When smiling, the eyelid closing muscle contracts and draws the skin just above the orbital bone inward so that the transition is easier to see.

The area at and below the red dots is considered 'cheek'. Orbital volume does not influence the fullness in this area. Most "dark circles" below the eyes are thus not helped by pearl fat grafting.

When upper cheek hollowness is more widespread, this state is described as a "suborbital volume deficiency." As with a tear trough depression, this is a cheek phenomenon located below the eyelid.

In contrast to the other types of hollowness discussed in this section of our website, tear trough and suborbital volume deficiencies are not caused by a shortage of orbital fat and so are not helped by orbital fat grafting. This is a common point of confusion.

The easiest way to distinguish between upper cheek and true orbital hollowness is to look in a mirror and push your finger against the depression.

If you encounter bone, the hollowness is on your upper cheek. If you feel the eyeball, the hollowness is orbital.

Of course, if the hollowness developed only after lower blepharoplasty, it is likely orbital in origin.

If an upper cheek depression becomes overly deep with time, augmentation can be partially accomplished using the following methods . . .