Lower Eyelid Bags vs. Hollow Under-Eyes: What’s the Difference?

Many people struggle with tired-looking eyes even when they’re well-rested. While “under-eye bags” and “hollow eyes” are often used interchangeably, they’re actually two very different conditions that require distinct treatments. At Khan Eyelid & Facial Aesthetics in Plano, Texas, Dr. Tanya Khan, a board-certified oculoplastic surgeon, specializes in identifying the root cause of under-eye concerns and creating customized solutions to restore a refreshed, youthful look.

Understanding Lower Eyelid Bags

Lower eyelid bags occur when fat pockets beneath the eyes begin to bulge or shift downward. This can result from aging, genetics, fluid retention, or lifestyle factors such as lack of sleep and salt intake. Over time, the skin and muscles supporting the lower eyelid weaken, allowing fat to protrude and create puffiness or a shadowed appearance.
Common signs of lower eyelid bags include:

• Puffiness or swelling beneath the eyes

• Noticeable “bags” that don’t resolve with rest

• Loose or wrinkled skin in the lower eyelid area

• A tired or heavy appearance despite feeling rested

What Causes Hollow Under-Eyes

Hollow under-eyes—or tear trough deformities—occur when volume loss in the midface or under-eye region creates a sunken or shadowed look. This can develop naturally with aging as collagen and fat diminish, or it can be genetic. Unlike puffy bags, hollows give the appearance of dark circles and fatigue because of the shadow they cast.
Signs of hollow under-eyes include:

• A sunken or “scooped out” appearance beneath the eyes

• Dark shadows that persist even with good sleep

• Smooth, non-puffy skin but visible indentation under the lower lid

• Fatigue or sadness appearing in facial expressions

Treatment Options for Each Condition

Because bags and hollows have different causes, their treatments differ as well. Dr. Khan carefully evaluates eyelid anatomy to recommend the most appropriate solution.

For Eyelid Bags:

• Lower Blepharoplasty: A surgical procedure that removes or repositions fat, tightens skin, and restores a smooth lower eyelid contour.

• Skin Resurfacing: Laser or radiofrequency treatments to tighten loose skin and improve texture.

• Lifestyle & Non-Surgical Care: Reducing sodium intake, managing allergies, and using medical-grade skincare can minimize mild swelling.

For Hollow Under-Eyes:

• Dermal Fillers: Hyaluronic acid-based fillers restore volume to the tear trough and reduce shadows.

• Fat Transfer: Uses a patient’s own fat to naturally replenish lost volume and smooth transitions between the lower lid and cheek.

• Skin Treatments: Collagen-stimulating procedures help improve tone and elasticity.

When You Have Both

It’s not uncommon to have both puffiness and hollowness beneath the eyes, especially with age. In these cases, Dr. Khan often recommends a combination of surgical and non-surgical techniques to balance the under-eye area—removing excess fat while restoring volume where needed for natural, harmonious results.

Why Choose Dr. Khan

As an oculoplastic surgeon, Dr. Tanya Khan combines her expertise in both aesthetic and functional eyelid anatomy to deliver results that look natural and complement the entire face. Her goal is to help patients appear rested, youthful, and confident—without changing their unique expressions.

If you’re unsure whether your concern is puffiness or hollowness, schedule a consultation at Khan Eyelid & Facial Aesthetics. Dr. Khan will evaluate your anatomy and recommend the most effective treatment for lasting, beautiful results.

For more information about procedures and treatments at Khan Eyelid and Facial Aesthetics by Ophthalmic surgeon Dr. Tanya Khan. Click here to contact us.

Taking patients from in and around Dallas, Plano, Fort Worth, Grapevine, Garland, Mesquite, Carrollton, Irving, Frisco, Texas and more.