Hollowness under the eyes is a very common complaint, and treating it with under eye
filler is a relatively popular cosmetic procedure.
However, many people who have their under eye hollowing treated are sometimes not satisfied
with their results.
I’ve observed that many people who are focused on a particular area of their face miss the
forest for the trees and are unaware of other areas which contribute to their hollowed appearance.
I’ll discuss how I assess the under eye hollows and related areas to provide my patients
with a strategy that will result in looking their best.
I’m Dr Amiya Prasad.
I’m a Board Certified Cosmetic Surgeon and Fellowship Trained Oculoplastic Surgeon.
I’ve been in practice in Manhattan and Long Island for over 20 years.
I have extensive experience performing cosmetic eyelid surgery, facelift and facial implants.
I apply this expertise to nonsurgical solutions for facial aging, particularly in the eye
area as well as other parts of the face such as the cheeks, jawline, chin, brow, forehead,
and neck.
When I evaluate the eyes, I look at the whole area surrounding the eyes such as the area
where the eyelids meet the cheeks, called the eyelid-cheek junction.
In addition, I look at how the cheek appears from the front and from different angles.The
volume and projection of the cheeks support the eyelid area.
If there is hollowness in the eyes, and the upper cheek is full, then the cheek and under
eye area blend naturally.
This doesn’t mean that everyone needs cheek volume and I do a lot of tear trough and under
eye hollow correction without additional cheek filler.
Many people will identify the hollowness under the eyes and overlook the importance of cheek
volume.
If the lower eyelids are hollow with minimal cheek projection, then isolating volume in
the under eye area does not blend well with the cheeks and the rest of the face.
In this situation, the isolated filler under the eyes adds projection to the under area,
but then drops off at the cheek looking unnatural and even baggy in appearance.
Filler placement needs to be done so there is balance in the whole face.
I typically use a hyaluronic acid filler like Restylane the tear trough to fill the hollow
space.
In some cases, the hollow look may be caused by puffy eye bags, which project out of the
face, making the area adjacent to it appear hollow in comparison.
The fat pocket is like a mountain making the area next to it appear like a valley.
There are limits for example If eye bags are too prominent, then surgery is needed to reduce
and sculpt the fat pockets.
It’s important to understand that all under eye surgery is not the same and just like
the application of filler expertise, experience and the doctor’s aesthetic style determines
the results.
If the puffiness is minimal, then filler can effectively camouflage the puffiness by blending
the hollowness of the tear trough area with the puffiness above it.
If the cheeks are lacking projection and volume, then I offer the patient the option to also
address their facial volume.
Lack of volume is associated with genetics and facial aging.
The art is to place the fillers in a way that looks natural in relationship to the individual’s
other facial features.
I use a technique called Structural Volumizing where I place the filler deeper, between the
bone and muscle.
By placing the filler at this level,the filler takes the shape of the bone structure.
This is in contrast to more traditional filler placement which is more superficial which
can make the cheeks look too round and lumpy.
The procedures are done with a little local anesthetic for comfort, and with blunt cannulas
instead of needles for safety and to minimize the risk for bruising.
Filler placement can take minutes to perform , and can be done over lunch time.
Many of our patients return to work immediately since there is minimal swelling.
The healing process and recovery time for filler placement are minimal and since hyaluronic
acid naturally exists in the body, the material is slowly metabolized over time.
I normally see my patients two weeks after filler treatment to see how the filler has
settled, and if any enhancement may be needed.
The ideal filler for this purpose can stand up to the movement of muscle over the bones
and is longer lasting.My choice for fillers for structural volumizing are in the Juvederm
family such as Juvederm Ultra Plus and Juvederm Voluma.
These fillers work well in this space and can last over 1 year.
I do discuss with my patients that fillers do require periodic maintenance and that subtle
diminishing of the fillers effect does vary between individuals.
It’s important to see the face as a whole, rather than just focus only on a specific
which needs attention.
This area such as the under eye hollow can be the focus but at the same time its helpful
to take a step back and look at the whole face.
Your face conveys so much about who you are and how you feel.
Understanding facial balance and harmony with the right strategy can help you put your best
face forward.
I hope you found this information helpful...thank you for your question.