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The eyes have it series, post 38: breaking it down - deep look at a common and seemingly simple situation, lower lid hollowness. This fit, happy and healthy woman felt that her lower lids made her look run down. With a deeper dive, we see that a volume deficit in the mid face is largely responsible for something we call a neutral or negative vector. Surgically, this is incredibly important to recognize this as a yellow flag, and failure to do so I can get you into trouble.

It is also important to recognize the lateral hollowness outside of her orbital rim which often goes uncorrected and is very difficult to correct surgically. I have given a few lectures about this very specific area, which I call the “step child“ of the tear trough area.

Here you see the results of revolumizing the deep cheek fat pads along with the medial and lateral SOOF fat pads below the lids, which balances the junction between the cheek and the eyelid all the way out to the outer edge of her eye socket by supporting the midface. A cannula was utilized via a single access point to deliver filler here; fat transfer can also be utilized.

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