Hollow Under Eyes: Your Treatment Guide

Why Do Under-Eye Hollows Develop?

Hollow under eyes — clinically referred to as tear trough deformity — are one of the most common aesthetic concerns we see at our CQC-registered clinic on Furze Platt Road, Maidenhead. They can make you look perpetually tired, older than your years, or simply unwell, even when you feel perfectly fine.

The under-eye area is one of the thinnest, most delicate regions of the face. Unlike the cheeks or forehead, the skin here has very little subcutaneous fat and sits directly over the orbicularis oculi muscle and the underlying orbital bone. Several factors contribute to the appearance of hollowing:

• Age-related volume loss: From our mid-twenties onwards, we begin to lose approximately 1% of our facial collagen each year. The fat pads that once provided youthful cushioning beneath the eyes gradually diminish and descend, revealing the orbital rim beneath.
• Bone resorption: The orbital bone itself recedes with age, enlarging the eye socket and deepening the hollow. This structural change accelerates noticeably from the forties onwards.
• Genetics: Some individuals are genetically predisposed to thinner skin, less subcutaneous fat, or a more prominent orbital rim. In these cases, hollowing can appear as early as the late teens or twenties.
• Lifestyle factors: Chronic sleep deprivation, dehydration, smoking, and excessive sun exposure can all accelerate the breakdown of collagen and elastin in this already vulnerable area.

Understanding the underlying cause is essential because it directly informs which treatment approach — if any — is most appropriate. A hollow caused primarily by bone resorption, for example, requires a different strategy from one caused by skin laxity or pigmentation. You can read more about the condition on our under-eye hollows page.

Why the Under-Eye Area Is Considered High Risk

The periorbital region is classified as a high-risk zone for injectable treatments, and with good reason. The anatomy beneath the eye is complex, with several important blood vessels running close to the surface, including branches of the angular artery and the infraorbital artery. Inadvertent injection into or compression of these vessels can lead to serious complications, including vascular occlusion and, in extremely rare cases, visual impairment.

This is precisely why we believe under-eye treatments should only be performed by medically qualified practitioners with an advanced understanding of facial anatomy. Dr Langdon's medical training and hands-on anatomical knowledge allow her to navigate this area with the precision and caution it demands.

Beyond vascular risk, the tear trough presents other challenges. The skin here is so thin that even minor product misplacement can be visible. Overfilling is a common mistake — placing too much product creates a “pillow” effect that looks unnatural and can be difficult to correct. The Tyndall effect, where hyaluronic acid filler refracts light through thin skin and creates a bluish hue, is another well-documented complication that occurs when the wrong product is used or when filler is placed too superficially.

At Berkshire Aesthetics, we take a conservative, “less is more” approach. It is always safer to under-treat and review than to over-treat and need to dissolve product. Every patient receives a thorough assessment before any decision to treat is made.

What to Expect: The Treatment Process & Realistic Outcomes

All under-eye treatments at Berkshire Aesthetics begin with a comprehensive face-to-face consultation with one of our GMC-registered doctors. This is not a sales appointment — it is a clinical assessment during which we evaluate your facial anatomy, skin quality, degree of volume loss, and overall suitability for treatment.

Tear Trough Filler Procedure

If tear trough filler is recommended, the procedure itself takes approximately 20 to 30 minutes. A topical anaesthetic cream is applied to the area beforehand to ensure comfort. Dr Langdon uses a cannula technique, which involves a single entry point on each side, reducing the number of needle punctures and significantly lowering the risk of bruising.

Most patients require between 0.3ml and 0.5ml of filler per side. You will see an immediate improvement, though the final result settles over two to four weeks as any initial swelling resolves and the product integrates with your tissue.

Polynucleotide Treatment

Polynucleotide treatments involve a series of small injections across the under-eye area. The procedure takes around 15 to 20 minutes. There may be minor swelling or small bumps at the injection sites for 24 to 48 hours, but downtime is generally minimal.

Results and Maintenance

Tear trough filler typically lasts 12 to 18 months, though this varies between individuals. Because the under-eye area has relatively little movement compared to the lips or nasolabial folds, filler tends to persist well here.

Polynucleotide results build progressively over the treatment course, with optimal outcomes visible approximately four to six weeks after the final session. Maintenance treatments every six to twelve months help to sustain the improvement.

It is important to approach under-eye treatment with realistic expectations. The goal is to create a refreshed, rested appearance — not to erase every line or eliminate all shadowing. When performed well, the result should be subtle and natural, with friends and family noticing that you look well rather than “done.”

Related Treatments & Further Reading

If you are considering treatment for under-eye hollows, you may also find the following pages helpful:

• Dermal Fillers — our full guide to hyaluronic acid fillers, including the products we use and areas we treat.
• Polynucleotides — learn more about how polynucleotide therapy stimulates collagen and improves skin quality.
• Plinest — detailed information on the Plinest range, including Plinest Eye for the periorbital area.
• Under-Eye Hollows — our condition-specific page with before-and-after examples.
• Dark Circles — understanding the causes and treatment options for periorbital pigmentation.