certified plastic surgeons in your area with a reputation for delivering excellent results and compassionate care. While I can imagine it is frustrating to not yet be proceeding with treatment of your under-eye bags, it is worth taking the time to further assess what you would like to achieve, how you would like to achieve it, and whom you can trust to achieve the results you are looking to achieve.

Camille Cash, MD
Houston Plastic Surgeon
4.8 out of 5 stars 33 reviews

Treatment for hollow under eyes

Hello and thank you for your question.
It is difficult to give a definitive recommendation based on these photos alone. While you do have some hypoplasia (fancy way of saying small) of the cheekbones, and implants would be a reasonable option for you if you so desired, I certainly would not say they are necessary. You can correct the issue you mentioned in your comment with a blepharoplasty which would excise the fat that is pooching out and reposition it in the depression below. This would smooth the transition between your lower eyelid and cheek. I recommend that you see a board certified plastic surgeon in consultation to get more specific answers to your questions which can best be addressed after a thorough history and examination is performed.
Best of Luck to you!

David L. Cangello, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 14 reviews

Best treatment for under eye Hollows

Based on your photographs you have a slight amount of lower eyelid puffiness which is creating a dark shadow or Hollow beneath your lower eyelid.  The most effective permanent treatment is a trans-conjunctival blepharoplasty with release of the arcus marginalis and placement of a composite fat graft beneath the Hollow to plump the skin and reduce the shadow.  Fillers can be done but are temporary and very few people can inject fillers in the eyelid without creating visible lumps.  For more information on treating eye Hollows read the following link:

Under eye hollows

It looks like you are an excellent candidate for under eye filler injections. I prefer Restylane in this area and the results often last 1-2 years or more. I would not recommend removing fat from your under eye area, as this will only make you look more hollow. The goal is to blend the eyelid-cheek junction and make you look less tired. Get another opinion from a doctor who has a lot of experience injecting the under eye area. You should be able to find someone in your area based on comments and reviews posted to this website.

Mitesh Kapadia, MD, PhD
Boston Oculoplastic Surgeon
5.0 out of 5 stars 164 reviews

Permanent vs temporary

You have two main options:
1. Fillers [Restylane vs Boletero] to augment the lower eyelid/tear trough volume. This lasts between 6-12 months and sometimes a bit longer

2. Surgery- I would recommend a combination of fat repositioning blepharoplasty, plus additional fat grafting to cheek and lid. This would be a more permanent solution, but the up front cost is higher.
Below I've posted a photo of a young patient that underwent only blepharoplasty with fat repositioning [without additional fat grafting]

Seek another opinion from a surgeon that is experienced with both these options so you can decide what's best for you.

A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 37 reviews

Dark lower lids

You do have a deep tear trough, and some early fat prolapse which makes your lower lids look dark and tired.   While all of that surgery may help, why not try a little filler.  Either an injection belotero or restylane will help to fill in the tear trough and decrease the appearance of the dark circle.  Much less invasive, less costly, and usually very effective! See another provider for a consultation. 

John J. Martin, Jr., MD
Coral Gables Oculoplastic Surgeon
5.0 out of 5 stars 27 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.