I am 42 and not happy with two things: bags under eyes (bigger on my right side) and loss of fat on my face. I maintain my body weight by controlling what I eat and exercise thus have a great body but also a "fat-free" face, and as a result, sagging skin, no cheeks, and deep nasolabial folds. I tried Radiesse filler for nasolabial folds. It lasted only for 3 weeks (due to exercise?) What would be a long-lasting solution for my eyes, sagging skin, cheeks, and nasolabial folds?
Long-lasting Solution for Eye Bags, Sagging Skin, and Nasolabial Folds?
Doctor Answers 9
Long-lasting solution for eye bags, sagging skin, and nasolabial folds
There are two good options, both depend upon the skill and experience of your treating physician.
Sculptra is a collagen stimulator that has shown remarkable filling results in patients such as yourself. For the area immediately under your lower eyelids I would use Restylane.
If you are adverse to Sculptra, the other alternative is fat grafting.
For both choices it is very important to choose your treating physician most carefully.
Good luck and be well.
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Help for "Fat Free" Face
Exercise and a healthy diet are essential to a long, healthy life. Unfortunately this combined with aging often results in loss of facial fat. In your case aging is also leading to weakness of the lower lid septum leading to bags.
Here's the best solution for you. First a transconjunctival lower lid blepharoplasty with fat redraping will both correct the bags and the tear troughs. Next, micro fat injection of your cheek and nasolabial folds is a permanent fix to your loss of volume. Be sure your fat injection surgeons is using the smallest cannulas, 1.2-1.4mm for injection. This will result in a better take of the fat.
Sunken face fillers and botox
Your photograph does not show bags but it might be the lighting or angle that is disguising them. There appears to be a hypetrophic orbicularis lower eyelid muscle. This rolled up muscle is a sling underneath the lower eyelid and is creating a little bulge along its length. 1 to 2 units of Botox may help this become flatter, but you should see a physician who has a lot of experience in injecting this area.
You also have a tear trough, or groove running diagonally from the inner corner of the eye, towards the lower outer cheek about 1 1/2 inches in length. Fillers placed underneath the muscle in this area, an off-label use, helps gently smoothen the tear trough.
If you had so much of the Radiesse disappear in three weeks time, it still might be worth another attempt as it does last for many months to close to a year in many patients. Perlane or Juvederm Ultra Plus could also be tried, or Sculptra.
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Restylane and Sculptra for loss of volume in face
I have had good success with the use of restylane under the eyes in the tear trough for filling in the valleys. A more definitive treatment would mean surgery to remove the bags and fill in the tear troughs with an extended lower lid blepharoplasty. For the hollows in the face Sculptra is a great material to thicken the skin and give you back some contour.
Fat free face
Unfortunately, the picture you posted does not show the bags in the lower lids.
But the rest of the face is deflated, with deep nasolabial fold, hollow cheeks, tear trough deformity, and starting jowls.
I woud start with FAT TRANSFER to the face and lower lid and nasilabial folds. then reevaluate the bags in the lower lids. By then they may have disappeared.
Also, re-evaluate the rest of the face, and your level of satisfaction.
Filling the empty face
I agree with Drs. Aldea and Placik. You have a very substantial volume deficit in the tear trough region. I would plan to use at least 2-3 cc's of Juvederm or Restylane to build that area up. You probably just didn't have enough filler used. There is a learning curve here so make sure your injector has a lot of experience and is a plastic surgeon.
Volume enhancement of your nasolabial folds and IPL to blend out the discoloration of your skin would be very helpful. For an easy surgery recovery which will also really help you, have your upper lids done soon too.
Nonsurgical Correction of Eye bags, sagging facial skin, and Nasolabial folds
I largely agree with Dr. Placik. While you would derive a better result with a Mid Face Lift (which by lifting the cheek, cover the tear trough, smooth the Nasolabial lines and correct the jowls you are beginning to form), such a procedure is certainly more involved than the distant runner up - the placing of fillers along the tear trough (Restylane) and along the Nasolabial lines (deep placement of Radiesse, Perlane or Juvederm Ultra Plus).
Not skimping on fillers here is very important since enough needs to be placed to raise and maintain the elevation of the tissues. A single syringe is never sufficient and usually several are required.
You may wish to look into IPL treatments, especially Sciton's BBL with SkinTyte (look it up on YouTube). The increasing skin tightness achieved in several painless sessions may largely correct your mild jowling.
Dr. P. Aldea
Options for the face
I am generally pleased with the use of Radiesse for this purpose. It is my impression that you did not have sufficient volume injected and that is the primary problem. IT is truly highly unlikely that you underwent resorption of the product in that brief a period. I would first try additional Radiesse.
Other alternatives include the hyaluronic products such as Restylane.
Another option is aulogous fat injections harvested from your body.
Surgical corrections include the use of submalar cheek implants or some form of a cheek lift.
Correction of eye bags, sagging skin, and nasolabial folds requires a multi-faceted approach
Though difficult to be certain from one static, frontal photograph, you appear to have significant midface hollowing, mild R>L lower lid fat pseudoherniation, and early skin laxity.
I have had great success with lean/athletic men such as you with carefully selected/placed silicone cheek implants, conservative transconjunctival lower blepharoplasty for the bulging plus fat transfer to the tear trough, and resurfacing of the skin for the laxity/wrinkles. In my experience, lifting the skin "out" -- away from the bone --- is the appropriate treatment. It seems to look better -- and last longer -- than mid-facelift, which lifts the skin in a more "up" or "back" direction
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