5 Approaches to Hollows and Circles Under the Eye Area

I am 71, healthy and in good shape, but I have deep hollows & circles under my eyes that have gotten worse with age and make me look older and tired. I tried a Juvederm injection for the first time about 4 weeks ago, but really haven’t noticed any difference. Is surgery the only way to lessen the problem or is there a firming/lightening cream or serum that you could recommend?
Thanks. – Arlene

Thank you for asking this. Such a good question.  No matter what your age, I think it’s first important to do an accurate as possible self assessment. Pretend a good cosmetic dermatologist is looking at you. Take some notes even. 🙂

Your eye area can be improved and it can make a huge difference. Just work carefully and slowly, and find the best doctors/providers in your area.

Start with:

  1. Your heritage.  Think about your family, maybe schedule a family gathering, and look at old photos. How do their eye areas look at 30, 40, 50, and so on. You can see a lot. Does the skin sag on the upper lid drooping on the lateral part making it hard to see? Is there a hollowing on the upper eye area near the nose? Does the lower lid skin sag and get thin? Or is it more that there is a depression or hollow around the whole under eye area? Or is it just the “tear trough” closer to the nose?
  2. Good skincare products.  A good eye cream or two will help you. I use our MadisonMD Skincare Eye Rescue at night and both morning and night if I’m puffy. In the morning, I use the Pevonia eye cream if I’m not puffy. We have other good eye products in our shop.

Then think about:

  1. Fat transplantation. If the problem is a trough, then the goal is to fill it. Plastic surgery alone, which just tightens the skin, rarely works well for this.  So generally, filler or fat transplantation is effective. Fat transplantation, unless done by a truly expert surgeon, is tricky because it can’t be reversed. Whereas a hyaluronic filler can be reversed or adjusted fairly easily by an expert dermatologist.
  2. Hyaluronic acid filler. It’s really about the technique used and the product used. Generally, for example, Restylane works better than Juvederm because Juvederm attracts more water and can cause puffiness. Whereas Restylane in that location is more stable. It can take 2-3 syringes, properly placed, to fill this area. This depends on age and exact anatomy.  Whereas maintenance is usually 1 syringe a year once the base is set. This is an FDA off-label area so experts only please!
  3. Skin tightening.  If the skin is too loose on the lower lid or filler isn’t place properly, then adding just filler may cause a bag to form or make one worse.  Then plastic surgery to tighten that skin may be helpful. Or non surgically, a CO2 (carbon dioxide) laser, in my opinion, is the best laser to tighten in this area. 2-3 treatments over a year or two may be needed. The Thermage eyelid tip can be used as an aid. And even on it’s own in patients 45ish or under.

Hope this helps,

Dr. Brandith

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