Sunken under eyes happen when the area beneath your lower eyelids loses volume, creating a hollow or shadowed look that can make you appear tired or older. The good news is there are several ways to address it, from simple skincare adjustments to longer-lasting medical procedures. The right approach depends on how deep the hollowing is, what’s causing it, and how much correction you’re after.
Why Under Eyes Look Sunken
The hollow beneath your lower eyelid, sometimes called the tear trough, deepens when the structures supporting that area weaken or shrink. Several things happen at once as you age: the fat pads around your eye socket atrophy and shift downward, the cheekbone (maxilla) gradually loses density through bone resorption, and the ligaments anchoring skin to bone stretch and loosen. As these ligaments lose tension, the fat that once filled the space beneath your eye slides lower, leaving a visible depression.
Bone structure plays a role too. If your cheekbone doesn’t project forward very much, either naturally or from age-related changes, the gap between bone and skin in the tear trough area is larger. That creates a deeper-looking hollow even without significant fat loss. This is why some people develop sunken under eyes in their twenties while others don’t notice it until their forties or fifties.
Beyond aging, common contributors include genetics, dehydration, poor sleep, smoking, and significant weight loss. If your parents have prominent tear troughs, there’s a good chance yours will follow a similar pattern regardless of lifestyle.
What Skincare Products Can (and Can’t) Do
Topical products won’t rebuild lost fat or bone, so they can’t fully reverse deep hollowing. But they can improve skin quality in the under-eye area enough to soften the appearance of mild sunkenness. The key ingredients worth considering each work differently.
Hyaluronic acid serums and eye creams act as an immediate plumping fix, drawing water into the skin’s surface layers to temporarily fill out fine lines and make the area look less deflated. The effect is modest and short-lived, requiring consistent daily use. Retinol works on a longer timeline by accelerating cell turnover, which gradually thickens the skin and improves its texture over weeks to months. Because under-eye skin is extremely thin, start with a low-concentration retinol product and use it every other night to avoid irritation.
Vitamin C and peptides help strengthen the skin and make it more resilient over time. Vitamin C supports collagen production and can brighten dark shadows, while peptides signal your skin to produce more of its structural proteins. None of these ingredients will dramatically change a deep tear trough, but layering them into a consistent routine can make a noticeable difference for mild cases, especially when combined with better hydration and sleep habits.
Hyaluronic Acid Fillers
For moderate to significant hollowing, injectable hyaluronic acid fillers are the most popular non-surgical fix. A practitioner injects a small amount of gel into the tear trough to restore lost volume, smoothing the transition between your lower lid and cheek. The procedure typically takes 15 to 30 minutes, and you’ll see results immediately, though final results settle over a few weeks as swelling subsides.
Several filler products are commonly used in this area, and your injector will choose one based on the depth of your hollowing and your skin thickness. Softer, more fluid formulations tend to work best under the eyes because the skin there is so thin that a thicker product can look lumpy or create a bluish tint (called the Tyndall effect).
Results were long thought to last 6 to 12 months, but a retrospective study published in the Journal of Clinical and Aesthetic Dermatology found that tear trough fillers often persist well beyond that window, with significant results lasting up to 18 months after treatment. Swelling typically peaks about two days after injection and resolves within 3 to 7 days, with residual puffiness sometimes lingering for two weeks. By the third week, the area usually looks balanced and natural.
Risks Worth Knowing About
The under-eye area sits close to important blood vessels. If filler accidentally enters or compresses a vessel, it can cause skin damage or, in extremely rare cases, vision problems. Globally, at least 98 cases of filler-related vision loss had been reported as of 2015, across all facial injection sites. The highest-risk zones are the area between the eyebrows and the nose, not the tear trough specifically, but the proximity of these structures means the risk isn’t zero. This is why choosing a highly experienced injector, ideally an oculoplastic surgeon, dermatologist, or other specialist who performs tear trough injections regularly, matters more here than almost anywhere else on the face.
More common side effects include bruising, mild asymmetry, and overcorrection that makes the area look puffy instead of hollow. Hyaluronic acid fillers can be dissolved with an enzyme injection if the result isn’t right, which provides a safety net that other filler types don’t offer.
PRP (Platelet-Rich Plasma) Injections
PRP uses your own blood to stimulate collagen and improve skin quality under the eyes. A small blood draw is spun in a centrifuge to concentrate the growth factors in your plasma, which are then injected into the hollow area. Rather than adding volume directly like a filler, PRP works by triggering your skin to thicken and regenerate from within.
Most patients need 3 to 4 sessions spaced about 4 weeks apart. Results build gradually over 1 to 2 months after the final treatment and typically last 12 to 18 months. Studies show patients can expect a 30 to 50 percent reduction in dark circle appearance along with improved skin texture and fewer fine lines. PRP is a good option if your hollowing is mild to moderate and you prefer a more natural approach, though it won’t fill a deep tear trough as effectively as filler.
Surgical Options for Lasting Results
When hollowing is severe or you want a permanent solution, lower eyelid surgery (blepharoplasty) offers the most dramatic and durable correction. The modern approach has shifted significantly from older techniques. For decades, lower eyelid surgery meant simply removing the fat pads that cause puffiness, but this sometimes left eyes looking even more hollow, tight, or aged than before.
The current gold standard is fat repositioning (also called fat transposition). Instead of removing the fat, the surgeon shifts the existing fat pads from where they’re bulging into the hollow areas beneath the eyes. This smooths the transition between the lower lid and cheek, eliminating both puffiness and shadow in one step. The benefits include natural-looking results that age well, preservation of the eye’s youthful fullness, a lower risk of post-surgical hollowing, and long-lasting improvement without the need for ongoing filler maintenance.
Fat grafting is another surgical option, where fat is harvested from another part of your body (usually the abdomen or thighs) and injected under the eyes. This can work well but carries some unpredictability in how much of the transferred fat survives long-term, sometimes requiring a second procedure.
Recovery from lower blepharoplasty generally involves 1 to 2 weeks of noticeable bruising and swelling before you’re comfortable being seen in public, with full settling taking several months.
Matching the Fix to the Problem
For mild hollowing with thin, dull-looking skin, a consistent topical routine with retinol, hyaluronic acid, and vitamin C can make a visible difference over a few months. Better sleep and hydration genuinely help in these cases.
For moderate hollowing that bothers you in photos or without makeup, hyaluronic acid filler provides the most reliable non-surgical improvement. PRP is a reasonable alternative if you prefer to avoid synthetic fillers, though results are subtler. Many practitioners combine the two for a more comprehensive effect.
For deep, structural hollowing or people tired of repeating filler treatments every year or so, surgical fat repositioning delivers the most complete and permanent correction. It’s the biggest commitment in terms of cost, recovery, and risk, but it’s also the only option that truly restores the anatomy rather than compensating for lost volume temporarily.