Eye Socket Hollowing (Sunken Eyes)

It is often said that the eyes are the windows to the soul. What would an aged periorbital appearance imply? It is no wonder that rejuvenation of the periorbital region is one of the commonest aesthetic requests. A youthful and aesthetically pleasing upper eyelid region consists of well-positioned eyebrows, crisp upper eyelid creases, appropriate degree of eye opening, and taut skin without wrinkles or pigmentary blemishes.

The eye sockets are filled with a good volume of fat and the bony contour should be well-concealed beneath this skin and fat. These findings impart the image of an individual who is youthful and in good health.

How Does It Manifest?

Hollowing of the upper half of the eye socket (orbit) may start to manifest in the forties. The thinning of the upper eyelid skin and loss of the fat around the orbit causes the upper margin of the bony socket to become prominent and may lead to a “skeletal” appearance. This is also sometimes observed in individuals with ill health. This is considered unaesthetic and contributes to the constellation of ageing changes around the eye. It adds to the perceived age of a person and may adversely affect the individual’s body image and social functioning.

How does it arise?

There is normally a good cushion of fat lining the eyeball and in the soft tissue around the eye socket that contributes to the appearance of a “full” orbit in youth. This fat acts as a cushion for the eyeball facilitating its movement within the body socket, and also transmits important nerves and blood vessels that supply the eye and the areas around it. 

With advancing age, there are changes in the metabolism of the adipocytes causing them to shrink (atrophy), resulting in a hollow appearance.





The principle of treatment of eye socket hollowing is the replacement for the lost volume. There are two commonly used methods: filler injection and structural fat grafting. Both techniques are able to effectively and safely restore the volume of the eye socket and rejuvenate one’s appearance. Successful outcomes restore self-confidence and improve social functioning.

Filler injection

Filler injection is a popular ambulatory procedure and is often used for restoring soft tissue volume in areas where age-related fat loss has occurred. There is a wide range of fillers with various different characteristics to suit each individual’s unique anatomy and help them meet their aesthetic goals. 

Individuals with mild eye socket hollowing and who desire a minimal recovery period are good candidates for filler injection. Individuals with other associated signs such as skin laxity, visual obstruction, droopy eyelids etc. may wish to consider surgery instead for comprehensive and harmonious correction of all the deformities.

The anatomy of the eye socket is rather complex and contains important nerves and blood vessels that should be avoided when delivering filler injection. Injection of eye socket hollowing is a fine art and requires appropriate product choice, precise technical execution and an experienced practitioner.

We use a proprietary technique of filler injection in the supraorbital region that will deliver an elegant, beautiful, and bespoke result. Injection site pain is significantly reduced with the use of a pain distraction device at Picasso Plastic Surgery.

The effects of filler injection may be observed almost immediately following the procedure. Most of the filler will be resorbed in 6 to 9 months and repeat treatment is required to maintain the result.

Individuals are advised to avoid vigorous massage or rubbing of the treatment area for 2 hours following filler injection to minimize the potential for bruising. Individuals may resume their usual activities immediately following the procedure.

Dr Yeo is a plastic surgeon in Singapore who is an experienced filler injector and is a trainer for several filler product lines. He frequently delivers lectures and conducts workshops on effective and safe filler administration in the Asia Pacific region. Injection site pain is significantly reduced with the use of a pain distraction device at Picasso Plastic Surgery. their usual activities immediately following the procedure.

Structural Fat Grafting

Structural fat grafting involves harvesting fat from areas of excess, purifying it, then grafting it in volume-deficient areas. A high proportional survival of fat cells may be attained with the use of specialized fat grafting cannulas available at Picasso Plastic Surgery. Structural fat grafting delivers elegant and long-lasting results. Structural fat grafting is a minimally-invasive ambulatory surgical procedure performed under local anesthesia, with optional intravenous sedation if requested.

Individuals with any degree of eye socket hollowing and seeking long-term improvement are good candidates. Structural fat grafting may be simultaneously performed in other areas of hollowing and volume loss such as the face, neck and hands, and deliver benefit in multiple sites in one single procedure. Those with severe hollowing will benefit from significant cost saving in the long term as compared with recurrent treatment using large volume filler injection.

Common sites for fat harvest include the inner thighs, hips, flanks and lower abdomen. Small incisions are made near the areas of intended liposuction, and local anesthetic is infused for optimal intra- and post- operative pain relief. The fat is broken up and aspirated under negative pressure. It is purified before being grafted into the eye socket using purpose-made fat grafting cannulas for optimal survival. Grafting is performed through 1-mm incisions that are well-concealed within the eyebrow.

Many individuals are able to return to work on the day after the surgery. Depending on the extent of liposuction performed, most of the swelling and bruising will resolve by the 7th postoperative day. Stitch removal is usually performed on the 5th postoperative day.

After structural fat grafting is performed, blood vessels grow into the fat grafted area (neovascularization). The degree of neovascularization determines the proportion of fat graft survival. In general, 60 to 80% of the grafted fat will survive and the appearance at 2 months postoperatively is normally representative of the long-term result. The body absorbs the non-surviving fat during the first two months. The fat grafts that survive persist for many years.g.