What Are Under-Eye Hollows?
The tear trough is the groove that runs from the inner corner of the eye diagonally downwards and outwards, along the junction between the lower eyelid and the upper cheek. In youth, this area has good volume and the transition from eyelid to cheek is smooth and well-supported. As we age, or in some people from a relatively young age, this groove deepens into a visible hollow or depression. The result is a shadowed, sunken appearance beneath the eyes that typically conveys fatigue, even when none is felt.
Under-eye hollowing is primarily a structural issue. It arises from changes in the volumes and positions of the fat compartments and bony structures that support the lower eyelid and mid-face. Unlike dark circles caused by pigmentation or vascular changes, a hollow does not respond to topical products and is only modestly improved by treatments that address skin quality alone.
Understanding the degree of hollowing and whether a skin quality component is also present is essential before selecting any treatment. Regener8 Aesthetics will assess this carefully at consultation and be clear about what our treatments can realistically achieve for your specific presentation.
Under-eye hollowing results from volume loss in the tear trough region due to fat pad descent, mid-face volume loss, and orbital bone resorption. It can produce structural dark circles, fine lines, and a generally fatigued appearance. For mild hollowing with a skin quality component, polynucleotide biostimulators can provide meaningful improvement. For significant structural volume deficit, the standard treatment is tear trough filler, which Regener8 does not offer. Assessment at consultation determines which applies to you.
How Under-Eye Hollows Present
The appearance of under-eye hollows varies in severity and often changes under different lighting conditions. Common signs include:
- A visible groove or depression beneath the lower eyelid, running from the inner corner of the eye outward towards the cheek
- A shadowed, darkened appearance beneath the eyes that is caused by the structural depression rather than by pigment or blood vessels
- A tired or aged appearance that persists regardless of sleep quality or rest
- Loss of the smooth, continuous transition from eyelid to cheek, with a visible step or groove where they meet
- Fine lines or crepey texture in the periorbital skin alongside or above the hollow area
- An appearance that worsens under overhead or directional lighting due to the shadow cast by the depression
- An improvement in appearance when looking upward, as the soft tissue redistributes slightly
- In some cases, a combination of hollowing below with periorbital fat protrusion (eye bags) above, creating a double contour
Causes
Under-eye hollowing has several contributing causes, and more than one typically plays a role in any individual presentation.
Volume Loss in the Mid-Face
The fat compartments of the face, including the malar fat pad that supports the cheek and lower eyelid area, descend and reduce in volume over time. As the cheek volume descends, the support beneath the tear trough is withdrawn, and the groove deepens. This is closely associated with the natural ageing process and typically becomes noticeable from the mid-thirties onwards, though it varies considerably between individuals.
Orbital Bone Resorption
The bony orbit, the skull structure surrounding the eye, undergoes gradual resorption with age. As the orbital rim recedes, the soft tissue of the lower eyelid has less bony support beneath it, contributing to the hollowed appearance and increasing the apparent depth of the tear trough. This skeletal change is not reversible and explains why under-eye hollowing can be progressive even in people who maintain healthy skin and facial volume.
Skin Thinning and Loss of Elasticity
The periorbital skin is among the thinnest on the face and loses elasticity and collagen density with age. As the skin becomes thinner and less resilient, it conforms more closely to the underlying structural changes, making hollowing more visible and increasing the prominence of fine lines in the area. Improving skin quality through biostimulatory treatments can address this component and make the area appear less hollow even where volume loss itself has not been directly corrected.
Genetics
Some people have a naturally prominent tear trough due to their facial anatomy. The depth of the groove, the position of the cheek fat pad, and the prominence of the orbital rim are all inherited characteristics. This explains why some people develop noticeable tear troughs in their twenties or even earlier, in the absence of age-related volume loss. If the hollowing is primarily hereditary, the underlying structural anatomy will always exert its influence, and treatment expectations should be calibrated accordingly.
Under-eye hollowing is typically driven by a combination of mid-face volume loss, orbital bone resorption, and skin thinning, all overlaid on a genetic structural baseline. Assessing the relative contribution of each helps determine what treatment can realistically achieve. Where the dominant cause is volume loss, structural volume replacement is the most appropriate intervention.
Puffy Eyes vs Hollow Eyes
It is worth briefly distinguishing under-eye hollowing from periorbital puffiness, as these are often confused. Puffy eyes involve swelling or fluid accumulation beneath and around the eyelids, creating a rounded or raised appearance. Common causes include fluid retention, allergies, salt intake, poor sleep, and in some cases periorbital fat herniation (prolapse of the orbital fat pad forward through the orbital septum, producing a permanent "eye bag"). Hollowing, by contrast, involves a deficit rather than an excess. Some people have both, prominent fat herniation above the tear trough combined with hollowing below it, which creates a complex dual contour. Understanding which is present is essential for appropriate treatment.
Who Is Affected?
Under-eye hollowing becomes increasingly prevalent with age, but it is not exclusively a concern of older patients. Some individuals, particularly those with leaner facial structures, deeper-set eyes, or a family history of prominent tear troughs, may notice hollowing from their mid-twenties or earlier. In these cases, the cause is largely genetic rather than age-related volume loss.
People who have lost weight significantly, whether through dieting, illness, or lifestyle change, often find that the periorbital area is among the first regions to reflect volume reduction. The face loses fat proportionally, and the tear trough and mid-face can become hollow even when overall health is good.
Individuals who have undergone significant medical treatment, including chemotherapy, certain long-term medications, or extended periods of illness, may experience accelerated periorbital volume loss as a side effect. The presenting appearance can be more pronounced than their chronological age would suggest.
People with darker skin tones may find that the structural shadow cast by under-eye hollowing is amplified, as the contrast between the shadow and the surrounding skin can be more pronounced. In these cases, hollowing and dark circles coexist and may both require assessment. Distinguishing structural shadow from pigmentary discolouration is important for appropriate treatment selection.
Fine lines around the eyes frequently accompany hollowing as a secondary feature. The loss of structural support from beneath can cause the overlying skin to fold and crease. This skin quality component is addressable with biostimulatory treatments and may partially improve even where the structural hollowing itself cannot be fully corrected without volume replacement.
Assessment at Regener8
Assessment of under-eye hollowing at Regener8 Aesthetics involves a structured evaluation of the severity of the hollowing, the contributing factors, and the presence of any co-existing skin quality changes. The practitioner will ask about the timeline of the presentation, any relevant weight changes, family history, and whether the appearance has changed following other factors such as illness or medication.
Visual examination under consistent lighting is used to assess the depth of the tear trough, the quality and thickness of the overlying skin, and whether any element of periorbital fat herniation or puffiness is present alongside the hollowing. The relationship between the hollow and any associated shadow or dark circle is also assessed, distinguishing the structural shadow from other causes of periorbital discolouration affects the treatment approach.
The critical distinction made at consultation is between mild hollowing with a skin quality component, where biostimulatory treatments can provide meaningful improvement, and significant structural hollowing where volume replacement is the most appropriate intervention. Regener8 Aesthetics does not offer dermal fillers. Where the presentation falls into the latter category, this will be communicated clearly, and you will receive appropriate advice on next steps.
Where fine lines around the eyes are a concern alongside the hollowing, these are addressed within the context of periorbital skin quality treatment. Polynucleotide preparations improve the overall periorbital environment and can reduce the appearance of fine lines alongside any improvement in the hollow itself.
Treatment Options
The treatments available at Regener8 Aesthetics for under-eye hollowing are appropriate for mild presentations, particularly where a skin quality component is also present. We are clear about what these treatments can and cannot achieve, and we will not position them as equivalents of tear trough filler where that level of correction is what is needed.
Vitaran Eyes (Polynucleotide)
Vitaran Eyes is a polynucleotide biostimulator formulated specifically for the periorbital area. Polynucleotides stimulate fibroblast activity, improve microcirculation, and support the structural quality of the periorbital skin. In the context of under-eye hollowing, Vitaran Eyes improves the quality of the overlying skin, provides modest biostimulatory support to the periorbital tissue, and can subtly improve the appearance of the area in mild presentations. It does not directly replace volume in the way that tear trough filler does, but it addresses the skin quality component that frequently accompanies hollowing.
Lumi Eyes (Polynucleotide)
Lumi Eyes is another polynucleotide preparation with a strong evidence base for periorbital use. It supports vascular integrity, reduces oxidative stress in the periorbital tissue, and improves overall skin quality in the under-eye area. Where a combination of hollowing and vascular or pigmentary dark circles is present, Lumi Eyes addresses the non-structural elements effectively. It may be used alongside or as an alternative to Vitaran Eyes depending on the clinical presentation.
Jalupro
Jalupro is an amino acid complex that stimulates fibroblast activity and supports the periorbital skin's structural integrity. It improves skin quality in the under-eye area, reduces crepiness, and contributes to a generally improved periorbital appearance. It works well as a complementary treatment alongside polynucleotide preparations and can enhance the overall result where skin quality is a significant concern alongside the hollowing.
What Regener8 Does Not Offer for Under-Eye Hollows
For moderate to significant structural under-eye hollowing, the most effective and widely evidenced treatment is hyaluronic acid tear trough filler, which directly restores volume in the groove and corrects the structural deficit. Regener8 Aesthetics does not currently offer dermal fillers of any kind. We will be direct about this at consultation, and we will not suggest our treatments as adequate alternatives where tear trough filler is what your presentation requires. Choosing a qualified and experienced practitioner for tear trough filler is important, the periorbital area is anatomically complex and this is not a treatment to seek on the basis of price alone.
Book a £25 consultation at Regener8 Aesthetics in Selly Oak, Birmingham. The fee is fully redeemable against any treatment booked within 30 days. No pressure to proceed. Consultations available in English, Farsi and Russian.
Finance available, subject to approval, via our Payl8r finance partner.
Why Choose Regener8 Aesthetics?
Transparency about what we can and cannot treat. Under-eye hollowing is a presentation where honesty matters significantly. Offering treatments that cannot meaningfully address significant structural hollowing would be doing a disservice to our clients. At Regener8, we are clear about when our treatments are appropriate and when a different approach, including referral elsewhere for tear trough filler, is the more helpful course.
Clinical healthcare background. The periorbital area requires particular care and precision. Our lead practitioner's clinical healthcare background ensures that assessments are thorough and that treatments in this sensitive anatomical area are carried out with appropriate skill and attention. The history taken before any periorbital treatment reflects a genuinely clinical approach rather than a commercial one.
Distinction between structural and skin quality components. Many people presenting with under-eye hollowing have a combination of structural volume deficit and skin quality deterioration. Even where the structural component cannot be fully addressed without filler, improving the skin quality element can meaningfully improve the overall appearance of the area. We assess and treat these components separately and honestly.
Connection to the wider picture. Under-eye hollowing does not exist in isolation. It is connected to overall facial volume, skin quality, and the relationship between the lower eyelid and mid-face. We consider these connections at consultation rather than treating the tear trough as a single isolated concern.
Multilingual consultations. Consultations are available in English, Farsi, and Russian. For clients from Birmingham and the surrounding West Midlands for whom English is not a first language, discussing a nuanced presentation such as tear trough hollowing with full linguistic clarity is meaningful. The clinic's multilingual capability exists because effective communication is part of effective care.
- Under-eye hollowing is a structural issue caused by fat pad descent, orbital bone resorption, and genetic anatomy; it is not primarily a skin quality problem, though a skin quality component frequently coexists.
- For mild hollowing with a skin quality component, polynucleotide treatments such as Vitaran Eyes and Lumi Eyes can provide meaningful improvement; for significant structural hollowing, tear trough filler is the most appropriate intervention.
- Regener8 Aesthetics does not offer dermal fillers; where filler is required, this will be communicated clearly and appropriate guidance provided.
- Fine lines around the eyes frequently accompany hollowing and can be meaningfully improved with biostimulatory periorbital treatments even where the structural hollow itself requires a different approach.
- Assessment at consultation determines the severity and primary cause; without this, any treatment decision is based on incomplete information and is unlikely to deliver the best outcome.