Sadly, the eyes are often the first to go. Under-eye puffiness and bags are common concerns, but there’s another concern that is being voiced more and more – ‘What can I do about my under-eye hollows?”  Over time, there’s an almost imperceptible hollowing. It happens slowly at first, but all at once, you notice how prominently in stands out. Perhaps you can’t pinpoint the cause, but one day you think “Wow. I look tired.”

Women who experience this feel like they look tired, even when they are not.   Yes, topical eye creams and treatments like Botox and lasers address the quality of the skin, but do not correct volume loss.

What are tear troughs?

The tear trough (in medical language: nasojugal groove) is the space that extends from the inner corner of the eye, making an arc shape, and continuing on to the outer corner of the eye. It’s basically the crescent-shaped area directly under your eye.  That volume loss causes the orbital bone, which is just under the tear trough and sits at the top of the cheek, to show more, creating a hollow trough that appears as a dark circle. The hollowness can also create a shadow that contributes to darkness under the eye.

Why do our eyes hollow out?

This may come as a surprise, but the most common factor is heredity. Thanks mom and dad!  To get a bit more technical, a hollowing of the eyes is caused by the inevitable downward shift of the face. We see this change as early as our 20’s, when we start to lose fat and collagen and the face starts to drop, creating a little concavity under the eye. As we age, fat in the cheek slides down the bones of the face (which are also thinning). A few things occur simultaneously that have a significant impact. The fat pads that shape this area begin to drop, leaving a hollow look. Concurrently, you also have bone loss, which offers less support to the area.  Finally, as we age, the elastin and collagen in the mid-dermis diminishes, which causes sagging to occur.  This process can be delayed by applying sunscreen daily, not smoking and wearing polarized sunglasses regularly to minimize damage.

Why Dermal Fillers?

To combat the hollowing effect, dermal fillers offer a game changing solution. Dermal fillers are comprised of hyaluronic acid, a naturally occurring sugar in the body that literally “fills” hollowed areas in order to restore volume under the eye and in the upper cheek.  The most popular filler to treat hollowing is Restylane® or Juvederm, ^® which delivers instant results.  And the best part?  If you don’t like the outcome, there is a treatment available that dissolves the dermal filler. One or two treatments are typically enough to see a difference, depending on the number of syringes used. How long the results last depend on skin type, lifestyle and age, but the typical longevity for filler is between six to eight months.

Most of the problem is concentrated in the mid-face, from the mid-eye down to the upper lip. As volume loss in the cheeks can also impact the look of the eyes, many aesthetic specialists look to that area to see if it needs to be restored in any way. It may sound counter-intuitive to start with anything other than the under eyes, but volume loss in the face has many effects.

To prove it here’s a little test for you to try at home (or even on your lunch break!): while looking in the mirror, pinch your outer cheeks (toward the temple) with all five fingers to lift them up a bit. When you do, you might notice under eye shadows lightening a bit. The added lift in the cheeks makes the under-eye hollows appear less deep and defined. Filler in the upper cheeks mirrors that effect in a natural way.

When doctors fill the cheek they typically do so with a thicker filler that creates volume, like Voluma or Restylane. They place it close to the bone so the result is a natural lifting of the facial tissue.

The technique for filling the tear trough is similar in that the hyaluronic acid is generally placed on top of the bone. Once you put the filler on top of the bone, you can use a Q-tip and roll it in there. You can see it going into the channel and filling it in. Doctors use a thin tube called a cannula to place the filler. It’s flexible so it doesn’t damage surrounding tissue as much as a regular needle. Patients are also less likely to bruise.

Instant Results

For patients, this procedure is instantly gratifying. The eyes and face seem brighter and more awake because the filler reduces under-eye hollowing. And while the procedure isn’t cheap, the instant results are a major upside, and justification enough for the spend. The procedure typically costs around $800, depending on how much filler is used. And because hyaluronic acid, the substance fillers are made of, is naturally occurring in the body, its effect is not permanent. The body eventually metabolizes the product.

But there are two points of good news. First, unlike other areas of the face that are more mobile and where filler only lasts about nine months, filler in the tear trough lasts closer to one year. Also, placing hyaluronic acid inside the skin stimulates collagen production. So, you may end up with some added, long-lasting benefits. Because of this effect, it’s great to start filling early.