Few things age the face as quietly as the under-eye area. Many people first notice it in photographs or under bright light: a shadow beneath the eyes that reads as tiredness, even after a full night of sleep. Under-eye hollowing, or sunken eyes, is one of the most common concerns raised in consultation, and one of the most misunderstood.
The cause is rarely as simple as lost volume, and the right response depends entirely on what is driving the change in your particular case.This article looks at the fuller picture, from structural and skin-related causes to hormonal and lifestyle factors, and how each concern may be treated differently. You can also read our dedicated sunken eyes concern page, which covers assessment and treatment in more detail.
Authored and reviewed by Dr Duncan Brennand, Lead Aesthetic Doctor, L’Atelier Aesthetics, Harley Street
The under-eye area is anatomically delicate. The skin here is among the thinnest on the body, the fat pads cushioning the eye are small, and the supporting bone changes shape over time. Because so many structures sit close together, small changes in any one of them alter how light falls across the face, which is why two people with similar hollowing can need very different plans.
Most cases involve a combination of factors rather than a single one, and identifying the dominant driver is the first step towards a natural-looking result. Here are a few of the most common reasons for undereyes appearing hollow:
The most recognised cause is loss of volume in the tear trough, the groove running from the inner corner of the eye towards the cheek. As the soft tissue and fat that once filled this area diminish, the groove deepens and casts a shadow.
This can be age-related, but some people have a naturally prominent tear trough from their twenties onwards. Where genuine structural volume loss is the main issue, dermal fillers placed with care can restore support and soften the shadow. This is a precise treatment in a sensitive area, so assessment and technique matter far more than the product itself.
Sunken eyes are not always caused by tissue disappearing. Sometimes the fat is still present but has shifted position. With age, the deeper fat pads of the mid-face can descend, so support that once sat high on the cheek moves downward, hollowing the upper under-eye area while creating slight fullness lower down.
Because the issue is often fat movement rather than fat loss, treatment needs to address the face as a whole rather than simply replacing volume beneath the eye.
The skin itself plays a large role. Collagen gives skin its strength and thickness, while elastin allows it to recoil. From our late twenties, production of both slows, and the skin beneath the eyes becomes thinner and more translucent, letting underlying structures and vessels show through and deepening any hollowing already present.
When the concern is skin quality rather than lost volume, filling is not the answer. Polynucleotides, regenerative injectables that support the skin’s own repair, and skin boosters, which improve hydration and texture, can both help strengthen thin, crepey under-eye skin over a course of treatment.
Oestrogen supports collagen production, skin thickness and hydration, so as levels fall, particularly around the perimenopause and menopause, the skin can lose density more quickly.
For many women, this is when under-eye hollowing becomes noticeably more pronounced. It points towards a plan that supports skin quality rather than simply adding volume, and helps set realistic expectations about what one treatment can achieve.
A common question is which deficiency causes sunken eyes. No single nutrient is solely responsible, but poor overall nutrition affects how the area looks. Iron deficiency, for instance, is linked to pallor and more visible under-eye shadows, while low protein, vitamin C or B12 can affect skin quality.
That said, nutritional factors usually contribute to the appearance rather than cause deep, fixed hollowing on their own. If you suspect a deficiency, a conversation with your GP and a blood test are the right first steps; correcting it supports skin health but will not restructure an anatomical tear trough.
Everyday factors can accentuate sunken eyes even when the underlying structure has changed little. Dehydration reduces the plumpness of the skin, poor sleep affects circulation and fluid balance, smoking accelerates collagen breakdown, and sun exposure thins the skin over time. People often ask whether drinking more water helps.
Staying well hydrated genuinely supports the appearance of the skin and can soften mild, dehydration-related hollowing, but the effect is modest: water cannot replace lost volume or rebuild thinned skin. Where lifestyle is the main driver, small consistent changes help; where the cause is structural, they support treatment rather than replace it.
In most cases the appearance can be improved, often significantly, though the honest answer depends on the cause. For example, volume loss responds to restoring support, while thin skin and collagen decline respond to regenerative treatment over time, and lifestyle-related hollowing responds to simple changes.
Genetic bone structure and deep-set eyes are harder to alter without surgery, but even then the shadow can usually be softened. The realistic goal is meaningful, natural-looking improvement that suits your face rather than a return to how the area looked decades ago.
| Cause of Sunken Eyes | Treatment That May Help |
|---|---|
| Tear trough volume loss | Dermal fillers |
| Thin, crepey skin | Polynucleotides |
| Poor skin quality | Skin boosters |
| Collagen loss | Regenerative injectables |
| Lifestyle factors | Hydration, sleep and sun protection |
| Multiple contributing factors | Personalised treatment plan |
No. These two concerns often occur together, which causes confusion. Sunken eyes describe a loss of fullness and a hollow contour, whereas dark circles refer to discolouration that can come from pigmentation, visible blood vessels or the shadow cast by hollowing itself.
Treating the structure can improve shadow-related darkness, but pigment-related circles need a different approach. If discolouration is your main concern, our dark circles concern page explains the distinction and the relevant options.
Because sunken eyes have so many possible causes, every plan begins with a consultation with Dr Brennand, who assesses the under-eye area alongside the cheek and overall facial balance before recommending any treatment.
Injectable treatments such as fillers and polynucleotides are performed by Dr Brennand; where a device-based treatment forms part of the plan, it is delivered by the trained clinical team under his clinical lead. In an area this delicate, subtlety and safety go hand in hand, and the aim throughout is a rested appearance that still looks unmistakably like you.
It depends on the cause. Structural volume loss may be addressed with dermal fillers, thin or crepey skin often responds better to polynucleotides or skin boosters, and lifestyle-related hollowing can improve with better sleep, hydration and sun protection. A consultation is the only reliable way to identify the right combination for you.
No single deficiency causes sunken eyes on its own, but iron deficiency is commonly linked to pallor and more visible under-eye shadows. Low protein, vitamin C or B12 can also affect skin quality. If you suspect a deficiency, ask your GP for a blood test; correcting it supports skin health but will not rebuild lost volume.
Staying well hydrated supports the appearance of the skin and can soften mild, dehydration-related hollowing, so it is worth doing. The effect is modest, though: water cannot replace lost volume or rebuild thinned skin, so where the cause is structural, hydration supports treatment rather than replacing it.
The appearance can usually be improved, sometimes considerably, though whether it can be fully reversed depends on the cause. Volume loss and skin thinning respond well, and lifestyle factors can be addressed directly. Genetic bone structure is harder to change without surgery, but the resulting shadow can generally be softened.
Whether your under-eye hollowing is caused by volume loss, thinning skin or a combination of factors, the first step is an expert assessment. Dr Duncan Brennand will take the time to understand your concerns before recommending the treatment, or combination of treatments, best suited to you.
Book a consultation online or get in touch with our Harley Street clinic to discuss your options.
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Whether you are travelling from within London or further afield, our Harley Street clinic provides a calm, professional environment for personalised aesthetic and skin health treatments in one of the capital’s most respected medical locations.
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