One of the first signs of aging is hollowing out under the eyes. Patients often ask about having fillers injected to make the tear troughs appear plumper. Although injectable fillers are a wonderful tool to enhance a patient’s appearance for many areas of the face, they don’t always yield the best results when used under the eyes. In many cases I recommend eyelid surgery at my Chicago practice because the hollow appearance is caused by the lack of fat, which I can reposition during this surgery and if necessary supplement with additional fat added as a graft (taken from another site such as the abdomen).
Blepharoplasty, combined with fat grafting, can produce excellent results for patients who want a fuller look beneath their eyes. One of the reasons patients have hollows below their eyes is because the muscle surrounding the eyes attaches to the bones without tissue, which would provide more volume. Treating the area with fillers risks getting uneven results.
Blepharoplasty on the lower lids surgically releases the muscle from the bone and, if enough fat is present, it can be rearranged to help fill the hollow areas. Grafting with small amounts of fat taken from another part of a patient’s body is also useful in some cases.
Keep in mind that regardless of the treatment chosen, the most important factor when treating hollows under the eyes is the skill and experience of the plastic surgeon performing the procedure. If performed properly, eyelid surgery can be a relatively simple procedure with a short recovery period that can make a big difference in a person’s look.
For many patients, fat grafting (as a better alternative to fillers in my experience) can be performed without surgery. Fat grafting is done in the office by taking a tiny amount of fat from another location such as the abdomen, and then using micro cannulas through a small needle stick can be placed into the hollow area. Fat is softer, and smoother than a filler, but has the disadvantage that it is difficult to remove if too much is added. Experience is important, and having done several hundred, I can attest to that. There is minimal swelling, but minor bruising can last for several days.