Stephen Nightingale, MD

I have found that Q Switch lasers work best for benign unwanted facial pigmentation. What would normally take 4-6 treatments with IPL can be done in 1-2 treatments with a Q Switch. Hydroquinone free topicals such as kojic acid, retinols, ascorbic acid and phytic acid will also help. Finally, sun protection with a UVA/UVB sunscreen/block is vital in order to preserve the effect of the laser and prevent new pigmentation from developing.

You are correct, steroid injections can cause atrophy of both the skin and the fat that lies beneath the skin.  We can see this with cystic acne and acne scar steroid injections as well as steroid injections for tendonitis and scalp nerve blocks.  Typically it takes longer than a week to develop atrophy from a steroid injection. I'm wondering if you are actually seeing the acne cyst shrink and possibly leave a slight depression.   In my experience, fat atrophy may improve over time but it can take months.  Atrophy of the skin is more difficult to treat but may resolve if there are no further injections in that area.  Depending  on type of atrophy, a filler may help, but I would not try this until waiting 6-12 months to see how much this resolves on its own.  In the future, I would recommend using a laser to treat your cystic acne or photodynamic therapy.  Neither of these two treatment modatlities cause atrophy.  I hope this helps.

I would agree, your dark circles appear to be a hereditary issue as opposed to an aging issue.  The skin under the eye is the thinnest on the face so anything that causes vascular congestion in the lower lid will cause dark circles.  I would first make sure there are no medical issues that are contributing such as allergies, excessive irritation or dryness.  Some patients find that  topical  vitamin  K  products help.  Finally, regenerative procedures to help improve the quality of the skin under the eye are likely to be of benefit such as PRP and/or nanofat injections. I am less inclined to use a filler for this problem, but if you do make sure the filler has a low HA concentration/G prime.  This will prevent complications in this difficult region.

It is difficult to tell from the photos whether you have true or pseudo-tear troughs.  In both cases they can be improved with fillers.  It is important to distinguish between the two conditions as the placement of the filler and the type of filler used is usually different. Remember small volumes in this area are usually sufficient and there is no need for over correction.  Good luck!

Good afternoon,

In reviewing your photos it is not entirely clear to me whether these were all taken at about the same time or whether you have had facial fillers before.  You do have mid facial volume loss at least apparant in one of the photos.   Although fillers are not specifically for laxity,  mid facial descent and skin laxity can be improved when fillers are injected into the deep fat regions of the face.  The fillers can create a mild lifting effect which gives the skin a tighter look.  To improve mid face descent you may want to first consider either laser procedures that enhance the laxity of the skin and create additional collagen and/or PDO threads which can help reposition the mid face.  It is not unusual that patients need less filler after these procedures.