Under-eye Hollow Treatment, Marylebone, London

Hollow under-eyes are one of the most common concerns I see in clinic, and they can make you look tired even when you feel perfectly rested. While dermal fillers have long been the go-to treatment for restoring lost volume in this area, it is not the only option. Many patients want to avoid filler because of personal preference, previous complications or simply because they’re not a suitable candidate. The good news is that under-eye hollowness can often be improved without adding volume at all. The key is understanding what is causing the hollow, then choosing a treatment that strengthens and revitalises the area from within. Let us explore what really works.

Why under-eye hollows happen

The tear trough area is one of the thinnest and most delicate parts of the face. As we age, the skin becomes thinner, collagen levels decrease, and the fat pads under the eyes shift or diminish. This creates a shadow or indentation that we recognise as hollowness. Lifestyle factors such as stress, poor sleep, dehydration and genetics can make it more noticeable.

Filler is one way to replace lost volume, but it is not suitable for everyone. Some patients are prone to puffiness or water retention, others have very thin skin that shows the filler, and some simply prefer not to use volumising injectables. In these cases, a regenerative approach often provides a more natural and elegant improvement.

Strengthening the skin with polynucleotides

One of the most effective non filler treatments for hollow under eyes is polynucleotides. These are powerful regenerative injectables derived from purified DNA fragments. Rather than adding volume, they work by stimulating fibroblasts, improving tissue quality and encouraging hydration at a cellular level.

Under the eyes, polynucleotides can thicken and strengthen the skin, reduce crepiness and improve elasticity. This often makes the hollow look less deep because the skin is healthier and better supported. Results build gradually over weeks as the tissue regenerates and the area becomes brighter and more refreshed.

For patients with early hollowness or thin, fragile skin, polynucleotides are one of my favourite treatments because they restore function rather than disguise a problem.

Improving skin density with Sunekos

Sunekos is another excellent regenerative option for the under-eye area. It combines hyaluronic acid with a patented blend of amino acids that support the extracellular matrix. This means it encourages the skin to rebuild and repair itself, improving elasticity, hydration and fine lines.

Sunekos is particularly useful for patients who have hollowing combined with crinkling or crepey skin. By restoring the integrity of the tissue, the tear trough appears softer, and the shadowing becomes less noticeable. Like polynucleotides, Sunekos does not add bulk, which makes it a safer option for those who want a subtle and natural improvement.

Boosting collagen with skin-tightening treatments

Sometimes the appearance of hollows is caused not just by lost volume but by laxity in the lower eyelid or midface. When the skin begins to droop, it creates an exaggerated shadow under the eyes. In these cases, tightening treatments can play an important role.

Energy based treatments such as microneedling or radiofrequency can stimulate collagen in the deeper layers of the skin, improving firmness and reducing laxity. While these are not used directly on the very thin skin under the eye, they can be applied to the surrounding areas to give a lifting effect. By improving support in the cheek and lower lid area, the under eyes appear less hollow and more youthful.

This approach is particularly effective for patients whose hollow appearance is linked to mild to moderate skin laxity rather than true volume loss.

Medical-grade skincare that makes a difference

The right skincare will not eliminate a deep hollow, but it can absolutely improve the quality of the skin and enhance the results of in-clinic treatments. Retinoids strengthen the dermis over time, vitamin C brightens pigmentation that may contribute to darkness, and peptides support repair processes.

An eye cream containing ingredients that boost collagen and hydration can make the area appear smoother and less sunken. For some patients in their early thirties or those with very mild hollowing, skincare alone can make a noticeable difference. 

When filler might still be the right option

Although there are many non-filler treatments that can help, filler still has an important place. Some people have significant anatomical hollowness or deeper volume loss that simply cannot be corrected without adding structure. In these cases, a tiny, carefully placed amount of filler can provide a beautiful, natural improvement. The key is choosing the right patient, the right product, and the right technique.

Often, the best results come from combining regenerative treatments with minimal filler. By improving the quality of the skin first, far less filler is needed, and the outcome looks softer and more harmonious. Beyond filler, the only way to truly restore lost volume is through a surgical fat grafting procedure.

Choosing the right approach

Under-eye hollowing is rarely caused by just one factor, which is why a personalised plan is essential. During your consultation, I assess the skin quality, fat distribution, bone structure and degree of laxity to understand what is really contributing to the hollow. From there, we can create a tailored treatment plan that gives you the most natural and effective result.

Whether you want to avoid filler or simply want to explore regenerative options first, there are many ways to improve the appearance of hollow under eyes without adding volume.

If you are ready to rejuvenate the under-eye area in a way that looks fresh, subtle and authentically you, I would be delighted to guide you through the best options for your anatomy and your goals. Click here to enquire or to book a consultation with me in my Kent or London clinic.