Should I get tear trough implants, fat grafting, or filler?
Hollowness under the eyes is a common problem that can even appear in young people.
People suffering from under eye hollowing often seek a permanent solution in the form
of implants, or fat grafting.
I’ll discuss how I counsel my patients about the options for under eye hollowing in my
I’m Dr Amiya Prasad.
I’m a Board Certified Cosmetic Surgeon and Fellowship Trained Oculofacial Plastic & Reconstructive
I’ve been in practice in Manhattan and Long Island for over 20 years.
For patients who’ve come to me for under eye hollowing, I have performed procedures
such as the placement of tear trough implants, as well as fat grafting.
I’m also well known for my work with cosmetic fillers throughout the face, including the
under eye area to treat hollowing and slight eye bags.
It’s a common request from patients is to have a permanent solution for many things
including under eye hollowness.
Earlier in my career, long before the introduction of injectable fillers, I would place implants
called tear trough implants.
Tear trough implants are made of soft silicone, and are specifically designed for the under
eye area.
When I perform tear trough implant surgery, I insert them through a transconjunctival
approach, meaning from the inside of the eyelids without any external or visible incision.
We understand very well how facial aging is proportionately greater at the bone level,
which means bone loss will progress regardless of the presence of an implant.
This means that with normal aging, the implant may become more visible and additional volume
would be needed.
Another so-called “permanent” option, which is offered is fat grafting.
Simply stated, fat does not provide uniform and predictable improvement and is likely
to not survive or worse become lumpy and irregular.
Patients come to us from around the world distressed about the results of fat grafting
under the eyes with the desire to have them removed.
Technically, the procedures for removal and grafted fat under the eyes is complex and
often requires multiple sessions..
Some doctors offer permanent or semi-permanent fillers.
In my opinion, if given a choice, I would prefer to use a filler that can be easily
If any of these semi-permanent and permanent fillers were to be seeded with bacteria resulting
in biofilm or frank infection, management can be very difficult.
Once again, placing something permanent in the soft tissue can be cosmetically problematic
as aging and volume loss naturally progresses.
Like fat grafting, removing permanent or semi-permanent fillers is an extremely complicated process,
and not all the material will be removed.
At this time, my preferred treatment for under eye hollowing is with a soft hyaluronic acid
filler such as Restylane or Juvederm.
I place these fillers in my office exam room with minimal trauma using blunt cannulas.
This approach allows me to improve under eye hollows with precision and usually without
Soft tissue fillers move well with facial expressions, and they have no rigid edges
which are more often associated with implants.
Hyaluronic acid that makes up fillers like Restylane and Juvederm occurs naturally in
the body, so these types of filler are well tolerated and safely metabolized by the body.
I find that a filler is more customizable than an implant.
Fat graft which can lose 30-70% of their mass during the healing process cannot be customized
in the way fillers can.
Further, I appreciate the security of being able to dissolve a hyaluronic acid filler
within minutes of placement of an enzyme called hyaluronidase.
Just as the face changes with aging as well as other factors such as weight gain and weight
loss, filler placement can be customized to these changes.
Hollow eyes are often associated with crepey and sun damaged skin.
I often use PRP or platelet rich plasma to improve the quality of the delicate under
eye skin.
PRP or platelet rich plasma is a concentration of the wound healing factors in your blood
which stimulates collagen and blood supply to the skin.
There is also a medically well established synergy between hyaluronic acid and PRP.
Placement of filler for the tear trough is quick, however I explain to my patients that
it takes about 2 weeks for the material to settle.
At the 2 week point, I look at the results and compare to the appearance before the procedure
and make adjustments as is appropriate.
When considering under eye hollowing treatment, it’s important to understand there are no
permanent treatments as the body itself is not permanent.
In particular, the bone and soft tissue.
The eye area is delicate, and eyelid skin is the thinnest skin in the body.
In comparing the options of tear trough implant, fat grafting and hyaluronic acid filler, my
preferred approach is the use of hyaluronic acid filler.
My ability to accurately contour with minimal trauma, with convenience as well as ease of
removal makes hyaluronic acid filler the best choice for my patients for tear trough and
hollow under eyes. Thank you for question