Under Eye Hollows

Dr. Brock Lanier, MD, FACS  |   OncoPlastic Surgery in Newport Beach

What Causes Under-Eye Hollowing?

Anything that causes a loss of volume or thinning of the skin in the under-eye area can contribute to hollowing.

Aging:

As we age, we naturally lose collagen and elastin, which are proteins that keep our skin firm and elastic. This loss leads to thinning skin and a decrease in facial fat, causing the under-eye area to appear hollow.

Genetics:

Some people are genetically predisposed to having deeper tear troughs or thinner under-eye skin. This means that under-eye hollowing can run in families.  

Dehydration:

When the body is dehydrated, the skin loses its plumpness, which can make under-eye hollows more noticeable.  

Lack of Sleep:

Insufficient sleep can cause the skin to appear dull and the blood vessels under the eyes to become more visible, emphasizing the appearance of hollows.  

Weight Loss:

Significant weight loss can result in a loss of facial fat, including the fat pads under the eyes, leading to a hollowed appearance.

 Sun Exposure:

Excessive sun exposure can damage collagen and elastin, accelerating the aging process and contributing to under-eye hollowing.  

Smoking:

Smoking also damages collagen and elasin, and contributes to premature aging of the skin.

Treating Under Eye Hollows

At our medical practice we get a lot of questions about the best way for treating those under eye hollows. You should be an individual - and get a personalized assessment by a board-certified plastic surgeon.

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Under-Eye Hollows: treatment options at a glance

  • Hyaluronic acid-based fillers (e.g., Juvederm Volbella) are injected into the tear trough area to restore lost volume, smooth transitions, and reduce shadowing under the eyes. Results are immediate, predictable, and last 6 months to 2 years depending on the product used. The procedure is quick and virtually painless, with minimal downtime.

  • Also known as collagen induction therapy, microneedling involves creating microscopic-sized pinpricks in the skin to stimulate collagen and elastin production. This enhances skin texture and firmness, helping reduce the appearance of hollows over time.

  • Chemical peels and laser facials exfoliate the outer layers of skin, improving texture, reducing pigmentation, and stimulating collagen production. This treatment brightens the under-eye area and enhances overall skin quality.

  • SkinTyte uses infrared light to heat the dermal layer of the skin, stimulating collagen production and causing collagen fibers to contract. This process tightens and firms the skin over time, improving sagging and fine lines. It is non-invasive, painless, and requires no downtime, making it suitable for delicate areas like the skin around the eyes. It is safe for use on the sensitive area around the eyes, but not typically applied to the eyelids themselves.

  • Topical treatments and eye creams containing ingredients such as hyaluronic acid and vitamin C can improve skin hydration and texture decreasing the laxity and also minimize discoloration. Topical hyaluronic acid is the same substance as the dermal filler. It can hold and lock-in a lot of water, more than a hundred times its weight of water. That’s why hyaluronic acid is a hydrator, rather than simply a moisturizer. This is important but it can really plump and thicken the skin around the cheek and eyelid junction where the hollows form.

  • Adequate hydration, balanced nutrition, sun protection (e.g., sunscreen), and sufficient sleep can prevent worsening of under-eye hollowing over time.

  • Surgery with an eyelid lift can simultaneously address all the causes of under eye hollowing - both skin tightening and under eye volume loss. It is a long-term solution. It is typically reserved for significant under eye hollowing. It is a is a surgical procedure, done as an outpatient (you can go home same day), with recovery time typically lasting 1.5–2 weeks.

Our practice, SoCal OncoPlastic Surgery, offers all of these options. And the practice specializes in individualized evaluations in oder to avoid one size-fits all treatment approaches. The most important thing is to get expert advice from a board-certified plastic surgeon, like Dr. Lanier, at SoCal OncoPlastic Surgery.

Treatment Areas & Concerns

The most common area treated is the face, neck, chest, arms, & hands. However, microneedling can be performed almost anywhere. Stretch marks on the stomach and thighs are popular targets for treatment.

What are the benefits and risks?

Microneedling Benefits

  • Reduced Appearance of Scars: Can help fade acne, surgical, and other types of scarring (including stretch marks). It will not completely erase scars.

  • Improved Skin Tone and Texture: Can help even out skin tone, minimize the appearance of large pores, and improve overall skin texture.

  • Reduced Wrinkles and Fine Lines: Can help diminish the appearance of fine lines and wrinkles with the stimulation of increased collagen production.

  • Increased Product Absorption: Can enhance the absorption of topical skincare products.

Microneedling Risks

While generally safe, the microneedling does carry some potential risks and side effects. These include:

Skin Irritation: redness, swelling, mild discomfort, dryness, & flaking. These are common side effects that usually subside within a few days.

More Serious Risks (Less Common):

  • Bruising

  • Bleeding: More likely in individuals with bleeding disorders or those on blood thinners.

  • Infection: never re-use or share needle cartridges.

  • Pigmentation Changes: Temporary or permanent changes in skin color, particularly in people with darker skin tones.

  • Very rarely, scarring and/or nerve damage (including numbness and/or tingling) can occurs, especially if the procedure is not performed correctly.

Due to these potential risks and complications, it is recommended to choose an experienced board-certified plastic surgeon.

Who is it for?

Microneedling typically has no downtime and a short overall recovery. It can restore & improve the skin’s appearance, as well as help maintain skin health. Good candidates are individuals who are in good overall health, have realistic expectations, and are looking to address issues like:

  • Scarring

  • Fine lines and wrinkles

  • Uneven skin tone or texture

Microneedling is one of the most popular options for both men and women in all age groups.

How is it performed?

  • It is performed in the comfort of the clinic.

  • The skin is cleaned and a numbing cream is usually applied to the treatment area.

  • A pen-shaped device with tiny needles is moved across the skin, creating tiny punctures. It usually takes about 30-45 minutes to perform.

  • The micro-injuries help release and improve scars, and they stimulate the skin's natural healing response to trigger more collagen and elastin production. This helps improve skin texture, firmness, and its overall appearance.

  • Multiple sessions are typically required to achieve the best results.

After your treatment…

Immediately after the treatment, your skin will likely:

  • Look red and feel warm, similar to a mild to moderate sunburn

  • Feel tighter than usual

  • Be more sensitive

These effects are normal and usually subside within 24-48 hours.

Recovery & Results

At home. Usually there is no downtime but the healing process goes through phases. It will be very important to moisturize and avoid direct sun exposure/wear sun protection.

First Few Days

During the first 2-3 days post-treatment:

  • Redness and sensitivity may persist

  • Mild swelling and possible bruising might occur

  • The skin may feel dry, flaky, and itchy

  • You might experience some pinpoint bleeding

Recovery Timeline

Days 1-2: Your skin will be red, sensitive, and possibly swollen.

Days 3-5: Redness and sensitivity should start to improve. Skin may sometimes flake or peel. You might feel mild itching or tingling.

Days 6-10: Flaking and peeling may continue. Skin may feel dry or rough if moisturizers are not used regularly.

Days 11-14: Most of the visible healing is complete, though some mild redness or discoloration may persist.

Visible improvements in skin tone and texture typically start to appear 2-4 weeks after the procedure. Collagen and elastin production increases, leading to improved skin firmness and elasticity.

Full results may continue to develop for several months.

Repeat microneedling is usually performed after about 6 weeks in order to achieve the best results.

Microneedling Skin Rejuvenation.

Microneedling a minimally invasive procedure that can help you achieve smoother, younger-looking skin by reducing the appearance of scars, wrinkles, and texture.

Get customized treatment from a board-certified plastic surgeon.

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