Joelle Rogal, MD

Thank you for your question. Based on your photos, it appears you may have a condition called xanthelasma, which is a cholesterol deposit under the skin, in addition to also having the fat underneath. Based on your photos, I would recommend a lower blepharoplasty and excision of the xanthelasma at the same time. While this involves an incision on the front of the face, these incisions tend to heal remarkably well.

Thank you for your question. Based on your photos you appear to be a good candidate for a rhinoplasty. The purpose of a rhinoplasty is to draw attention away from the nose. Your eyes and your mouth should stand out, not your nose. That means that a rhinoplasty should be tailored to each person, so that it fits with their facial features. You can certainly undergo a rhinoplasty that makes the nose smaller, without completely losing the character of the nose.

A collapsed nostril could be caused by several factors. A nostril can appear collapsed due to a deviated septum or due to supporting cartilage that has collapsed. Without a photo or examination, it is difficult to diagnosis. I would recommend seeking a consultation with a facial plastic surgeon to determine the cause of the collapse, and to determine a specific treatment.

Evaluation of a deviated septum is made through examination of the inside of the nose. The frontal photo can give some hint of the shape of the septum (if it is curved), but is not enough to diagnose a deviated septum. I would recommend seeing a facial plastic surgeon or ENT in consultation to determine if you have a deviated septum.

Without photos, it is difficult to tell whether fillers or fat would be recommended.  In general, fat or fillers can be used to restore volume and balance to the midface. Fat transfer requires an operation, more downtime, and more upfront costs, but the results are permanent.  Fillers are temporary and easily reversible, with less upfront cost, but can be done in the office with minimal downtime.

It is hard to tell without examining you, if the volume in your cheeks is your own or related to the Voluma.  An in person consultation and possibly dissolving the filler would help to determine if that is causing the under eye area to look worse.  Regardless, I think you are still a candidate for fillers under the eye.  From the photos, there appears to be some volume loss under the eyes as well as possibly too much filler in the cheeks.  I recommend seeing a facial plastic surgeon in consultation to determine the best treatment for you.  

A revision rhinoplasty is an option if you are still unhappy.  I would recommend seeing a facial plastic surgeon in person to discuss your concerns.  Together, you can figure out a treatment plan that works for you.  

Unfortunately, fat grafting to the face will only help restore volume to the face-- it will not help with sagging skin.  Blepharoplasty (eye lift) and facelifts are two surgeries that can help with sagging skin.  Sometimes fat grafting is used in combination with these surgeries to achieve the most desirable result.  

In general, there are no disadvantages to using cheek filler long term.  The main risks for cheek filler are the same they are for any other hyaluronic acid: bruising, infection, and very rarely vascular complications.  Once cheek filler is injected it should not shift.  The only person who can make the cheek filler look unnatural or weird is the injector!  I would recommend seeing a facial plastic surgeon and someone you trust to inject.  They should tell you when you would no longer benefit from adding filler.  

Your result appears to be due to overfilling, swelling, and/or bruising from the injection.  The discoloration is not permanent.  I would recommend seeing a facial plastic surgeon to correct the problem.  You most likely need to have the filler dissolved.  Once you've dissolved the filler, new filler can be placed if you choose.  I would recommend a provider that uses a cannula in order to help reduce bruising and swelling in that region.