Ask someone what their number-one eye concern is, and puffiness comes up majority of the time. But, a close second, and something dermatologists and plastic surgeons are asked about frequently, is under-eye hollows (you may hear your doctor refer to this area as the tear trough).
More noticeable on slender faces without as much fat underneath the eyes, hollows can be hereditary or the result of aging and volume loss in the face—“a lack of sleep can make them appear worse, too,” says Fort Lauderdale, FL dermatologist Dr. Igor Chaplik. In the past, they’ve been tough to hide, as well as eliminate altogether, but modern options make the task easier than ever.
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“Currently, no fillers are FDA-approved in the U.S. to treat under-eye hollowing, but there is an FDA clinical trial in progress for using hyaluronic acid in the area,” says New Orleans dermatologist Skylar Souyoul, MD. Bannockburn, IL dermatologist Heather Downes, MD says the filler a doctor recommends for this area is important because “many of them are too thick or cause too much swelling under the eyes. For this reason, I only use Restylane or Belotero, both of which are hyaluronic acid fillers that give a natural-looking result without the swelling.”
Drs. Souyoul and Chaplik prefer Belotero: “I find it to be the most predictable and cohesive and least likely to cause a reaction,” says Dr. Chaplik. A newer hyaluronic acid filler to the market, Revanesse Versa, is also an option for this area.
Placement of the filler is also important. “When placed too superficially under the eyes, fillers can cause a bluish swelling called the Tyndall effect,” says Dr. Downes. “Therefore, I tend to inject fillers under the muscle layer in this area.” In some cases, doctors will suggest filling the cheeks as well, as Covington, LA dermatologist Christel Malinski, MD says the cheeks and tear troughs are intimately related. “If it’s necessary to address both, I most often use a more supportive filler, such as Restylane Lyft or Juvéderm Voluma, in the cheek area, and a softer filler, such as Restylane or Juvéderm Volbella, in the tear trough.”
Dr. Souyoul says “the tear trough is a very tricky area to fill,” so to ensure you’re getting safe injections and optimal results, be sure to choose a board-certified dermatologist or plastic surgeon who is familiar with facial anatomy and properly trained.
“I have seen so many patients who have had filler done very poorly under their eyes,” says Dr. Downes. “These patients were typically injected at a medspa by someone with questionable qualifications. I stress to my patients that a medspa isn’t a bargain when you have to go to a board-certified doctor afterward to have your fillers corrected. Typically, the way we correct or reverse them is by injecting hyaluronidase into the area, which dissolves the filler.”
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A lower eyelift, aka blepharoplasty, can remove any loose skin under the eyes that makes hollowing look worse, and the fat can be repositioned or added to smooth out sunken skin. “Lower blepharoplasty provides conservative repositioning or removal of the herniated fat,” says Lake Mary, FL facial plastic surgeon Edward J. Gross, MD. “Oftentimes we offer lower blepharoplasty along with hyaluronic acid fillers, which are always recommended after surgery for optimal results.”
“If you’re considering undergoing any type of treatment or procedure to address under-eye hollows, you should also be using a topical retinoid,” says Huntington Beach, CA dermatologist David Rayhan, MD.
“Topical retinoids, like prescription Retin-A or over-the-counter retinols, will improve the quality of your lower eyelid skin by smoothing small wrinkles and thickening the skin to help reduce the appearance of the hollow or dark circle. This will give you a better result from any treatment.” If OTC products are preferred, we like RoC Retinol Correxion Eye Cream ($18) and Avène RetrinAL EYES ($49).
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Helen Phillips, Sephora Collection’s national makeup artist, says the best way to mask under-eye hollows is by using various shades of foundation or concealer. “To start, use a foundation or concealer that matches the skin tone under your eyes. This provides a smooth base, as well as helps conceal darkness,” she explains.
“Using a flat concealer brush like Sephora Collection Pro Concealer Brush #71 ($22), lightly sweep a concealer that is at least two to three shades lighter than your skin tone where the deepest part of the hollow is. Using the same brush, lightly blend out the edges but leave the opacity of the light concealer in the center. If you are concerned about the concealer moving or creasing, set it with powder and a damp sponge or powder puff. Then sweep excess powder away with a clean brush.”
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