Hello, I'm Dr. Yoosuk Chung, plastic surgeon at TheLine Plastic Surgery.
It feels like just this one area of my face is hollowing first
To get straight to the point: it's not a coincidence that this area shows change first. The region from under the eyes to the upper cheek has a thinner cushioning fat layer than the rest of the face, and the skin here is anchored relatively close to the bone through a ligament. As a result, even a small change shows up immediately as shadowing or hollowness. And because this underlying structure is often something people are simply born with, some people notice hollowness here from a young age, regardless of aging.
Why does this specific area react so sensitively?
The cheek area tends to have a relatively thick fat layer, so even if there's some change in the bone underneath, the thick fat acts as a buffer and it doesn't show much on the surface. The area from under the eyes to the upper cheek, however, has a much thinner fat layer, and a structure called the orbitomalar ligament (also known as the orbicularis retaining ligament) holds the skin relatively close to the bony rim of the eye socket[1].
Think of it this way: the cheek is like being covered with a thick blanket — even if the shape underneath shifts slightly, you won't see it from outside. The under-eye to upper-cheek area, on the other hand, is more like a thin curtain — even subtle changes in the bone or fat behind it can show through as a shadow or contour.
This relationship between this area and the SMAS layer follows a similar logic. As discussed in "Why Doesn't My Firming Cream Work: The Part of Sagging Skincare Can't Reach," different layers of the face tend to age at different rates — and areas like the under-eye to upper-cheek region, where the cushioning layer is thin to begin with, are exactly where these layer-by-layer changes tend to show through fastest and most visibly.
Why can this happen even without aging?
Interestingly, hollowness in this area can appear at a young age, independent of aging. The paper that first systematically described the anatomy of this region explains that, due to the way the orbitomalar ligament holds the skin close to the bone, this hollow (known as a tear trough deformity) can appear even in young individuals[2]. In other words, hollowness in this area is heavily influenced by inherited anatomical structure.
With age, changes in bone are added on top of this. A study analyzing skulls from a medieval European osteological collection found that orbital (eye socket) height and width increased significantly with age[3]. An enlarging orbit reflects changes in the bony structure that once supported the area around the eyes — and in a region that already has minimal cushioning to begin with, such changes can become visible more easily.
In summary, the under-eye to upper-cheek area hollows first because it naturally has a thin cushioning fat layer and skin anchored close to the bone. As bone and fat changes accumulate with age, this can become even more pronounced.
Individual variation and things to keep in mind
The inherited structure of this area (fat layer thickness, ligament position) varies from person to person, so the degree of hollowness can differ even at the same age.
Hollowness appearing at a young age is more likely related to inherited anatomical structure than to aging.
Changes that appear with age seem to result from a combination of bone remodeling and fat layer changes, and the pace and degree can vary between individuals.
The studies cited above analyze anatomical structure and age-related changes; they are not clinical trials directly testing the effectiveness of any specific procedure.
Three Key Takeaways
1. The area from under the eyes to the upper cheek has a thinner cushioning fat layer than the rest of the face, with skin anchored close to the bone via a ligament[1].
2. This structure is often inherited, so hollowness in this area can appear from a young age, independent of aging[2].
3. With age, changes in the orbital bone are added, which can make hollowness in this area even more pronounced[3].
Whether your hollowness stems from inherited structure or age-related change is best confirmed through an in-person consultation with a specialist.
By Dr. Yoosuk Chung (Board-Certified Plastic Surgeon)
--- Sources
1. Woodward J, et al. Infraorbital Hollow Rejuvenation: Considerations, Complications, and the Contributions of Midface Volumization. Aesthet Surg J Open Forum. 2023. Oxford Academic
2. Hirmand H. Anatomy and Nonsurgical Correction of the Tear Trough Deformity. Plast Reconstr Surg. 2010;125(2):699-708. Plastic and Reconstructive Surgery
3. Insight into age-related changes of the human facial skeleton based on medieval European osteological collection. Sci Rep. 2023. Nature Scientific Reports
This article summarizes questions around under-eye and upper-cheek hollowing based on anatomical references and research published in academic journals. Please consult a specialist to confirm your individual condition.