Sunken eyes look hollow or deep-set because of reduced volume around the eye socket. Common causes include natural anatomy, ageing and bone changes, significant weight loss, dehydration or illness, and occasionally too much fat removed during previous eyelid surgery. Treatment depends on the cause and can range from lifestyle measures to filler, fat grafting or a revision of earlier surgery.
Deep-set eyes versus sunken eyes
Some people are simply born with deep-set eyes: a prominent brow ridge and a well-defined socket mean the eyes sit further back. This is a normal feature and often looks striking.
Sunken eyes, by contrast, describes a change over time, when the upper lid develops a hollow beneath the brow, the upper-lid crease deepens, or the lower lid and tear trough become more concave. The eyes can then look tired, older or unwell, even when you feel fine.
Common causes
- Ageing: the fat pads around the eye thin, and the bony socket slowly enlarges, so the eye appears to sit deeper.
- Weight loss: significant or rapid weight loss, including with weight-loss medication, reduces facial fat, including around the eyes.
- Genetics: inherited facial structure influences how early hollowing appears.
- Previous eyelid surgery: removing too much upper-lid fat can leave a sunken, hollow upper eyelid.
- Dehydration, poor sleep and illness: these can temporarily make the eyes look more hollow.
- Sinus and eye socket conditions: rarely, a problem affecting the sinus beneath the eye socket causes one eye to sink; this needs medical assessment.
When to see your GP
Hollowing that develops slowly on both sides with age is common and not a cause for concern. See your GP if one eye appears to be sinking compared with the other, if the change happens over weeks rather than years, or if there is double vision, facial numbness, pain, weight loss you cannot explain or persistent tiredness. These symptoms should be assessed to rule out an underlying medical cause before any cosmetic treatment is considered.
Simple measures
Good hydration, regular sleep, treating allergies and reducing alcohol can improve how tired the eyes look, although they will not restore lost volume. If you are losing weight, gradual weight loss tends to be gentler on the face. Make-up techniques, such as a lighter concealer in the hollow and a matte shade on the lid, can reduce the appearance of depth.
Volume-restoring treatments
- Dermal filler: carefully placed dermal filler can soften a hollow tear trough or, in experienced hands, a hollow upper lid. Effects are temporary and the area needs a cautious approach.
- Fat grafting: your own fat, taken by gentle liposuction from another area, can be injected in tiny amounts to restore volume. Some of the fat is reabsorbed, and more than one session may be needed.
- Fat repositioning: in the lower lid, existing fat can be moved over the rim during blepharoplasty to fill a groove.
The right option depends on whether the upper or lower lid is affected, your skin quality and your preferences.
When previous surgery is the cause
A hollow upper lid after earlier blepharoplasty is a recognised problem, particularly with older techniques that removed more fat. Correcting it usually means adding volume back rather than removing more tissue, often with fat grafting. This is a delicate procedure with a less predictable outcome than primary surgery, and Mr Nassab will explain what is realistic. See revision blepharoplasty for more on correcting earlier eyelid surgery.
Recovery and expectations
After filler, swelling usually settles within a week or two. Fat grafting causes more swelling and bruising, often for two to three weeks, and the final result is judged after several months once the grafted fat has settled. Any treatment aims to soften hollowing and restore a more rested look; it cannot stop the natural changes of ageing. Fat grafting and complex treatments are quoted at consultation, and the £150 consultation fee is separate.
Frequently Asked Questions
Can sunken eyes be reversed?
Volume can often be restored with filler or fat grafting, softening the hollow. Results vary and ageing continues.
Why do eyes look sunken after weight loss?
Losing weight reduces fat throughout the body, including the small fat pads around the eyes, which can make them look hollow.
Does blepharoplasty cause sunken eyes?
Removing too much fat can. Modern techniques aim to preserve or reposition fat to avoid hollowing.
Is fat grafting better than filler for sunken eyes?
Each has advantages. Filler is quicker and adjustable; fat grafting may last longer but involves a minor operation and less predictable take.
Should one sunken eye be a concern?
Yes, a change affecting only one eye should be assessed by your GP to rule out a medical cause.
