Eyebags, crease and loss of volume at eye-cheek junction in early 20s. Which treatment is best? (Photo)

I have volume loss around my cheek area, resulting in purple bags under my eyes (hereditary). I was ok when it was just a tear trough deformity, but the bag has now gone around to meet the outer corner of my eye (I think this is the palpebromalar groove). My biggest concern is that every morning I now wake up with a permanent crease here and it is getting worse. I’m willing to consider ANYTHING (blepharoplasty, fillers, fat grafting, etc) – whatever is best to treat this and my dark circles.

Doctor Answers (3)

Your problem is more about relative hollowness, and your eye bags are mild enough to be treated non-surgically

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In the absence of a physical exam, it’s very difficult to make a definitive recommendation. People like you are in a situation where it’s more about the volume loss than it is about the fat prolapse. Thanks to more recent fillers, it is actually possible to camouflage that transition or restore a little bit of volume along the orbital rim. We refer to this area as the V-deformity. Basically, we are just looking at a relative hollow.

In my practice, I routinely use hyaluronic acid such as Restylane. I’ve also been doing a combination of hyaluronic acid with platelet-rich plasma. There has been some very well established information in the literature of the synergistic effect of the combination of platelet-rich plasma. Platelet-rich plasma is derived from your own blood and contains growth factors and helps improve skin quality. Hyaluronic acid provides some volume and there’s collagen deposition that helps to improve these areas more long-term. A lot of our younger patients appreciate avoiding surgery and having this type of treatment. If the fat pockets underneath their eyes are too prominent, then we recommend a surgical procedure.

I would caution you about fat grafting. Lower eyelid skin is the thinnest skin in the body and is about half a millimeter in thickness. In my experience, I had many patients from all over the world that have me treat them because they had fat grafting and they ended up with a lot of irregularities, scars, lumps and basically things that are very complex to deal with.

I think that your puffy under eye bags are not that prominent and you can use hyaluronic acid fillers, but there’s an art to doing this. It may take a doctor more than one treatment to get it right just for you, but I think it’s the least invasive and most effective way to treat you. Hyaluronic acid can last from months to over a year, but there’s some variability. If you are doing anything that is any way toxic to your skin then it’s advisable to stop, including: smoking, rying to lose weight and doing any crash dieting or even drinking excess alcohol. These things are very toxic and can advance the aging process.

So think about fillers as a starting off point before moving ahead with surgery. Again, in the absence of a physical examination, it’s hard to appreciate your situation in 3-dimensions.

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New York Oculoplastic Surgeon
4.5 out of 5 stars 26 reviews

Dermal fillers for eyelid hollows

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Very small amounts of Restylane may be used to plump the depressed areas beneath your lower eyelids.  However fillers must be repeated and over the years the effect of repeated injections into the eyelid cannot be predicted.  Open fat grafting, not fat injection is another alternative to plump these depressed areas.

IPL treatments can improve the purple color of your eyelid that is caused by small venule's or blood vessels.

Please see an expert board certified plastic surgeon who is experienced an oculoplastic surgery.

Brooke R. Seckel, MD, FACS
Boston Plastic Surgeon
4.5 out of 5 stars 29 reviews

Eyelid treatment

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I suggest pulse dye laser for the veins, and a combination of resurfacing and pigment lasers to lighten the skin.
Hydroquinone cream can be used as well.

I recommend Belotero to fill your tear trough.

Having given you treatment suggestions I suggest you avoid rubbing your eyes to avoid worsening your condition.

Gregory Herbich, MD
Honolulu Dermatologist

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These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.