With age, under eye hollowing can occur in which case the trough becomes deeper, the circles darker and tears run down the trough and out toward the side of the cheeks instead of straight down the cheek when a person was younger.
This can also be from genetics and afflicts many in their 20’s and older leaving them feeling self-conscious about their appearance. The upper and lower eyelids often lose elasticity as well and start to sage while fat can accumulate under the lower eyelids, leaving a shadow, deeper tear trough, and under eye wrinkles. Patients will start to complain about looking tired, having eyelid bags, puffy eyes, and under eye bags. Often they are frustrated with others continually asking if they are tired and/or angry when they aren’t.
Surgery was traditionally the only option available and in a lot of cases, is still recommended for full under eye rejuvenation. But today, our UFP providers use advanced techniques and injection treatments, sometimes in combination with surgery, to rejuvenate under eye wrinkles and restore a more youthful, refreshed appearance.
What treatments are best for under-eye hollowing?
Frequently Asked Questions
A good candidate is any patient who suffers from tear trough or under eye deformity and desires correction. It’s important the patient has good to excellent health and realistic expectations regarding their outcome.
Doctors Thompson and Henstrom, double board certified facial plastic surgeons in Utah, have extensive experience with tear trough rejuvenation, as do our expert injectors trained by Dr. Thompson. During your consultation, your provider will discuss your concerns as well as your goals and motivations for treatment. An exam and review of your current and previous health history will also take place.
They will then examine the structures of your face and eyes, and will make recommendations they feel will help you achieve your aesthetic goals. Your provider will discuss the procedure(s) he or she recommends and give information on where incisions will be placed, possible risks and complications, and make any non-surgical recommendations to enhance the overall surgical outcome. These options may include dermal fillers and/or botox.
Your injector will advise you to avoid taking aspirin, ibuprofen products, Vitamin E and certain herbal medications before surgery, as these medications can cause increased bleeding and/or bruising. He or she will also insist that you discontinue smoking for at least one month prior to surgery to ensure proper healing, if applicable.
One of our staff members will then provide you with all the financial details on any procedure discussed at your consultation and give financing options if applicable. They can also help facilitate the next step in the process and/or provide additional resources, such as before and after photos, articles, educational videos, etc.
Our providers will tailor procedures specific to each patient depending on their facial structure, concerns, and goals.
They often recommend a dermal filler to patients with mild to moderate hollowing. Common fillers used for under-eye rejuvenation include Restylane, Belotero, Juvederm, Volbella and Vollure. The filler is added to the under-eye area, also known as the tear troughs, to restore the volume loss that creates the under eye tear trough. A blunt cannula is used to inject the dermal filler and decreases the chances of bruising and swelling. The actual treatment takes approximately 15 minutes, is done in the office with no downtime involved. Numbing cream is applied before hand to minimize any pain.
Fat injections are another great way to restore lost volume in the under eye or tear trough and is a more permanent option. This is where fat from a different area of the patients body is injected under the eyes. Doctors Thompson and Henstrom treat patients with fat injections in the office under local anesthetic or in a surgical center if the patient is more comfortable under general anesthesia.
For more advanced hollowing, your provider will likely recommend a lower blepharoplasty, a surgical procedure in which excess skin and underlying fat are removed, and the incisions are closed with fine sutures. In some cases, Dr. Thompson and Dr. Henstrom reposition the fat instead of removing any excess. Fat repositioning is a different method of handling the bulging fat under the eye during surgery. Your surgeon surgically distributes a layer of fat over the rim of the orbital bone and advances it into areas of depression or hollowing. By doing so, deep troughs and puffiness are addressed for a well-rested, rejuvenated appearance with no visible scarring.
The approach your provider will take for under-eye rejuvenation depends not only on the evaluation of the lower lid but also of the cheek region. When patients have lower lid bulging and a pronounced lid/cheek junction (tear trough), simply removing fat will not correct the aged appearance. In such cases, one of our surgeons would perform fat repositioning to smooth the under-eye area for a more natural and aesthetic result. If skin also needs to be removed, this can be through the same fine incision under the lower eyelashes. In many cases, he will also recommend lifting the cheek upward simultaneously to meet the lower eyelid and achieve a more youthful lid/cheek junction.
Under correction or over correction are not uncommon so it’s important to see an experienced facial plastic surgeon when it comes to any cosmetic eyelid procedure.
If dermal filler is injected there won’t be any downtime involved but there is a chance of slight bruising and swelling that will subside over 3-7 days. An ice pack is given to help with these possible effects.
For fat injections, plan on 1- 2 weeks of recovery with some bruising and swelling. There will be a small incision with 1-2 sutures on the thigh where the fat was taken from.
If surgical intervention is involved with under eyelid surgery, refer to the blepharoplasty page for further details on what to expect with surgery.