Eyes are one of the most important parts of our face for nonverbal communication with others. The eyes and the areas around the mouth are the first areas that people evaluate subconsciously when viewing one another.
Puffy upper lids and swollen or hollow lower lids can make a person appear tired, sick and older even when they feel fine inside.
This can be frustrating to those people with these conditions. The normal healthy lower eyelid is a short tight vertical line in the lower lid just underneath the lower eyelid lashes which then continues on with a convexity that connects the cheek with this short vertical line.
With increasing age and sometimes at birth, this normal convexity becomes interrupted.
This can lead to the impression that someone has tired looking lower eyelids. Some individuals call this condition hollow eyes. This term can be a misnomer.
In some individuals, in certain families at a young age, they can have fullness in their lower eyelids due to a forward projection of a normal retaining layer of the lower lids called the orbital septum. This layer usually lays vertical with the lower lid allowing the normal smooth convexity of the lower lid vertical line into the cheek. But, when this layer is set more forward, it can allow the fat pads which are held back by that orbital septum to shift forward. This results in fullness in the lower lids which are usually only seen in older individuals in their 40s-60s.
When these lower lid bags occur either in this situation of young individuals with a forward placed orbital septum or in older individuals with age related fat pushing forward into the lower eyelid space, a person could either see the puffiness of the fat pads creating a convexity in this area or they could see the indentation underneath this convexity and consider this a hollowing of the lower lid. Both can be correct depending on what a person concentrates on.
In cases like this surgery to remove or relocate the fat in this region can result in a more permanent resolution of this condition. This is known as a lower eyelid blepharoplasty.
I often perform this surgery using a transconjunctival approach to hide the incision on the inside of the lower lid and avoid any visible scars on the outside skin. This has helped many older and some younger patients in my experience.
The second cause for lower eyelid hollows is rarer and involves a similar alteration of the lower eyelid retaining layer known as the orbital septum. In this genetic situation, the orbital septum, which should normally be vertical to the lower lid allowing the normal smooth convexity of the lower lid vertical line in the cheek convexity, instead is set more posteriorly or behind the rim of the orbit. This results in a true hollowing of the area in the lower lid region. This can likewise make someone appear to have a less than “Normal” lower eyelid configuration that a person might interpret as looking tired.
In cases like this, the relatively new use of fillers under the eyes can be helpful. This is the main and only time fillers belong under the eyes in order to help true hollowing under the eyes which usually occurs in young individuals.
When fillers are used to try and camouflage lower lid bags, which usually occur with age, the results are often poor and sometimes can cause scarring.
Cases like these are best addressed with surgery to remove or relocate the fat in the lower lid region.
Under eye hollowing can also be caused by the cheeks. The lower lids do not exist in isolation. They exist in balance with the surrounding facial areas. The cheeks influence the appearance of the lower lids. With age and sometimes through birth, the cheeks can be thin and flat. This can then make the lower lids stand out in contrast. In conditions like this, rebuilding the cheeks with a permanent cheek implant or more commonly with cheek fillers can improve the appearance of hollowness under the eyes.
The last cause of hollowing under the eyes refers to festoons and malar mounds and malar bags. These swelling on the cheek can make a person appear to have hollowing underneath them. Some individuals have tried to use dermal fillers to fill underneath the festoons or malar mounds. This usually doesn’t work out well and can result in an awkward appearance.
I prefer to use my RESET treatment for festoons to flatten the festoons and malar mounds, as seen below.
I hope this discussion was helpful in educating you on different causes for under eye hollowness. If we can be of further service to you, please contact our office for an appointment.