There are several ways to address Marionette lines that are non-surgical, but the results will never be as good as surgery. That being said, you can achieve near surgical results with the current treatment available today. Sometimes a combination of treatments is recommends. Looking at the photo, filler placed directly into the lines would help efface them as well as filler placed into other parts of the face to give the appearance of lifting, without actually lifting (other parts being the cheeks, angle of the mandible (or jaw), chin, and pre-jowel sulcus (also part of the jaw)). These would respond nicely to thread lifting as well, though the results after threading typically last less than a year and for some patients, less than 6 months with a repeat treatment (and sometimes included in the price) needed at 6 months after the first treatment of threads. Hope this helped answer your question! Other devices out there may help - i.e. microneedling, CO2 laser resurfacing - but will not achieve quite the effacement of the lines you are looking for like the first two treatment options.
Hi there! As an oculoplastic surgeon, I have performed thousands of injections of filler in order to address under eye hollows including the tear trough deformity (which is the nasojugal groove). Oftentimes, I place filler in the nasojugal groove (aka tear trough) directly and at the lateral orbital room if there is a hollow there. I also place it in the cheeks at the zygomatic arch to address volume loss because that contributes to under eye hollows. This cheek placement may explain why your injector put the filler in the cheeks for the under eye hollows. The picture sheds some light on the situtation, however, a photo without smiling is perferred as the orbicularis muscle contracts during smiling and can hide filler and under eye hollows. It does appear that there is some filler on your right in the T zone - since I can see it even with smiling. The solution would be to have a skilled injector dissolve that zone of migrated filler by using hyaluronidase, the enzyme that dissolves filler, which is made of hyaluronic acid (which most fillers are). If it does not dissolve and improve with this injected medication, then it is another filler (possibly Radiesse) or facial anatomy. I hope this helped!
Another surgical correction for prominent eyes is an orbital decompression. This surgery is performed by fellowship-trained oculoplastic surgeons (they specialize in plastic surgery around and behind the eyes, including orbital lesions, etc.). Fat and sometimes bone are removed from around and behind the eyes to help them move back so they are less prominent. There are risks, as with any surgery, of vision loss, and so again, only trust an oculoplastic surgeon for this type of surgery as they receive an extra two years of training dedicated to just the eyes and fat and bone around and behind the eyes.
That's a great question - you're right, some doctors and nurses are adamant about avoiding under eye filler, while others perform under eye filler on a regular basis. It's important to consider the pros and cons of under eyelid filler, but above all, only trust an expert - who is usually an oculoplastic surgeon who has had special training in orbital and eyelid anatomy, filler, and surgery around the eyes. Filler placed too superficially in the skin can appear lumpy and bumpy as well as take on a blue hue known as the Tyndall effect. The eyelid skin is the thinnest skin on the body, and so placing filler too superficially comes with these types of problems. The type of filler used is also important. A filler that pulls in a lot of water like, for example, Juvederm Voluma, is not meant for under the eyes because it can lead to puffiness. I like Restylane products such as Restylane-L or Restylane silk for under the eyes. If your injector considers all these factors and has lots of experience, they should not have a problem filling in dark circles under your eyes. Another option is fat transfer plus or minus a lower eyelid blepharoplasty - again, important to visit someone who is aware of filler techniques and all your options.
This is a very common problem and question! Filler under the eyes in all about placement. It should be placed deep, along the orbital rim bone, and not in the muscle - filler placement (and even fat placement) in the muscle is a very common mistake with serious complications. Filler placed in the muscle will result in accentuation of the muscle and abnormal movement during animation. Filler placed too superficially can be seen as a blue hue, and often requires dissolution. Under eye filler placement also usually requires a combo approach with cheek filler, as part of the problem with volume loss around the eyes is a result of cheek deflation and descent. I would recommend visiting an oculoplastic surgeon for under eye filler placement, as these physicians receive dedicated training on the eye and periorbital zones. They are well familiarized with the anatomy and layers of tissue around the eyes, including exercising the highest safety standards for vision.
