Skin Care Education

Under-Eye Hollows

Depressions that develop beneath the lower eyelid where the eyelid meets the cheek, caused by volume loss in the tear trough area. Create a shadowed, tired, or aged appearance independently of actual fatigue.

What Are Under-Eye Hollows?

Under-eye hollows, also referred to as tear trough hollows or tear trough deformity, are the depressions that develop beneath the lower eyelid in the area where the eyelid transitions to the upper cheek. They are caused by volume loss in the tear trough region: the anatomical groove that runs from the inner corner of the eye outward along the lower orbital rim, separating the lower eyelid from the cheek.

In a younger face with adequate periorbital volume, the transition from the lower eyelid to the cheek is smooth and gently curved. The lower eyelid and the upper cheek form a continuous convex surface without any visible demarcation or depression between them. When the fat pad underlying the tear trough area reduces, whether through age-related volume loss, overall weight loss, or due to natural anatomy, this smooth transition is lost. A depression develops along the tear trough groove, creating a shadowed, hollow appearance beneath the eye that imparts a tired, aged, or sunken look.

Under-eye hollows are frequently confused with dark circles, and the two conditions often coexist. However, they are distinct. Under-eye hollows are structural: caused by a genuine physical depression or volume deficit that creates a physical shadow. Dark circles can have multiple causes including pigmentation, visible blood vessels, and the shadow from structural hollowing. Understanding which is present, and in what proportion, is important because the approaches to addressing each differ.

Causes and Contributing Factors

Factor	Description
Age-related periorbital volume loss	The orbital fat pads that support the lower eyelid and the upper cheek naturally reduce in volume with age. This reduction removes the internal support for the overlying skin in the tear trough area, allowing the groove to deepen and a visible hollow to develop. This process can begin from the late 20s or early 30s in some individuals, making under-eye hollows one of the earlier signs of facial volume loss.
Genetics and natural anatomy	The depth of the natural tear trough groove, the size of the orbital fat pads, the thickness of the periorbital skin, and the degree of bony orbital rim definition are all significantly influenced by genetics. Some individuals have a naturally prominent tear trough that creates visible hollowing from early adulthood, independent of ageing or volume loss. In these cases the hollowing is an anatomical characteristic rather than an ageing change.
Overall weight loss	Facial fat loss from overall body weight reduction, including that associated with GLP-1 medications, can reduce the periorbital fat volume and deepen the tear trough hollow. Even modest overall facial fat reduction can make previously mild under-eye hollows noticeably more prominent in individuals with a naturally prominent tear trough anatomy.
Skeletal anatomy	The degree of projection of the infraorbital rim, the bony rim beneath the eye, influences how prominent the tear trough groove appears. Individuals with less infraorbital rim projection have less bony support for the overlying soft tissue in this area, creating conditions for more apparent hollowing even with normal fat pad volume.
Skin thinning	As the skin beneath the eye becomes thinner with age, the depression of the tear trough groove becomes more visible through the overlying surface even with only modest changes in the underlying fat volume. Thinner skin provides less visual masking of the structural anatomy below.
Dehydration and fatigue	While these do not cause structural hollowing, dehydration and fatigue can temporarily worsen the appearance of existing hollows by reducing the plumpness of the periorbital skin and increasing the transparency of the skin in this area, making any existing hollow appear more pronounced.

Frequently Asked Questions: Under-Eye Hollows

The tear trough is the anatomical groove that runs from the inner corner of the eye outward along the lower orbital rim toward the lateral cheek. It represents the junction between the lower eyelid and the upper cheek, specifically the point at which the orbicularis oculi muscle attaches to the periosteum of the orbital rim below. In youth, the transition across this groove is smooth and the groove itself is not visible. As the overlying fat pad reduces with age, or in individuals with naturally less periorbital fat, the groove becomes visible as a depression beneath the eye. The term tear trough derives from its historical description as a channel along which tears might flow from the eye.

No, though they are closely related and frequently occur together. Under-eye hollows are structural: they are caused by a physical depression or volume deficit in the tear trough area that creates a shadow beneath the eye. This shadow is often perceived as dark circles. However, dark circles can also be caused by pigmentation of the periorbital skin, by visible blood vessels through the thin under-eye skin, and by combinations of these factors alongside or independent of structural hollowing. Many people have both structural hollowing and pigmentation contributing simultaneously. The distinction matters because structural hollowing and pigmentation-based dark circles have different causes and respond to different approaches.

Yes. Under-eye hollows can be present in individuals from early adulthood, particularly those who have a naturally prominent tear trough anatomy due to their genetic facial structure. In these individuals the hollowing is an anatomical characteristic rather than a sign of premature ageing. Under-eye hollows can also develop at any age following significant weight loss, which reduces periorbital fat volume. Additionally, some individuals with naturally thin periorbital skin and less subcutaneous fat in the orbital area will show more prominent hollowing earlier than those with more abundant periorbital tissue.

No. Under-eye hollows are a structural condition caused by a volume deficit in the tear trough area. They are present regardless of fatigue levels. Tiredness and sleep deprivation can temporarily worsen the appearance of existing hollows, primarily by making the periorbital skin appear paler and more translucent, which increases the visual contrast of the shadow created by the hollow. However, tiredness does not create structural hollowing, and under-eye hollows that are present due to volume loss or anatomy will not improve with improved sleep. This is the same principle that applies to dark circles caused by structural hollowing rather than by pigmentation.