Sunken eyes, often referred to as tear trough deformity or periorbital volume loss, are a common cosmetic concern that creates a tired or aged appearance. This hollowing under the eyes is characterized by a visible groove running from the inner corner of the eye down toward the cheek. The issue frequently stems from genetics and the natural process of aging, which causes fat atrophy and bone volume loss in the mid-face. Achieving a permanent correction for this structural deficiency typically requires targeted medical or cosmetic intervention. The following sections explore the range of established medical options available, aimed at restoring a smooth, refreshed contour to the under-eye area.
Non-Surgical Volume Restoration
Injectable dermal fillers, specifically those containing Hyaluronic Acid (HA), are the most common initial treatment for sunken eyes. This approach directly addresses the volume deficit by introducing a clear, gel-like substance that integrates with the existing tissue beneath the skin. The HA filler attracts and holds water, effectively plumping the tear trough and smoothing the transition between the lower eyelid and the cheek. The procedure is quick, minimally invasive, and offers immediate results with little downtime.
HA fillers are not permanent because the body naturally produces an enzyme, hyaluronidase, which gradually breaks down the gel over time. Results typically last between 9 to 18 months. Maintenance appointments are necessary to sustain the corrected contour, making this a long-term management strategy rather than a permanent fix.
Permanent Volume Replacement
For individuals seeking a permanent solution to periorbital volume loss, Autologous Fat Transfer, often called fat grafting, is a viable option. This surgical procedure uses the patient’s own fat cells, making it a natural alternative to synthetic fillers. The process begins with the gentle harvesting of fat, typically from the abdomen, thighs, or flanks, using a liposuction technique. The extracted fat is then purified to concentrate the healthy fat cells.
The refined fat is meticulously injected in tiny droplets into the hollowed tear trough area, ensuring a smooth, even distribution. The permanence of this technique lies in the successful integration of the transferred fat. Once the fat cells establish a blood supply and survive the grafting process, they become a living, stable part of the new tissue structure. The surviving fraction provides long-lasting, often permanent, volume restoration.
Structural Surgical Intervention
When sunken eyes are accompanied by prominent lower eyelid “bags,” the underlying issue is often structural, involving the bulging of orbital fat pads. In these cases, a Lower Blepharoplasty with fat repositioning offers the most comprehensive and lasting correction. Modern techniques, such as transconjunctival fat repositioning, preserve the fat and strategically use it to fill the adjacent hollow.
The surgeon accesses the fat pads through an incision hidden inside the lower eyelid (transconjunctival approach). Instead of excision, the orbital fat is gently released and repositioned over the bony rim and into the tear trough. This action simultaneously diminishes the appearance of the eye bags and smooths the depression, achieving a seamless, permanent contour between the eyelid and the cheek.
Patient Consultation and Post-Procedure Care
Before committing to any long-term treatment, a comprehensive patient consultation is necessary to assess the underlying anatomy and discuss realistic outcomes. Selecting a qualified, board-certified specialist, such as an Oculoplastic or Facial Plastic Surgeon, is important due to the delicate and complex anatomy of the periorbital area. The surgeon will review medical history and determine if the issue is primarily volume loss, structural fat bulging, or a combination of both.
Patients should be aware of potential risks, which include temporary bruising, swelling, and discomfort. Post-procedure care typically involves keeping the head elevated for the first week and applying cold compresses to minimize swelling. Patients are advised to avoid strenuous activity for at least one to two weeks.