What Is The Best Way Too Treat My Severe Undereye Hollows – Filler, Fat or Implants?

Q: Dr. Eppley ,Hi, I’m 25 years old and have had hollow under eyes all my life. I used to think it was just thin skin but I’ve realized I believe it’s a suborbital deficiency after seeing images. I wanted to see if I would be a better candidate for filler, fat transfer or a suborbital implant. My dermatologist said she wouldn’t do filler on me because under eye filler migrates. I also attached a photo of me at 19 showing a particularly bad photo of the hollows.

A: Thank you for your inquiry and sending all of your pictures. When you have significant undereye hiollows due to a bony deficiency, which is almost always the cause of significant undereye hollowing, the most significant improvement with the longest duration of effects is going to be a suborbital implant. Or more specifically custom infraorbital implants made from the patient’s 3D CT scan. To optimally correct the bony deficiency it requires an implant design that creates both horizontal and vertical augmentation of the infraorbital rim which no standard implant can do. (see attached)