What should you know about severe under eye hollows?

Tear-trough hollows form along the transition between the lower eyelid and cheek. A hollow can cast a shadow that looks like a dark circle, even when the skin is not deeply pigmented. Facial volume loss, inherited structure, thinner skin, changes in the lower eyelid fat compartments and skin laxity can all contribute. One-sided new hollowing, swelling, pain, colour change or a vision symptom should not be assumed to be a cosmetic issue.

A qualified clinician should assess the lower eyelid, cheek support, skin texture, pigmentation, puffiness and facial movement before suggesting treatment. Under-eye filler can soften a hollow in selected patients, but the area is delicate and requires an experienced injector and a discussion of benefits, limits and risks. Eyelid surgery may address skin or fat-related changes when anatomy calls for it. Fat transfer is another surgical option that uses the person’s own fat. Gentle skincare, sleep support and sun protection may improve the surrounding skin but cannot recreate lost structural volume.

Seek prompt medical assessment for sudden one-sided change, new eyelid swelling, redness, pain, discharge, double vision or reduced vision. After an injectable or procedure, urgent review is needed for severe pain, unusual skin colour, rapidly increasing swelling or any visual disturbance. Arrange a routine review when hollows are changing or when dark circles do not match the visible contour.

Ask what is creating the shadow in your case, whether puffiness or pigmentation is also present, and which option matches your anatomy. Ask about practitioner experience, expected recovery, alternatives, warning signs and what happens if the result is uneven or unsatisfactory.