Sunken Eyes


The skin on and around our eyes is some of the thinnest on the entire human body. That’s important to allow our eyelids to function and to allow us to create the breadth of expressions we form using our eyes.

But because the skin is so delicate it is susceptible to aging, damage from the sun and other environmental factors, and genetic tendencies. This can leave the area under our eyes sunken, dark, and hollow. Sometimes it’s just due to a poor night’s sleep or one drink too many the night before. But for others, their sunken under-eye area is a perpetual source of irritation.

What are Sunken Eyes?

These are the ways people typically describe sunken eyes:Hollowed look under the eyes
Dark circles underneath the eyes
Thin-looking skin under the eyes
Overall tired or fatigued appearance
Dark shadow over the lower eyelids“Sunken eyes” is one term for these problems. Others you may have heard are “tear trough hollows” or “under-eye hollows.” Most of these problems are due to aging, and they begin to show themselves in a person’s late 30s or early 40s.

What Causes Sunken Eyes?

These are cosmetic issues in the vast majority of cases. They can be due to a variety of factors:
Aging – Declining collagen production, slackening support tissues and muscles, decreasing fat, thinning skin: aging isn’t kind to our eyes.
Genetics – Odds are if you have sunken, darkened eyes, so did your parents.
Lack of sleep – Our society takes a perverse pride in not getting enough sleep. Getting less than seven hours frequently will show in your eyes.
Sun damage – If you already have darker skin under your eyes, the sun will make it darker.
Dehydration – This is usually a problem with children and severe dehydration, but if you don’t keep hydrated, your eyes become hollower.
Allergies – Seasonal allergies can cause dark circles to form under your eyes.
Sinus infections – Sinusitis and the inflamed nasal passages it creates makes your eyes appear dark and sunken.
Smoking – Smoking degrades collagen and causes your skin to lose elasticity. This leads to the sagging skin that exacerbates sunken eyes.

Can Your Cheeks Cause Sunken Eyes?

Some patients have lost volume in their cheeks, and this is causing their sunken eyes. Here, Dr. Douglas uses a thicker hyaluronic acid filler, Juvéderm Ultra Plus or Juvéderm Voluma. Returning volume to the upper cheek can effectively reduce under-eye hollowing.

How are Sunken Eyes Treated?

There are many home remedies you can use to improve your under-eye hollows. These include everything from applying almond oil to applying cold compresses, from drinking more water and less coffee, from sleeping more and smoking less. Even placing moist tea bags under your eyes is helpful.

But these usually won’t reverse your dark circles and sunken eyes. Dr. Douglas treats these conditions in his Beverly Hills practice with the use of dermal fillers or eyelid surgery.

How Do Dermal Fillers Help with Sunken Eyes?

Dr. Douglas uses his extensive knowledge of the anatomy of the eye area as an oculoplastic surgeon when using dermal fillers to treat sunken eyes. Soft cosmetic fillers made from hyaluronic acid can have excellent results when addressing the area under the eyes. These fillers offer a good deal of versatility for treating hollowness, deep tear troughs, and under-eye bags.

The best fillers for this area are Restylane, Restylane Silk, and Juvéderm Ultra. These are soft fillers that are appropriate due to the thinness of the skin under the eyes. Once injected, these fillers can move and flex with facial expressions. Dr. Douglas is also able to mold and customize the filler once it is injected.

A side benefit of these fillers is that, should the appearance not suit you, the filler can be instantly neutralized with the injection of an enzyme, hyaluronidase. This returns the area to its former appearance.

Is There Recovery After Dermal Fillers for Sunken Eyes?

There isn’t any recovery with these dermal filler injections. In some patients, there can be some bruising at the injection sites, but this only lasts a few days and can be easily hidden with makeup. There can be slight swelling, but this usually resolves within a few hours.

How Does Eyelid Surgery Help with Sunken Eyes?

Dr. Douglas can also perform transconjunctival blepharoplasty on the lower eyelids to address sunken eyes in some patients. This is not a difficult surgery or recovery. Dr. Douglas makes the incision inside the eyelid so there is no scarring. The fat that is causing under-eye bags is removed, repositioned, or sculpted. Dr. Douglas leaves some fat behind to avoid creating a hollow appearance.

As with the use of fillers, Dr. Douglas’s extensive experience with the anatomy of the entire eye area is a great benefit for his patients with these surgeries.

Are Sunken Eye Treatments Painful?

The majority of patients respond very well to treatment with dermal fillers for their sunken eyes. Depending on the patient, Dr. Douglas may apply topical numbing cream prior to these injections, ensuring they are painless.

For the rarer surgeries, these are not difficult recoveries, with most swelling resolving and recovery occurring in just a week or so.

What are the Risks Associated with Sunken Eye Treatments?

The dermal fillers Dr. Douglas uses for these treatments are made primarily from hyaluronic acid. Hyaluronic acid is a naturally occurring substance in the human body that is responsible for hydrating, plumping, and firming the skin. Because it exists naturally, these fillers are tolerated quite well. Over time, the body simply metabolizes the filler.

With lower eyelid surgery, the risks are low thanks to Dr. Douglas’s extensive training and experience as an oculoplastic surgeon. Still, there are the risks involved with any surgery: excessive bleeding, poor incision healing, infection, and the like. The main risks with eyelid surgery are problems with eyelid function, such as entropion or ectropion, where the eyelid turns inside out or outside in.

How Soon Will I See Results from Sunken Eye Treatment?

Dermal fillers provide instant results.

Are Sunken Eye Dermal Filler Treatments Permanent?

Dermal fillers used to treat sunken eyes don’t last quite as long as when used to treat issues such as marionette lines or smile lines. That’s because the area under the eyes moves more often, so the body tends to metabolize the filler more quickly. Some patients have longer results than others. You should expect these dermal filler results to last between 6-9 months.

Are Blepharoplasty Procedure Results for Sunken Eyes Permanent?

If you have lower eyelid blepharoplasty, your changes are permanent.

Schedule a Consultation

To schedule a consultation or to learn more about our Sunken Eye procedures, contact us today at (310) 657-4302. Our practice serves Beverly Hills, CA and our International office in Shanghai, China.

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