Hollow under eyes at 21 - what treatment options will help? (Photos)

Relax. At least from the photos provided, the use of an appropriate, robust HA volumizing filler properly injected can typically yield immediate results and engender little to no significant downtime. The upper cheeks are a major support for the under-eye region. Hence, the layering of a robust HA filler in that region can restore a smooth transition between the upper cheeks and lower eyelids, I.e. elevating the hollow and smoothing the transition to the under-eyes. In experienced hands, treatment should take no more than ten to fifteen minutes. You would be wise to consult with an experienced, board certified cosmetic dermatologist filler injection expert. Best of luck.

Based on these images it appears that you have a mild malar hypoplasia, small cheek bones, which is the reason your condition started very early. Augmentation of cheek bones with implants or fat grafting as well as transconjuctival lower blepharoplasty are good options for improvement. Good luck.

Under eye hollows can be genetic or age related, but there are solutions. A common approach is injection a hyaluronic acid filler to add volume. This lasts 6-9 months. There can be bruising after the injections, so I recommend finding an experienced injector that uses cannulas instead of needles. Some products can lead to a bluish discoloration under the skin, but we have a lot of success with Restylane in that area.

If you want something more natural, you can have far grafting, which involves using liposuction to remove a small amount of fat from the abdomen, hips, or thighs and transferring it under the eyes. That is a fairly permanent solution. There is also PRP (platelet rich plasma), which involves drawing blood, spinning it down in a centrifuge, and then injecting it. This doesn’t provide as much volume, and it’s temporary, but it has very few risks or side effects and could give you an idea if you like the look of more volume in that area. There is also a commercially available product called PDGF which is a lab version of the PRP that’s even more concentrated with growth factors that can add volume to the area.

The appearance will get worse as you age, so eventually under eye surgery could be indicated in your 50s or 60s as under eye bags accentuate the hollow underneath, but there are plenty of options before then. Best wishes.