Though due to a shortage of orbital fat, lower eyelid hollowness has a variety of possible causes, ranging from heredity to aging to overdone surgery. While bulging lower eyelid fat will make a face look tired, volume deficiency makes a face appear prematurely old or chronically ill.

When due to inherited traits, lower hollowness is usually mild to moderate and may be at least partially camouflaged with cosmetics. When inherited hollowness is more severe, surgery may be considered.

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.

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Where the Eyelid Ends and the Cheek Begins
Woman faintly smiling to accentuate the demarcation between the eyelid and the upper cheek. When smiling, the eyelid closing muscle contracts and pulls the skin just above the orbital bone inward so that the transition is easier to see.	The area at and above the red dots is considered 'eyelid'. Deep orbital volume influences the fullness in this area. The area below the red dots is considered 'cheek'. Orbital volume does not influence the fullness in this area.