Effective Treatments and Causes for Sunken Eyes and Under-Eye Hollows

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Sunken eyes and under-eye hollows, also known as tear trough deformities, are common cosmetic concerns that can affect individuals of all ages. These hollows, which appear as triangular-shaped depressions under the eyes, can make a person look tired, aged, and unhealthy. Understanding the causes and exploring effective treatments can help alleviate this issue, improving both appearance and self-confidence.

Causes of Sunken Eyes and Under-Eye Hollows

Genetic Predisposition and Anatomy

Some individuals are naturally predisposed to have more prominent under-eye hollows due to their genetic makeup and anatomical structure. These features can be present from a young age and are characterized by a thinner and more underdeveloped under-eye area, leading to a more noticeable nasojugal fold—the junction between the thin skin under the eyes and the thicker skin of the upper cheek.

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The appearance of sunken eyes becomes more pronounced with age due to several factors:

  1. Skin Thinning and Elasticity Loss: As we age, the skin around the eyes, which is already delicate and thin, becomes even thinner and loses its elasticity. This contributes to the prominence of under-eye hollows.
  2. Volume Loss: Aging causes the loss of facial volume, including the redistribution of fat pockets and the resorption of bone. This results in the descent of the cheek, creating a hollow appearance under the eyes.
  3. Muscle Weakening: The muscles that support the tissues around the eyes weaken over time, contributing to the sagging and formation of hollows.
  4. Bone Resorption: The bones that form the eye socket undergo resorption with age, making the eye socket larger and causing the soft tissues to sag.

Additional Contributing Factors

  1. Hyperpigmentation: Dark circles under the eyes can be caused by hyperpigmentation, which may be due to genetics, sun damage, or prominent under-eye veins. This can create the illusion of deeper hollows.
  2. Fat Prolapse: Prolapse of the orbital fat pad under the eyes can lead to the appearance of under-eye bags and exacerbate the hollow look.
  3. Wrinkling: Rhytidosis, or wrinkling under the eyes, can also contribute to the appearance of sunken eyes and should be considered when planning treatment.

Effective Treatments for Sunken Eyes and Under-Eye Hollows

Treating under-eye hollows effectively requires a tailored approach that considers the specific causes and contributing factors for each individual. Both non-surgical and surgical options are available, with varying degrees of effectiveness based on the underlying issues.

Non-Surgical Treatments

  1. Tear Trough Fillers

    Tear trough fillers are a popular non-surgical option for treating under-eye hollows. These fillers typically contain hyaluronic acid (HA), a substance that helps restore volume and smooth out the depression. HA fillers can last anywhere from six months to two years, depending on the individual.

    However, tear trough fillers are technically challenging to administer. The under-eye area is prone to unusual light scattering, making it difficult to achieve smooth contours. Therefore, the skill of the injector is crucial in obtaining a satisfactory outcome. Ideal candidates for tear trough fillers have thick, smooth skin and well-defined under-eye hollows without significant fat prolapse or hyperpigmentation.

  2. Autologous Fat Transfer

    This procedure involves harvesting fat from other parts of the body, such as the thighs, buttocks, or abdomen, and injecting it into the under-eye area. The fat helps restore volume and smooth out the tear trough. While some of the injected fat may be reabsorbed by the body, the procedure can offer longer-lasting results compared to HA fillers.

    Autologous fat transfer is typically performed through a small incision hidden in the natural crow’s feet around the eyes. Complications are generally minor and may include swelling, discomfort, and, in rare cases, irritation of the conjunctiva.

Surgical Treatments

  1. Blepharoplasty

    Blepharoplasty, or eyelid surgery, has advanced significantly and now focuses on preserving orbital fat while addressing mid-facial volume loss and cheek descent. This surgical approach can rejuvenate the under-eye area by strategically removing or repositioning fat and tightening the skin.

    Modern blepharoplasty techniques can be combined with fat transfer to maximize the improvement of the lid-cheek junction, resulting in a more youthful appearance. The procedure’s complexity requires a skilled surgeon, preferably one specialized in oculoplastic surgery.

  2. Infraorbital Rim Implants

    For individuals with significant bone loss around the eyes, infraorbital rim implants can be an effective solution. These implants help replace the lost bone volume, providing better support for the soft tissues and reducing the appearance of hollows. Complications from this procedure can include eyelid tightness and irritation, but these risks are typically manageable with appropriate medical care.

Skin Care Products and Temporary Solutions

While various skin care products claim to reduce dark circles and under-eye hollows, their effectiveness is limited. These products may provide temporary brightening effects by hydrating the skin, but they do not address the underlying anatomical changes. Concealers and makeup can be effective for camouflaging the appearance of sunken eyes, but they are not a permanent solution.


Sunken eyes and under-eye hollows can be caused by a combination of genetic, anatomical, and age-related factors. Effective treatment requires a comprehensive understanding of the underlying causes and a personalized approach. Non-surgical options like tear trough fillers and autologous fat transfer offer temporary solutions, while surgical treatments such as blepharoplasty and infraorbital rim implants provide more permanent results. Consulting with a qualified medical professional can help determine the best treatment plan to achieve a rejuvenated and youthful appearance.


Rejuvenated and youthful appearance

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