When it comes to aesthetic eye concerns, “solutions for puffy under-eyes ” is one of the highest google searches. But , a close second, and something dermatologists and plastic surgeons are asked about all the time, is “under-eye hollows. ” You may hear your doctor refer to this area as the tear trough, and with age, it can appear hollow as we lose volume, collagen plus elasticity in our skin. It can make someone look older or more tired than they really are, and who wants to listen to “you look tired” when you’re four cups of coffee deep? Here, a lot more on what under-eye hollows are plus six different ways to treat them if they bother you.

What are under-eye hollows?

More noticeable on slender faces without as much fat underneath the eyes, hollows can be hereditary or the result of aging and quantity loss in the face—“ a lack of sleep can make them show up worse, too, ” says Fort Lauderdale, FL dermatologist Dr . Igor Chaplik. In the past, they’ve been tough to hide, as well as eliminate altogether, but modern options make the task easier than ever.

Tucson, AZ plastic surgeon Raman C. Mahabir, MD states there are usually two key components to assess whenever looking at lower eyes: “There is often a bulge of the lower eyelid and a sunken area where the eyelid meets the particular cheek—essentially the peak and a trough when viewed from the side. The high plus low region creates shadows or dark circles under the eyes, which is a common concern. ” Oftentimes, the best solution to achieve a natural-looking result is a combination of fillers, injectables, lasers, and lower eyelid surgery.  

Laser Treatments

“If the patient only has a little extra skin and a little bulge, the ideal option is really a CO2 laser to tighten the bulging skin, ” says Doctor Mahabir. “I find that this approach is better for younger people. ”

Hyaluronic Acid Fillers

In February, the first-ever FDA-approval for a filler being used to treat under-eye hollows was announced: Hyaluronic acid fillers   Juvéderm Volbella , which has been utilized in the particular U. S. since 2016 for lip enhancement, is now also indicated for the improvement associated with under-eye hollows in adults over the age of 21. “Under-eye fillers are a great option for those who have hollows, but no visible fat prolapse, ” says Beverly Hills, CA ocuplastic surgeon  Christopher Zoumalan, MD , that likes working with Volbella for this purpose. “Careful  injections to the particular correct area without overfilling can often create beautiful  results.

Bannockburn, IL dermatologist Heather Downes, MD says the filler the doctor recommends for this particular area is important because “many of them are too thick or cause too much swelling under the eye. ” It is for this reason exactly that New York facial plastic surgeon Dilip D. Madnani, MD likes in order to use the thinnest fillers possible in this delicate area. “Though Volbella will be approved with regard to this region, there are multiple off-label options out there, as well, including Belotero Balance, Restylane, RHA 2 and Revanesse Versa, ” he says. “I preferentially use Belotero; it comes down to the particular doctor’s preference. ” Dr . Chaplik also prefers Belotero: “I find it to be the most predictable plus cohesive and least likely to cause a reaction, ” he says.

Beverly Hills, CA facial cosmetic surgeon Kimberly J. Lee, MD prefers using Restylane for the under-eye area. “All fillers have different qualities, viscosities plus characteristics, ” she says.   “Restylane underneath the eyes, for me, yields the best outcomes in terms of natural-appearing results, viscosity and duration. ”

Placement of the filler is furthermore important. “When placed too superficially below the eye, fillers can cause a bluish swelling called the Tyndall effect, ” states Dr. Downes. “Therefore, I tend to inject injectables beneath the muscle layer in this area. ” In some cases, doctors will suggest filling the cheeks as well, as Covington, LA dermatologist Christel Malinski, MD says the cheeks and tear troughs are intimately related. “If it’s necessary to address both, We most often use a more supportive filler, such as Restylane Lyft or Juvéderm Voluma, within the cheek area, plus a softer filler, like Restylane or even Juvéderm Volbella, in the particular tear trough. ”

Dr. Mahabir likes to inject Juvéderm Voluma or Restylane Lyft deep into the face, right next to the particular bone. “The good news is that will these deeper injections rarely show any bruising when done correctly and there is little to no downtime—very small swelling and the patient can essentially go right back to work, ” he admits that. “They should avoid vigorous workouts or contact sports regarding a few days after, but otherwise, minimal restrictions. ” 

It’s important to keep in mind that the tear trough can end up being a very tricky region to fill, so make sure you’re getting safe shots and optimal results by choosing the board-certified skin doctor or plastic surgeon who is properly trained and very familiar with this particular part of the face anatomy.   “I have got seen so many patients who have had for filler injections done really poorly under their eyes, ” says Dr. Downes. “These patients were typically injected at a medspa simply by someone along with questionable qualifications. I stress to my patients that a medspa isn’t a bargain when you have to go to a board-certified doctor afterward to have your additives corrected. Typically, the way we correct or reverse them is by injecting hyaluronidase into the area, which dissolves the filler. ”

Fat Grafting

Though he acknowledges HA fillers are best intended for shallower hollows, Doctor Mahabir’s go-to for filler injections for much deeper hollows is usually the patient’s own body fat, which is definitely acquired through a process called fat transfer: fat is taken from one section of the body like the stomach or even thighs, cleaned and processed, and then injected within the region under the eye. “It can be permanent, has less risk than fillers because it is their own tissue, and there is a large supply, ” he explains. “For people with really heavy troughs, this is the particular best option due to the fact the cost of a lot of filler will exceed the cost of the fat grafting. ”

Dr. Lee  adds that will it’s crucial to understand that not everyone is a candidate for fat grafting under the eyes. “This is because in order for the treatment to be effective, there must be good-quality fat that’s harvested and then grafted. A marathon runner with less than 4 percent body fat, for example , is not a good candidate, but for the particular right person, it can create a smoother appearance. ”

Dr . Mahabir performed body fat transfer to this 33-year-old patient’s lower eyelids,
as well as laser resurfacing around her eyes.

Blepharoplasty Surgery

lower eyelift , aka blepharoplasty, may remove any loose skin under the eyes that makes hollowing look worse, and the particular fat can be repositioned or added to smooth out sunken pores and skin.   “If the patient has more extra skin or more of a bulge, the best option is a lower lid blepharoplasty where the excess fat is either resected or repositioned, “ says Dr. Mahabir.

“Those who actually have under-eye fat prolapse and hollowing are better suited to undergo a lower eyelid blepharoplasty with fat repositioning, where both the particular prolapsed body fat and hollowing are addressed at the same time, ” adds Dr. Zoumalan. “If you are considering under eye fillers but are usually concerned that you may actually be better served by having a lower eyelid blepharoplasty, you should meet with an expert surgeon that will performs both lower eyelid blepharoplasty plus under eye fillers so that you have the best options presented in order to you. ”

Dr. Madnani says that oftentimes, lower blepharoplasty is combined with fat transfer or hyaluronic acid injectables for optimal results. “There are other nuanced procedures too, such as lower eyelid fat transposition, but these are all advanced techniques that require surgeons with lots of experience treating these areas. ” The most important piece of the equation, according to the doctors interviewed here, is doing the particular right procedure on the right patient.

Potent Skin-Care Products

“If you’re considering undergoing any kind of type associated with treatment or procedure to address under-eye hollows, you should also be using a topical retinoid, ” says Huntington Beach, CA dermatologist David Rayhan, MD. “Topical retinoids, like prescription Retin-A or even over-the-counter retinols, will improve the particular quality of your reduce eyelid epidermis by smoothing small wrinkles and thickening the skin in order to help reduce the appearance associated with the hollow or dark circle. This will give you a better result from any treatment. ” If OTC products are preferred, we like RoC Retinol Correxion Eye Cream ($18) and Avène RetrinAL EYES ($49).  

Makeup Magic

Helen Phillips , Sephora Collection’s national  makeup artist, says the best way to mask under-eye hollows is by using various shades of foundation or concealer. “To start, use a foundation or even concealer that will matches your skin tone under your eyes. This provides a smooth base, as well as helps conceal darkness, ” she explains.  

“Using a flat concealer brush like  Sephora Collection Pro Concealer Brush #71   ($22), lightly sweep a concealer that is at least two to three shades lighter than your skin tone in which the deepest  part of the hollow  will be. Using the particular same brush, lightly blend out the edges but leave the particular opacity associated with the light concealer in the center.   If you are concerned about the concealer moving or creasing, set it with  powder and a damp sponge or powder puff. Then sweep extra powder away with the clean. ”

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