Hollow under-eye areas, known clinically as tear trough deformity, can be treated with dermal fillers, surgical fat repositioning, or supportive skincare, depending on how pronounced the hollowing is. Fillers are the most common first-line option, with results lasting roughly 10 to 18 months, while surgery offers a more permanent correction. The right approach depends on what’s actually causing your hollows and how deep they’ve become.
What Causes Under-Eye Hollows
The sunken look under your eyes isn’t one single problem. It’s usually a combination of changes happening at every layer, from bone to skin. Understanding what’s driving your hollowing helps explain why some treatments work better than others for different people.
At the deepest level, the bony rim around your eye socket gradually shrinks with age. This bone loss is most noticeable along the inner cheek and the ridge just below your eye, and it creates a depression where the lower eyelid meets the cheek. On top of that, the small ligaments holding your under-eye fat pads in place loosen over time. As these ligaments stretch, fat can either slip downward (creating bags) or lose volume entirely (deepening the hollow). Both can happen simultaneously, which is why some people have puffiness directly above a hollow groove.
The skin itself plays a role too. Lower eyelid skin is already among the thinnest on your body, and it loses elasticity and thickness with age. Hyperpigmentation and sun damage compound the effect, making shadows appear darker and the hollow more pronounced. Genetics, dehydration, significant weight loss, and lack of sleep can all accelerate or exaggerate these changes, sometimes well before your 30s.
Dermal Fillers: The Most Popular Option
Hyaluronic acid fillers are the go-to non-surgical treatment for under-eye hollows. They work by physically replacing lost volume beneath the skin, smoothing the groove between your lower eyelid and cheek. One product, Juvéderm Volbella XC, received specific FDA approval for improving infraorbital hollowing in 2021, making it the first filler explicitly approved for this area. Other commonly used fillers include Belotero Balance, Restylane, and Juvéderm Vollure XC, all of which practitioners use off-label in the tear trough with well-documented results.
Older estimates put the duration of filler results at 8 to 12 months, with an average around 10.8 months of noticeable effect. But newer research using 3D imaging shows that measurable volume improvement can persist for about 14.4 months, and significant results have been documented up to 18 months after treatment. The under-eye area sees less muscle movement than lips or cheeks, which may help fillers last longer here than in other parts of the face.
The procedure itself takes 15 to 30 minutes. Most people return to normal activities immediately, with minor swelling settling within a few days. Results are visible right away, though the final look refines as swelling resolves over the first week or two.
Filler Risks Worth Knowing
The under-eye area is one of the higher-risk zones for filler injections because of the blood vessels running through it. Complications range from mild to severe. On the mild end, filler placed too superficially can create a bluish tint visible through the thin skin, called the Tyndall effect. Lumps, persistent swelling, and irregular contours are also possible and sometimes require dissolving the filler with an enzyme injection.
Rare but serious complications include vascular occlusion, where filler accidentally blocks a blood vessel. This can cause skin tissue death in fewer than 0.5% of cases, but the tear trough is specifically flagged as a high-risk zone for this complication. In extremely rare instances, filler near the eye can cause irreversible vision loss if it enters blood vessels supplying the retina. Warning signs include sudden blanching of the skin, intense pain, or vision changes during injection. These risks underscore why choosing an experienced, trained injector matters more here than almost anywhere else on the face.
Surgical Correction for Deeper Hollows
When hollowing is severe, or when puffy fat pads sit directly above the groove, surgery often produces a better result than fillers alone. The standard procedure is lower blepharoplasty, and surgeons have two main approaches for addressing the tear trough during the operation.
Fat repositioning (also called fat transposition) takes the bulging fat pads that create under-eye bags and shifts them downward into the hollow groove. This simultaneously reduces puffiness and fills the depression. A newer technique called segmental fat grafting transplants a small piece of fat into the tear trough area during the same surgery. A comparison of 339 lower blepharoplasties found that segmental fat grafting produced a greater reduction in tear trough width than traditional fat repositioning. Blinded expert reviewers rated the fat grafting results as superior or equal in 82% of cases. Complication rates were similar between the two approaches, at about 4%, with revision surgery needed in roughly 9% of cases.
Recovery from lower blepharoplasty typically means about a week before returning to work and daily activities. Initial improvements are visible within that first week, but full healing and final results can take several weeks to a few months as swelling fully resolves and tissues settle into their new position. The results are considered long-lasting, often permanent, though aging continues and some degree of hollowing may return over the years.
What Topical Products Can (and Can’t) Do
No cream or serum will fill a deep hollow. What topical treatments can do is modestly improve skin thickness and quality in the under-eye area, which helps reduce the shadowed appearance in mild cases.
A clinical study testing a gel containing retinol, vitamin C, vitamin E, and vitamin K on the under-eye area found measurable improvement in wrinkles after 8 weeks of daily use. About 47% of participants also saw a reduction in dark discoloration. Pigmentation was harder to treat and didn’t clearly improve. These results reflect what topicals realistically offer: gradual, subtle improvements in skin texture and tone rather than structural volume restoration.
Retinol (or its prescription-strength counterpart, tretinoin) is the most evidence-backed ingredient for thickening skin over time by stimulating collagen production. Vitamin C supports collagen synthesis and can brighten discoloration. Peptide-containing eye creams claim similar benefits, though the evidence is thinner. If your under-eye hollows are mild, a consistent topical routine with retinol and vitamin C may be enough to soften the appearance. For moderate to deep hollowing, topicals work best as a complement to fillers or surgery rather than a standalone solution.
Platelet-Rich Plasma Injections
Platelet-rich plasma (PRP) therapy involves drawing your blood, concentrating the growth-factor-rich portion, and injecting it under the eyes. The theory is sound: growth factors stimulate collagen production and tissue regeneration, which could improve skin density and reduce the hollowed look. PRP has been used for periorbital dark circles and facial rejuvenation, and some practitioners report improvements in skin quality over a series of treatments.
However, the evidence specifically for filling under-eye hollows is limited compared to fillers or surgery. PRP doesn’t add structural volume the way a filler does. It’s better understood as a skin-quality treatment that may complement other approaches. Multiple sessions are typically needed, spaced a few weeks apart, with gradual results developing over months.
Choosing the Right Treatment for Your Situation
Mild hollowing with thin, slightly dark skin often responds well to a combination of topical retinol and vitamin C, good hydration, and adequate sleep. These won’t reshape the area, but they can reduce the visual contrast that makes shadows more obvious.
Moderate hollowing, where the groove is clearly visible but you don’t have significant puffiness, is the sweet spot for hyaluronic acid fillers. One treatment session can smooth the contour for a year or longer, and the results are reversible if you’re unhappy with the outcome.
Deep hollowing, especially combined with under-eye bags, usually benefits most from lower blepharoplasty with fat repositioning or grafting. This addresses both the excess fat creating the bags and the deficit creating the hollow in a single procedure. The longer recovery time and higher cost are offset by results that last years rather than months.
Age, skin type, and bone structure all influence which approach makes sense. Someone in their late 20s with genetically deep-set eyes may get years of benefit from a single filler treatment, while someone in their 60s with significant bone loss and skin laxity may find that fillers alone can’t recreate the support structure that’s been lost.