In this guide12 sections
Summary
- “Sunken eyes” describes three different things — cosmetic hollowing, true enophthalmos where the eyeball itself sits deeper, and naturally deep-set eyes you were born with. Only one is a cosmetic problem.
- Sudden or one-sided sunken eyes need a doctor, not a clinic. An orbital floor fracture or silent sinus syndrome can present exactly this way.
- Cosmetic hollowing is volume loss — fat pads shrink and reposition, and the orbital bone gradually recedes. It builds over years, symmetrically.
- Rapid weight loss is now a common cause. Losing weight quickly, including on modern weight-loss medication, strips facial fat before anywhere else.
- Eyelid surgery can cause this. Removing too much orbital fat deepens a hollow rather than treating one — and it is one of the harder complications to correct.
- Volume replacement is the answer for cosmetic hollowing — tear trough filler, fat transfer, or fat repositioning. Not fat removal.
Three Different Things Called “Sunken Eyes”
Cosmetic hollowing
The eyeball is in its normal position; the soft tissue around it has thinned. Fat pads beneath the eye shrink and descend, the tear trough deepens, and the bony orbital rim becomes visible as a shadowed groove.
This is what most people mean by sunken eyes, and it is what ageing around the eyes produces. It develops gradually, affects both sides, and is genuinely a cosmetic concern.
True enophthalmos
The eyeball itself has moved backwards into the socket. The medical term is enophthalmos, and it is a different problem entirely — the volume of the orbit has changed, or its contents have.
Causes include orbital floor fracture (the socket floor gives way and orbital contents drop into the sinus below), silent sinus syndrome (the maxillary sinus collapses inward, pulling the orbital floor with it, often with no symptoms at all), orbital fat atrophy, severe dehydration or illness, and neurological conditions.
The distinguishing features are speed and symmetry. Enophthalmos usually affects one eye and appears over weeks or months rather than years. Cosmetic hollowing affects both and takes decades.
Deep-set eyes
An inherited bone structure, not a change. A prominent brow ridge and a deeper orbit place the eye further back, creating shadow. If your eyes have always looked this way and so do a parent’s, this is anatomy rather than ageing.
Deep-set eyes are not a problem to be corrected, though makeup technique and lighting change how prominent they look. Filling a naturally deep orbit rarely produces a natural result.
When a Sunken Eye Is Not Cosmetic
See a doctor rather than a cosmetic clinic if:
- It came on suddenly rather than developing over years
- It affects one eye only
- It followed a blow to the face, a fall or an accident — even months earlier
- You have double vision or any change in vision
- You also have a drooping upper eyelid or a smaller pupil on the same side
- You have had significant unexplained weight loss or feel generally unwell
An orbital floor fracture can produce enophthalmos that only becomes obvious weeks after the injury, once swelling settles.
Silent sinus syndrome is exactly what its name suggests — painless, symptomless collapse of the maxillary sinus that pulls the eye downward and back. People often present to an aesthetic clinic first.
Horner’s syndrome combines apparent enophthalmos with a drooping lid and constricted pupil, and always warrants medical assessment.
We would rather send you for a scan than inject filler into a problem that needs investigating.
What Causes Cosmetic Hollowing
Fat pad loss and descent. The face has discrete fat compartments. Those around the eye shrink with age and the mid-face pads slide downward, leaving the upper cheek flat and the under-eye area hollow. See dark circles under eyes for how this same change produces shadowing.
Bone resorption. Less widely known, and important. The orbital rim genuinely recedes with age — the socket becomes wider and the bony support behind the soft tissue retreats. No topical treatment addresses this.
Rapid weight loss. Facial fat is lost early and disproportionately. Losing a large amount of weight quickly — including on modern injectable weight-loss medication — commonly produces facial hollowing well before people are happy with their body result. Slower loss allows skin and tissue to adapt.
Genetics. Determines your starting fat volume, bone shape and how quickly both change.
Smoking. Accelerates both dermal thinning and fat loss.
Sun damage. Degrades the collagen that gives the overlying skin substance, deepening the appearance of any hollow. Daily SPF and good periorbital skincare slow this.
Dehydration and poor sleep. Make an existing hollow look worse. They do not cause one.
Chronic illness. Significant systemic illness with muscle and fat loss produces a sunken appearance. This is a reason to treat the illness, not the eyes.
Why Eyelid Surgery Can Cause This
This needs stating plainly, because a good deal of published material gets it backwards.
Lower blepharoplasty removes or repositions orbital fat to treat eye bags. Done conservatively, it improves the lid-cheek transition.
Done too aggressively, it produces exactly the hollowing this page is about. Removing too much fat leaves the orbital rim unsupported, the socket edge visible, and a skeletal appearance that is harder to correct than the bag ever was.
So blepharoplasty is not a treatment for sunken eyes. Any page describing it as a permanent solution for hollowing has confused two opposite problems.
If surgery has left you hollow
It is correctable, though not always completely. Fat transfer is usually the best option, replacing what was removed with your own tissue. Filler can help in the short term and has the advantage of being reversible — useful when the surgical result is still settling. Wait at least six months after the original surgery before intervening; some apparent hollowing is swelling resolving unevenly.
See revision blepharoplasty for surgical correction.
Restoring Lost Volume
Dermal filler
Tear trough filler uses hyaluronic acid placed deep, against the bone, to restore volume beneath the eye. Lasts nine to eighteen months.
Its real advantage is reversibility. If the result is not what you wanted, it can be dissolved with hyaluronidase — see filler dissolving. For a first treatment in a difficult area, that matters.
The risks are real. Placed too superficially it produces a blue-grey Tyndall discolouration. Hyaluronic acid attracts water, so it can also cause persistent swelling — see malar bags and festoons. Under-eye filler is among the most technically demanding injectable treatments and should not be a beginner’s procedure. See why under eye filler is not for everyone.
Fat transfer
Facial fat grafting harvests your own fat, processes it, and injects it in small amounts around the eye. Results take three to four months to settle as the graft establishes a blood supply.
Longer lasting than filler and made of your own tissue, with the additional benefit that grafted fat appears to improve overlying skin quality. Not reversible, and some graft loss is expected — occasionally a second session is needed.
Fat repositioning
During lower blepharoplasty, rather than removing orbital fat, the surgeon releases and redrapes it over the orbital rim to fill the tear trough. The right operation where a genuine bag sits above a hollow — it treats both with one manoeuvre and avoids creating the problem this page describes.
Skin quality treatments
Radiofrequency microneedling and laser resurfacing improve the skin over a hollow. They do not fill it. Useful as an adjunct, disappointing alone.
What Does Not Work
Cucumber slices, cold spoons and tea bags. Reduce puffiness for an hour. Volume loss is structural — nothing topical replaces it.
Eye creams. Hydrate the surface. No cream reaches or replaces an orbital fat pad.
Drinking more water. Sensible, and dehydration does make hollows look worse, but hydration does not restore lost fat or bone.
Facial exercises. No mechanism for increasing fat volume or altering bone.
Face yoga and massage. Pleasant, no structural effect.
Supplements marketed for facial volume. No evidence.
And the important one: fat removal of any kind. If a practitioner proposes removing tissue to treat a hollow, ask them to explain how.
Realistic Outcomes
Cosmetic hollowing responds well to volume replacement. Expect a rested rather than transformed appearance — over-filling this area looks worse than the hollow did.
Post-surgical hollowing improves substantially with fat transfer, though scarred tissue takes grafts less reliably than untouched tissue.
Deep-set eyes are anatomy. Filling them heavily produces an odd result, and we would usually advise against it.
True enophthalmos needs its cause treated. Filling the hollow left by an orbital fracture without repairing the floor is treating a symptom.
Costs
Consultation £100, redeemable against treatment.
Tear trough filler from around £450, lasting 9 to 18 months.
Filler dissolving from around £250.
Facial fat transfer from £4,000.
Lower blepharoplasty with fat repositioning from £3,000.
Revision blepharoplasty quoted individually after assessment.
Finance is available through Chrysalis Finance, subject to status; see our finance options page.
Sunken Eyes FAQs
What causes sunken eyes?
Cosmetic hollowing comes from age-related fat loss, fat descent and gradual recession of the orbital bone, accelerated by smoking, sun damage and rapid weight loss. True enophthalmos — where the eyeball itself sits deeper — has different causes including orbital fracture and silent sinus syndrome, and needs medical assessment.
How do I fix sunken eyes?
For cosmetic hollowing, volume replacement: tear trough filler, facial fat transfer, or fat repositioning during eyelid surgery. Skin treatments improve the surface but do not fill a hollow. First establish which of the three types you have.
Can sunken eyes be reversed naturally?
Not meaningfully. Sleep, hydration and stopping smoking help appearance and slow progression, but lost fat and resorbed bone do not return on their own.
What is enophthalmos?
The medical term for the eyeball sitting further back in its socket than normal. Distinct from cosmetic hollowing, usually one-sided, and often caused by orbital floor fracture, silent sinus syndrome or orbital fat atrophy. It needs assessment by an ophthalmologist or oculoplastic surgeon.
Are deep-set eyes the same as sunken eyes?
No. Deep-set eyes are an inherited bone structure — a prominent brow and deeper orbit — present since childhood. Sunken eyes are a change from how you previously looked.
Can weight loss cause sunken eyes?
Yes, and it is increasingly common. Facial fat is lost early and disproportionately during rapid weight loss, including on injectable weight-loss medication. Losing weight more slowly allows tissue to adapt.
Can blepharoplasty cause sunken eyes?
Yes. Removing too much orbital fat during lower eyelid surgery leaves the socket rim unsupported and produces a hollowed appearance. It is one of the more difficult complications to correct, usually requiring fat transfer.
Will blepharoplasty fix my sunken eyes?
Standard blepharoplasty removes fat, so on its own it makes hollowing worse. Fat repositioning — redraping orbital fat over the rim rather than removing it — can help where a bag sits above a hollow.
Is tear trough filler safe for hollow eyes?
In experienced hands, for the right candidate, yes. The area is technically demanding: superficial placement causes a blue-grey Tyndall effect, and because the product attracts water it can cause lasting swelling. Its advantage is that it can be dissolved.
How long does filler last in the under-eye area?
Typically nine to eighteen months, sometimes longer than elsewhere because there is little muscle movement to break it down.
Is fat transfer better than filler for sunken eyes?
It lasts far longer and uses your own tissue, but it is surgical and not reversible. Many people start with filler because a poor result can be dissolved, then move to fat transfer once they know what they want.
Why do my eyes look sunken all of a sudden?
Sudden change is the important word. Rapid onset, particularly on one side, suggests something other than ageing — dehydration and acute illness are common, but orbital fracture and silent sinus syndrome need excluding. See a doctor before booking cosmetic treatment.
Can dehydration cause sunken eyes?
Severe dehydration reduces orbital tissue volume and produces a genuinely sunken appearance, which resolves on rehydration. Everyday mild dehydration accentuates an existing hollow without causing one.
Do sunken eyes make you look older?
They tend to read as tired rather than old. The under-eye shadow that hollowing creates is one of the strongest visual cues for fatigue, which is why restoring volume so often makes people look rested rather than different.
Assessment at Centre for Surgery
Assessment starts by establishing which of the three you have. Your surgeon will examine both eyes, compare them, ask when the change began and whether it followed any injury or surgery, and consider whether investigation is needed before any cosmetic treatment.
We will say when treatment is not the answer. Naturally deep-set eyes are usually best left alone, and a sunken eye that appeared suddenly needs a diagnosis first.
All surgery is performed by GMC-registered surgeons at our own day-surgery facility at 95–97 Baker Street, Marylebone, under TIVA anaesthesia. We are regulated by the Care Quality Commission and rated Good overall. We recommend a two-week cooling-off period before any surgery. No GP referral is required.
Phone: 020 7993 4849
Email: contact@centreforsurgery.com
Address: 95–97 Baker Street, Marylebone, London W1U 6RN
Contact us to schedule your consultation
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Related Reading
- Tear trough deformity
- Dark circles under eyes
- Malar bags and festoons
- Under eye wrinkles
- How to get rid of eye bags
- Why under eye filler is not for everyone
- Blepharoplasty (eyelid surgery) in London
- Lower eyelid surgery
- Revision blepharoplasty
- Facial fat transfer
- Tear trough filler
- Heavy eyelids
