Undereye hollows are a common periorbital condition due to either aging, congenital development or both. They represent an anatomic deformity of which one major component is loss of volume. They are exacerbated when an infraorbital rim-cheek skeletal deficiency is also present. They are very much the antithesis of lower eyelid bags which are an excess volume issue.
Because of the visible volume loss the most common ‘non-surgical’ treatment is fat injections and the most common surgical blepharoplasty technique is fat transposition. While effective for many patients fat grafting alone may be inadequate for others. This is particularly true when there is a bony infraorbital deficiency. (negative orbital vector)
While a custom infraorbital rim implant is always the ideal treatment which can be placed through a lower blepharoplasty the added cost and time to create the implant is its disadvantage. An alternative is a soft tissue graft, like Alldoerm, that can be fashioned intraoperatively to augment the rim by wrapping around it or saddling the rim. A 1.5mm to 2mm thick Alloderm piece is the size needed. The superior orbital fat can then be transposed over yeh draped Alloderm graft for maximal volume augmentation.
As a supple soft tissue graft that adds a layer of infraorbital rim augmentation which also allows for tissue ingrowth, this is a viable adjunct in the open treatment of undereye hollows. It is available off-the-shelf, can be shaped and adapted to the bone intraoperatively and becomes permanently incorporated into the surround tissues without resorption.
Dr. Barry Eppley
World-Renowned Plastic Surgeon