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How do I fix hollowness under my eyes?

Question posted by Sarah from Ottawa

I have very deep set eyes and the area under my eyes looks very hollow. It looks like a have very dark bags under my eyes and they never go away. Would you recommend some kind of injections to fix this problem or would a mini face lift be better. Or are there any other options?

Doctor's Response

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2 thoughts on “How do I fix hollowness under my eyes?

  • Dear Sarah,

    Hollowness under the eyes can be a
    hereditary or developmental aging condition. 
    In general, it involves inadequate fat and soft tissue contours over the
    orbital rim.  The most common cause of
    this is normal soft tissue aging.  With
    deflation and descent the cheek fat pads descend, elongating the lid cheek
    junction and exposing the orbital rim and the lower lid fat pads to visibility
    and often a baggy appearance.  Little
    grooves called the tear trough, orbital malar grooves can develop and these can
    be aging as well as appearing tired. 
    Some patients are born with inadequate cheek volume and malar hypoplasia
    and hollowness under the eyes can be a hereditary condition.

    The treatment for hollowness of the
    under eye can involve camouflage techniques with the use of soft tissue fillers
    where simple sugar gels like Restylane, Belotero or Juvederm can be injected
    into the tear trough or hollowness adjacent to hill to build up the valley and
    smoothen the lower lid contour.  Fillers
    are often placed in the upper cheek to add volume and shorten the lid cheek
    junction.  Other soft tissue fillers can
    include a patient’s own fat which, if it picks up a blood supply, can last for
    many years.  Finally, one can perform
    operative procedures by removing lower lid fat pads to smoothen bulges and
    using soft tissue elevation techniques such as an endoscopic mid face lift or
    malar fat pad elevation to shorten the lid cheek junction and permanently fill
    a lower lid area of hollowness. 
    Transposition of the fat pad of the lower lid into the hollow can also
    be performed for a long-term correction.

    There are quite a few techniques to
    improve lower lid hollowness and you should seek out a certified plastic
    surgeon with years of experience in treating lower lid hollowness.

    Best of luck.  I’m sure you’ll get an excellent result.

    To schedule a consultation or find
    out more, please visit:

    R. Stephen Mulholland, M.D.

    Certified Plastic Surgeon

    Yorkville, Toronto

  • Thanks for your question, Sarah. Hollowing or dark circles under the eyes is a common concern I frequently hear about from patients in my practice. This is a bit of a complex issue, so let’s start with some basics. Hollowing under the eyes may be genetic in nature or sometimes it’s related to the aging process, amongst other things. With time, we tend to lose fat and hollow out under the eyes, creating a so-called ‘tear trough’ appearance. Additionally, it’s not uncommon to see a fat bulge just above the tear trough, making the hollow appear even worse.As for darkness under the eyes, it may be related to a number of issues such as genetically dark skin colouring, thin or translucent skin in the lower eyelid area to the point where blue-green veins are visible through the skin, or fat loss leading to a concave or hollow appearance.Sarah, management of hollowing and dark circles under the eyes will vary depending on what the specific issue is in your case. In general, if there is hollowing, a soft tissue filler such as Restylane or Juvederm can be cautiously used to create a more aesthetically pleasing contour, thus filling out the hollow. Done properly, the results look great and are long-lasting but caution is advised. This treatment is considered to be an advanced technique and is not without risk so it is best done by a physician with a thorough knowledge of anatomy and lots of experience treating this area.Treatment of dark skin under the eyes may be as simple as using a concealer, but in some cases may also benefit from a bleaching agent. This problem can be particularly challenging, especially when the pigment is familial in nature.For those with a large fat pad bulge in the lower eyelid region, surgery may be the treatment of choice in some circumstances. For milder cases, use of fillers for the hollow below the bulge as described above may also be effective in camouflaging the bulge.The bottom line is that no two patients are alike, so the best thing to do is to see a recognized physician expert for a personalized consultation. You’ll want to make sure that the physician you choose has a detailed knowledge of anatomy in this complex area, a discerning aesthetic eye, and is technically skilled in treatment of the subtle nuances of lower eyelid issues.

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