Dr Bhavin Garara
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Hollow Eyes

Hollow Eyes

Hollow eyes — clinically described as the tear trough — are a depression at the junction where the lower eyelid meets the cheek. The depression catches overhead light and casts a shadow downwards, often producing the appearance of dark circles or chronic tiredness. The tear trough is one of the most anatomically demanding areas of the face to treat: it is supplied by branches of the ophthalmic artery, the skin is very thin, and conventional filler placed superficially can produce chronic puffiness, a bluish discolouration (the Tyndall effect), or — rarely but seriously — vascular complications. For these reasons the clinic’s approach is foundational and conservative: support the cheekbone scaffolding underneath rather than place filler into the eyelid itself.

Medically reviewed by Dr Bhavin Garara, GMC 7155707 · Last reviewed: 31 March 2026

On this page

The tear trough is a specific anatomical zone where injection-related complications can have serious consequences. The page below describes how the clinic addresses this conservatively and what the safety considerations are. If you have previously had filler placed directly into the tear trough and are concerned about migration, puffiness, or discolouration, see our filler removal and dissolving page.

What it is

What Are Hollow Eyes / Tear Troughs?

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A youthful lower-eye area has a smooth, continuous transition from the lower eyelid down into the cheek. The bony orbital rim is well-supported by fat pads, and the soft tissues drape evenly across that scaffolding. When the mid-face fat pads decline, the bony orbit subtly remodels, and the cheek descends, the transition becomes a step rather than a curve — the tear trough deformity.

Dr Bhavin Garara’s approach is foundational. The aim is to address the underlying volume loss in the cheek and orbital rim, so the tear trough is lifted out of shadow without placing volume directly into the very thin eyelid skin.

Side by side

Why a Foundational Approach Matters

The tear trough is widely treated, but it is also widely treated badly. Common patterns of complication include:

Chronic puffiness

Hydrophilic (water-loving) hyaluronic acid placed superficially in the eyelid skin attracts water over weeks and produces persistent under-eye swelling.

The Tyndall effect

A bluish discolouration that appears when filler is placed too superficially and scatters light through the very thin skin.

Migration

Product moves from the intended location into adjacent tissue, distorting the lid-cheek contour.

Vascular events

Rare but recognised — including, in worst cases, skin necrosis or vision loss when product enters small arteries that connect to the ophthalmic artery.

For these reasons, Dr Garara’s strategy is to address the volume loss underneath the tear trough rather than fill the trough itself. By restoring support on the cheekbone and orbital rim, the tear trough is gently lifted out of shadow without placing product into the highest-risk part of the eye area.

What causes it

What Causes Hollow Eyes?

  1. 1

    Mid-face volume loss

    The fat pads of the cheek and the area just below the eye (the suborbicularis oculi fat, or SOOF) gradually lose volume with age. Without support beneath, the lower lid skin drapes more loosely and the tear trough becomes more visible.

  2. 2

    Bony remodelling of the orbit

    The shape of the bony eye socket changes subtly over decades. The orbital rim opens and the lower edge moves inferiorly, deepening the natural groove at the lid-cheek junction.

  3. 3

    Descent of the cheek

    Loss of structural support in the cheek allows the malar fat pad to descend, exposing the orbital rim above and creating the step from lid to cheek.

  4. 4

    Thin under-eye skin

    The skin of the lower lid is the thinnest on the body. As collagen and elastin decline with age, the thin skin reveals the underlying anatomy more clearly — including the tear-trough depression.

  5. 5

    Genetics

    Some people have a deep tear trough from a young age — a function of bony anatomy and fat-pad distribution rather than ageing. The cause is the same; the timing is earlier.

  6. 6

    Dehydration, sleep deprivation, and short-term factors

    These do not cause the depression but make it look more pronounced day to day. They are aggravating factors, not the underlying issue.

Dr Bhavin Garara
Dr Bhavin Garara, MBBS, BMedSci, PGDip
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Dr Garara's approach

How Dr Garara Treats Hollow Eyes

From this, he designs a plan that usually leads with structural support placed on the cheekbone and orbital rim, then layers in skin-quality treatments to improve the very thin under-eye skin, and considers autologous regenerative options where they suit the patient and the anatomy.

At the clinics in London, Dr Garara assesses at consultation the depth and shape of your tear-trough depression, the position and support of your cheekbone and mid-face fat pads, the quality and thickness of the under-eye skin, the relationship between the tear trough and any pigmentation or vascular component (see dark circles), and your suitability for the various structural approaches available.

  • Anatomy-led assessmentTreatment plans built around your unique facial structure and movement.
  • Personalised planCombinations chosen for your skin, goals, and lifestyle — not a one-size-fits-all protocol.
  • Natural resultsA refreshed, well-rested version of you — never a frozen or over-treated look.

Features

Treatment Options for Hollow Eyes

Structural support on the cheekbone and orbital rim, Seffiller (autologous regenerative), skin-quality treatments, and — for some patients — surgical referral.

Structural support on the cheekbone and orbital rim (the foundation)

Structural support on the cheekbone and orbital rim (the foundation)

Hyaluronic acid filler placed deep on the bone with a micro-cannula, or PLLA / CaHA biostimulators (including HA + CaHA hybrids), lift the mid-face so the tear trough drops out of shadow.

Seffiller — autologous regenerative treatment (selective)

Seffiller — autologous regenerative treatment (selective)

Seffiller uses the patient’s own fat (the SEFFI / microfat / nanofat technique) for autologous facial and skin volume restoration. A proportion of transferred fat integrates and provides long-lasting volume; results vary between individuals.

Skin-quality treatments for the under-eye skin

Skin-quality treatments for the under-eye skin

Polynucleotides (Rejuran®, including the formulation suited to the eye area), PDRN, multi-ingredient skinboosters, and autologous PRP / platelet-derived exosomes support the thin under-eye skin so it drapes evenly over any restored support.

When non-surgical treatment is not the right answer

When non-surgical treatment is not the right answer

Significant lower-lid fat herniation, festoons, or excess redundant lower-lid skin are better addressed by lower-lid blepharoplasty by an oculoplastic specialist. The clinic does not perform surgery.

The first-line approach for most tear-trough patients is foundational support placed deep on the cheekbone — not into the eyelid.

Structural support on the cheekbone and orbital rim (the foundation)

  • Best for: Tear-trough shadow from mid-face volume loss; reversible structural support
  • Downtime: 2–5 days of mild swelling or bruising
  • Lasts: Around 12–18 months

The first-line approach for most tear-trough patients is structural support placed deep on the cheekbone — not into the eyelid. Options include hyaluronic acid (HA) filler placed deep on the bone, using a micro-cannula technique for safety, to lift the mid-face and reduce the tear-trough shadow (HA filler is reversible if needed); and collagen biostimulators — poly-L-lactic acid (PLLA) or calcium hydroxyapatite (CaHA) preparations including HA + CaHA hybrids — to gradually build collagen over months and provide long-term structural support.

Hyaluronic acid filler is reversible — it can be dissolved using an enzyme called hyaluronidase. If you are considering correcting or reversing previous filler, or want to understand more about how filler can be safely removed, see our page on filler removal and dissolving.

See our page on filler removal and dissolving.

Seffiller — autologous regenerative treatment (selective)

  • Best for: Selected patients with mid-face volume loss; autologous preference
  • Downtime: 5–10 days of swelling or bruising
  • Lasts: Variable — a proportion of transferred fat integrates and provides long-lasting volume; results vary between individuals

For patients suited to it, Seffiller is the clinic’s autologous regenerative treatment using the patient’s own fat via the SEFFI (Superficial Enhanced Fluid Fat Injection) technique. Seffiller is autologous — it uses the patient’s own tissue, not a manufactured product — and is described as autologous fat grafting for facial and skin volume restoration. A proportion of the transferred fat integrates and provides long-lasting volume; results vary between individuals, and not every patient is suitable. Seffiller is not a polynucleotide and not an off-the-shelf HA filler. Suitability is decided carefully at consultation.

Skin-quality treatments for the under-eye skin

To improve the very thin under-eye skin so it drapes more evenly over any restored support, regenerative skin treatments are used: polynucleotides (PN) such as Rejuran® (including the formulation suited to the eye area), PDRN, multi-ingredient skinboosters (Profhilo, Sunekos, NCTF, klardie), and autologous PRP / platelet-derived exosomes (both derived from your own platelets, both administered by injection in this context). These do not add volume; they support skin quality and thickness over a course of treatments.

When non-surgical treatment is not the right answer

  • Best for: Significant lower-lid fat herniation, festoons, redundant skin
  • Downtime: Surgical recovery
  • Lasts: Long-lasting

Some tear-trough presentations — particularly significant lower-lid fat herniation, festoons, or excess redundant lower-lid skin — are better addressed by lower-lid blepharoplasty by an oculoplastic specialist. The clinic does not perform surgery; where surgery is the right pathway, Dr Garara will say so at consultation and direct you appropriately.

Considering treatment for hollow eyes?

Book a consultation with Dr Bhavin Garara to discuss whether the foundational approach is right for your anatomy.

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Compare at a glance

Treatments at a Glance

HA filler deep on cheekbone / orbital rim

Best suited for
Tear-trough shadow from mid-face volume loss; reversible structural support
Typical downtime
2–5 days of mild swelling or bruising
How long results last
Around 12–18 months
What it does
Lifts the cheek so the tear trough drops out of shadow

Collagen biostimulators (PLLA / CaHA / HA + CaHA hybrids)

Best suited for
Gradual loss of mid-face support; longer-term structural rebuilding
Typical downtime
1–3 days of localised swelling
How long results last
Around 12–18 months following a course
What it does
Builds new collagen over months for cheek support

Seffiller — autologous regenerative

Best suited for
Selected patients with mid-face volume loss; autologous preference
Typical downtime
5–10 days of swelling or bruising
How long results last
Variable — a proportion of transferred fat integrates and provides long-lasting volume; results vary between individuals
What it does
Restores volume using the patient’s own tissue

Polynucleotides, PDRN, skinboosters, PRP / exosomes

Best suited for
Thin, crepey under-eye skin draped over restored support
Typical downtime
1–3 days of mild bumps
How long results last
Around 6–12 months with a course
What it does
Supports skin thickness and quality

Surgical blepharoplasty (not offered here)

Best suited for
Significant lower-lid fat herniation, festoons, redundant skin
Typical downtime
Surgical recovery
How long results last
Long-lasting
What it does
Surgical correction by an oculoplastic specialist

Downtime and duration figures are typical averages only. Individual results vary considerably. Dr Garara will give you a more personalised picture at consultation.

Safety & risk

Is Tear Trough Treatment Safe?

The tear trough is on the list of explicit higher-risk anatomical areas in the face. The area is supplied by branches of the ophthalmic artery — the main blood supply to the eye. Any injection here, particularly with dermal filler, biostimulator, or autologous fat, carries a small but recognised risk of vascular complications, which in rare cases can include skin necrosis or, where the vascular network connects to the eye, loss of vision.

We share this not to alarm you, but because patients deserve full information to make a confident decision. It is also the reason this area should only be treated by an experienced medical practitioner who understands the anatomy, uses safe technique (typically deep placement on the bone with a micro-cannula rather than superficial sharp-needle injection), and is equipped to manage complications immediately if they arise — including the immediate availability of hyaluronidase to reverse hyaluronic acid filler. Dr Garara is always happy to discuss the specific risks of any treatment, and the safety protocols he follows, in detail at your consultation.

A more common, less serious risk is the Tyndall effect — a bluish discolouration that can appear when filler is placed too superficially and scatters light through the very thin under-eye skin. This is reduced by placing product deep on the bone rather than in the eyelid skin.

  • Qualified medical practitionerTreatment carried out by an experienced doctor with detailed anatomical training.
  • Reversal agents on handHyaluronidase and other complication-management tools are immediately available.
  • Full informed consentRisks, alternatives, and expected outcomes discussed in detail before any treatment.
Dr Bhavin Garara
Reviewed byDr Bhavin Garara

Frequently Asked Questions

Common questions about treating hollow eyes / tear troughs.

Read next

Related Concerns

Hollow eyes connect closely with other eye-area concerns. You may also want to read about:

Dark circlesAgeing eyesHooded eyesFacial volume lossFiller removal and dissolving
← All eyes concerns

For an overview of all the facial concerns we treat, visit our Eyes treatments hub.

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This page is for general information and does not constitute medical advice. All treatments require a personal consultation. Suitability, risks, and expected outcomes will be discussed with you in detail before any treatment is carried out.