CORRECTIVE GUIDE
Why hollow under-eyes happen, how Etonne corrects them, and why we prefer not to create them in the first place.
Hollow under-eye correction options: HA filler (temporary, 6–12 months), fat grafting (autologous, semi-permanent), or fat repositioning (only viable for primary cases, not revision). The most common cause of hollow eyes is aggressive fat excision lower blepharoplasty performed elsewhere — Etonne does not perform aggressive fat excision.
Hollow under-eyes — sometimes called sunken eyes or skeletal under-eyes — most commonly result from aggressive fat excision during a previous lower blepharoplasty.
For much of the 20th century, lower blepharoplasty meant removing herniated orbital fat. Patients in their 40s and 50s with under-eye bags emerged with smooth, flat under-eye contours.
The problem became visible 5–10 years later. Without the volume the excised fat had provided, the under-eye region collapsed. The tear trough deepened. The orbital rim became visible through the thin skin. The face read as older than chronological age.
ETONNE'S POSITION
Our default lower blepharoplasty technique is fat repositioning — moving the herniated fat downward into the tear trough, where it fills the depression rather than being thrown away.
Volume is preserved. The under-eye does not collapse 5 years later. For patients who already have hollow under-eyes from prior surgery elsewhere, the corrective options below apply.
CORRECTION OPTIONS
Fat is harvested from another body site (typically abdomen or inner thigh), processed, and injected into the tear trough region. Permanent volume restoration with typical 60–80% retention after the first 3 months. No risk of Tyndall effect. Recovery 7–10 days.
A surgical procedure that releases the tear trough ligament — the fibrous attachment between the lower lid skin and the orbital rim — allowing the soft tissue above to redrape. Often combined with a small amount of fat grafting.
Tyndall effect risk: filler in thin under-eye skin can produce a bluish discoloration. Once Tyndall effect is established, additional filler often makes it worse. Filler is appropriate as a "test" or bridge, not long-term.
For severe hollowing with significant tear-trough depth, the most reliable correction is fat grafting + tear-trough release in the same operation.
HONEST DISCLOSURE