In Mathematica 12 [`BoundaryMeshRegion`](http://reference.wolfram.com/language/ref/BoundaryMeshRegion) objects can be used as a [`Graphics`](http://reference.wolfram.com/language/ref/Graphics) primitive. So, another idea is to use a [`BoundaryMeshRegion`](http://reference.wolfram.com/language/ref/BoundaryMeshRegion) as your primitive. For example: Typeset`MakeBoxes[ CutoutEllipse[center_, out_, in_], form_, Graphics ] := With[ { new = Replace[ RegionDifference[Disk[center, out], Disk[center, in]], b_BooleanRegion :> BoundaryDiscretizeRegion[b] ] }, Typeset`MakeBoxes[new, form, Graphics] ] Examples: Graphics[{Pink, EdgeForm[Blue], CutoutEllipse[{0,0}, {4,2}, .9 {1,2}]}] [![enter image description here][1]][1] Graphics[{Pink, EdgeForm[Blue], CutoutEllipse[{0,0}, {4,2}, 1.1 {1,2}]}] [![enter image description here][2]][2] You can use this [answer](https://mathematica.stackexchange.com/a/198915/45431) to get the above approach to work in earlier versions of Mathematica. [1]: https://i.sstatic.net/QdiGT.png [2]: https://i.sstatic.net/26rSX.png