Treating Under Eye Hollows with Fillers or Implants, and Why Fat Grafting Isn’t Advised

Hollowness under the eyes is a common problem
that can even appear in young people. People suffering from under eye hollowing
often seek a permanent solution in the form of implants, or fat grafting. I’ll discuss how I counsel my patients about
the options for under eye hollowing in my practice. I’m Dr Amiya Prasad. I’m a Board Certified Cosmetic Surgeon and
Fellowship Trained Oculofacial Plastic & Reconstructive Surgeon. I’ve been in practice in Manhattan and Long
Island for over 20 years. For patients who’ve come to me for under
eye hollowing, I have performed procedures such as the placement of tear trough implants,
as well as fat grafting. I’m also well known for my work with cosmetic
fillers throughout the face, including the under eye area to treat hollowing and slight
eye bags. It’s a common request from patients is to
have a permanent solution for many things including under eye hollowness. Earlier in my career, long before the introduction
of injectable fillers, I would place implants called tear trough implants. Tear trough implants are made of soft silicone,
and are specifically designed for the under eye area. When I perform tear trough implant surgery,
I insert them through a transconjunctival approach, meaning from the inside of the eyelids
without any external or visible incision. We understand very well how facial aging is
proportionately greater at the bone level, which means bone loss will progress regardless
of the presence of an implant. This means that with normal aging, the implant
may become more visible and additional volume would be needed. Another so-called “permanent” option,
which is offered is fat grafting. Simply stated, fat does not provide uniform
and predictable improvement and is likely to not survive or worse become lumpy and irregular. Patients come to us from around the world
distressed about the results of fat grafting under the eyes with the desire to have them
removed. Technically, the procedures for removal and
grafted fat under the eyes is complex and often requires multiple sessions.. Some doctors offer permanent or semi-permanent
fillers. In my opinion, if given a choice, I would
prefer to use a filler that can be easily removed. If any of these semi-permanent and permanent
fillers were to be seeded with bacteria resulting in biofilm or frank infection, management
can be very difficult. Once again, placing something permanent in
the soft tissue can be cosmetically problematic as aging and volume loss naturally progresses. Like fat grafting, removing permanent or semi-permanent
fillers is an extremely complicated process, and not all the material will be removed. At this time, my preferred treatment for under
eye hollowing is with a soft hyaluronic acid filler such as Restylane or Juvederm. I place these fillers in my office exam room
with minimal trauma using blunt cannulas. This approach allows me to improve under eye
hollows with precision and usually without bruising. Soft tissue fillers move well with facial
expressions, and they have no rigid edges which are more often associated with implants. Hyaluronic acid that makes up fillers like
Restylane and Juvederm occurs naturally in the body, so these types of filler are well
tolerated and safely metabolized by the body. I find that a filler is more customizable
than an implant. Fat graft which can lose 30-70% of their mass
during the healing process cannot be customized in the way fillers can. Further, I appreciate the security of being
able to dissolve a hyaluronic acid filler within minutes of placement of an enzyme called
hyaluronidase. Just as the face changes with aging as well
as other factors such as weight gain and weight loss, filler placement can be customized to
these changes. Hollow eyes are often associated with crepey
and sun damaged skin. I often use PRP or platelet rich plasma to
improve the quality of the delicate under eye skin. PRP or platelet rich plasma is a concentration
of the wound healing factors in your blood which stimulates collagen and blood supply
to the skin. There is also a medically well established
synergy between hyaluronic acid and PRP. Placement of filler for the tear trough is
quick, however I explain to my patients that it takes about 2 weeks for the material to
settle. At the 2 week point, I look at the results
and compare to the appearance before the procedure and make adjustments as is appropriate. When considering under eye hollowing treatment,
it’s important to understand there are no permanent treatments as the body itself is
not permanent. In particular, the bone and soft tissue. The eye area is delicate, and eyelid skin
is the thinnest skin in the body. In comparing the options of tear trough implant,
fat grafting and hyaluronic acid filler, my preferred approach is the use of hyaluronic
acid filler. My ability to accurately contour with minimal
trauma, with convenience as well as ease of removal makes hyaluronic acid filler the best
choice for my patients for tear trough and hollow under eyes.

18 thoughts on “Treating Under Eye Hollows with Fillers or Implants, and Why Fat Grafting Isn’t Advised

  1. if one takes finasteride during an early onset of baldness,and he continues it for 10 years.will he delay the baldness for that time.let us say he takes at 20 and stops at 30..if he had not taken finasteride he would have been bald at question is will the person get bald by 50 after quitting at 30 as he had delayed 10 years…

  2. Hello doctor, i know this comment is not related to the video but i wanted to ask. I am 20. I've been using minoxidil shampoo for 3 weeks or so and i am using it once a day, but my hair loss is increasing compare to before. Should i keep using it or not. Thanks for answering…

  3. Hello dr! My skin is oily and I have been suffering from a lot of pimples since 2017 and I never pick them but they get accidently scratched when I wash my face for apply moisturizer but they haven't scared yet…what procedure is best to prevent scars? Thanks in advance!

  4. Hello Doctor,
    I have genetic dark circles. I been using foundation since I was 12 and now I’m 22. I would like to change that. Do you recommend prp ? I don’t want to get fillers. Do you know any good doctors in Santa Barbra/ Ventura CA area? Please answer

  5. Dear sir ,
    i have loss my crown area hair a lot and remaining are very thing . i am still 24 years old.but my body hair (leg , chest,back) are very thick and the volume is a lot any suggestion please?

  6. Hi Dr Amiya,
    Dermal fillers used for acne scars are said to last only for about 6 months to 1 year, After which the treatment will have to be redone to maintain the result.
    Are acne scars for life? I'll have to continue getting the fillers done every one year for life long?

  7. Doctor, could you please explain the difference (mechanism, effectiveness) between injecting PRP & topical application of PrP with derma roller with respect to treating
    1. Hair thinning
    2. Under eye hollows

  8. Hi doctor!
    You are my favorite, most trusted , unbiased plastic surgeon. I had consulted you many time (with another id )for my unsatisfactory upper/lower blapharoplasty results, and you always replied me. I love your caring attitude.
    Now I'm again here , needing your advise. I was suffered with (left side of my whole body) minor paralysis attack when my age was just few months. It was almost fully recovered except some minor facial asymmetry because of left side facial paralysis that was not much noticeable in my young age, but as I crossed 40s, the difference starts to noticeable. It seems like bell palsy affected side. I consulted a cosmetic surgeon for less invasive treatment for correction,he recommend facial fat grafting for affected side and for under eye's bags irregularities like big bumps(,more prominent from right eye side resulted from blepharoplasty).
    Now my question is: if I avoid fat grafting for under eyes. Although some surgeons in www.real forum are in favor of fat grafting under eyes based on surgeon's successful techniques. My surgeon charge me a high price for cheeks tear trough ,nasolabial fold of affected side and under eyes.
    Kindly guide me if I avoid under eyes area as you are not in favor of fat grafting under thin and delicate area of lower lids in your videos then should I still consult a highly expensive surgeon, (but experienced) or any other less experienced with low charges surgeon can do well for cheek area near tear trough and nasolabial fold of one affected side to bring symmetry. One more thing would you advised fat grafting for upper eye lid, as my left eye also have some hollow area (big groove)after xanthalasma removal during blepharoplasty, which gives a impression of hollowness from one upper lid.
    Thanks in advance.
    Love your humanity and caring attitude.

  9. What if you have severe hollow sunken under eyes and the fillers pluss prp are to no help at all for the volume loss??

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