Original Article by Brittany Burhop. We often hear complaints from women about under-eye puffiness and bags, but there's another concern that's cropping up more and more: under-eye hollows. More often than not, women who experience them say they feel like they look tired even when they aren't. Yes, topical products can help to an extent with the appearance of the area (things like discoloration and crow's-feet), but when volume loss is the reason for this less-than-desirable hollowed-out effect, fillers are the answer. Here's why.

For many women, they begin seeing hollows develop in their mid-30s, but West Palm Beach, FL, dermatologist Kenneth Beer, MD, says that if you got a lot of sun when you are young or if you smoke, it will be earlier. "From that point forward, especially if you have fair skin, the process accelerates," he adds. Troy, MI, plastic surgeon and author of The Age Fix: How To Look 10 Years Younger Anthony Youn, MD, says some patients will even see them in their 20s if it's in their genes. "By the time we hit our 40s, almost everyone has some hollowing going on."

So what causes a hollow to occur? "A few things happen at the same time that really have a significant effect: The fat pads that line this area drop and begin to leave the area with a hollow look. In women, there is a loss of bone that leaves the region with less support and the area also loses some of the elastin and collagen support in the mid-dermis so it starts to sag," explains Dr. Beer. I think it is important to apply sun protection daily, avoid smoking and wear polarized sunglasses to minimize damage to this area."

This is where the magic of fillers comes into play. They literally "fill" the area to restore volume and rejuvenate your under-eye and upper cheek. Both doctors agree that the best filler to treat these hollows is Restylane, which they say delivers immediate results. "If you don't like the result, hyaluronidase can be injected into the area to dissolve the Restylane away," says Dr. Youn, who adds that the filler must be injected very carefully and just over the bone, in order to avoid lumpiness. Dr. Beer adds, "When injecting in this area, it is important to go to an experienced injector and to be aware that it is possible to swell and bruise for a few days."

According to Dr. Beer, one or two treatments are typically enough to see a difference, depending on how many syringes are put in each time. How long it lasts will depend on your skin type, lifestyle and age, but many people say about six to eight months.

Dr. Youn says there is another filler option for under-eye hollows that also works well: your own fat. This involves taking your own fat from an area where you have excess, like your outer thighs, and injecting it into your under-eye area. "Fat grafting is less predictable, but the fat that stays can stick around for many years. I personally find that my fat grafting patients usually look a little under-corrected when all is said and done."