If lower hollowness follows over-resection of fat during lower blepharoplasty, the loss of normal eyelid fullness and contour may be extremely bothersome as well as unattractive and cause patients to seek volume augmentation to help restore former appearance.

When deficient in volume, orbital fat is unable to provide adequate support for the eyeball and eye. The eyelid skin and muscle can collapse inward and the eyeball drops slightly downward under the influence of gravity. Minus sufficient "padding," the rim of the socket bone can become visible, a process described as "skeletonization."

Lower eyelid hollowness due to fat deficiency is treated by orbital pearl fat grafting.

Note: Upper cheek hollowness (tear trough, dark circles) is a distinct issue unrelated to eyelid or orbital fat deficiency. Since such depressions may occur very close to each other, they are often confused. However, treatment for cheek hollowness is very different and does not involve orbital fat grafting. For more, see the photos just below:

The area below the red dots is considered 'cheek'. Orbital volume does not influence the fullness in this area.