Regardless of cause, a hollowed socket once present often needs to be addressed. While eyelid fat bulging tends to make the face look tired, periorbital hollowness (a sunken look around the eye) tends to make a face look sick.
That fact established, it should be emphasized that restoring a deflated socket is by no means a simple or fully predictable undertaking.
Upper eyelid hollowness seems to be more of a noticeable problem in the patient with prominent eyes that tend to push the eyelids forward, thus placing them on full display. In such cases, any hollowness may be partially camouflaged by a drooping brow or baggy upper lid skin, which if inadvertently corrected by browlift or blepharoplasty will only expose and magnify the lack of volume unless simultaneous surgical steps are undertaken to add or restore deep tissue fullness.
The negative appearance of lower eyelid hollowness may be further exaggerated by a number of other anatomic factors, such as poor bony formation below the eye (malar hypoplasia, treated with implants) or the downward drift of the fat and muscles of the cheek (midface descent, treated by midface lift). While surgical attention to such deficiencies may improve on overall appearance, this does little to restore actual volume to the area from which it is missing (that is, the eyelid and orbit).
Currently, restoring lost volume to hollowed eyes (and face and body, for that matter) is an area of intense interest and research in plastic surgery. While a detailed exploration of the pros and cons of every available technique is beyond the scope of this site, the following descriptions and comments may prove helpful:
• Orbital Pearl Fat Grafting
• Orbital Strip Fat Grafting
• Orbit-to-Orbit Fat Transfer
• Internal Orbital Fat Relocation
• Dermal Fat Grafting
• Fat Injections
• Injectable Dermal Fillers
