What can help this new under eye bagginess (malar bags)? I'm desperate for a fix, or at least an improvement. (photo)

Thank you for your question. You have evidence of malar bags, given the presence of what appears to be swelling below the level of your lower orbital rim. Fullness here defines the region of the SOOF, or the malar bag fat pad, that for some people takes on fluid to generate the so-called bags. Fillers tend to exacerbate the problem. Certainly the filler above your orbital rim can be dissolved with hyaluronidase. However I find that if correction of malar bags is your desired goal, then an extended lower lid blepharoplasty proves to be very helpful. This can be better explained during your consultation during which I can share examples and the corrective surgery that has resolved similar issues for patients in my hands.

You are probably a great candidate for a blepharoplasty, eyelid lift procedure. Of all the features on our faces, our eyes are the most prominent indicators of our mood, energy level, and youth. Sagging, drooping, or tired-looking eyes can make us look older than we really feel. Eyelid surgery, or blepharoplasty, is a plastic surgical procedure designed to improve the message our eyes send to those around us.Who is a candidate?Patients who would benefit from a blepharoplasty include those who experience:
• Excessive, sagging, or wrinkled upper or lower eyelid skin.
• Excess upper eyelid skin that interferes with vision.
• Loss of your natural upper eyelid crease
• If you have puffy pouches of fat in the upper or lower lids that create a tired or aged appearance.
• Orbital Rim Show: visibility of the bone under the eye sometimes contributing to a dark ring or shadowing.
Normally, everyone has a small amount of fat around the eyes. If the quantity of fat increases or the local tissues stretch and weaken, the fat begins to bulge producing “bags.” Occasionally this bulging is seen in young patients and is an inherited family trait, and not a result of aging. These changes have a profound effect on one’s appearance giving a tired or haggard appearance. An attractive face with these early signs of aging can affect a patient’s self-image, attitude and sense of well-being.
Intended ResultA blepharoplasty is a procedure designed to improve the appearance of the eyelid area. This may involve removing excess skin and if needed tightening the surrounding muscle resulting in a more youthful, refreshed appearance. This procedure can treat both the upper and lower eyelids depending on the unique needs of the patient.

I am so sorry to hear about your bad experience with fillers. It's what I use on myself to treat my under eye bags but so much of the effectiveness is going to depend on placement. For now, I would advise you to schedule a consultation with a board certified plastic surgeon in your area to be assessed in person. Lasers could help bring down the swelling around your eye, but I still thing that filler is going to be your best bet for correcting the issue. My best,
Dr. Sheila Nazarian
@drsheilanazarian on Instagram

An in person examination is necessary to see if the irregularities of your lower eyelid can be corrected with a conservative lower eyelid blepharoplasty.  It may be beneficial to wait until the fillers dissolve prior to proceeding. 

you need less filler and more lasers and RF treatments. I suggest reversing your fillers and starting venus legacy treatments to help get rid of the swelling.  Once gone, you should start fractional lasers and do very small non inflammatory fillers (belotero, voluma) but in very little bits over time.  Best, Dr. Emer.

First, you want to make sure all the filler is dissolved. Then you want to wait about 3 months after re-evaluate. Considerations include laser resurfacing and/or surgery.  See an oculoplastic specialist.

I am sorry to learn of your difficulties. It is difficult to comment with certainty as to the nature of your problems. It does appear as if hyaluronidase may be of benefit. Do you have any underlying sinus issues? Obtaining a second opinion from a physician who is highly experienced with using fillers around the eyes might be worth considering.

Looks like a problem secondary to the last hyaluronic acid injection so it may be easy to dissolve it with hyaluronidase again. 

Hi schereso,Thanks for you question and photos. I'm sorry you've been struggling to achieve what you want with your lower lids. In looking at your photos, there are multiple areas of contour  and textural irregularity. However, I can't quite tell from the pictures whether this is related directly to the filler or if you have malar edema, a totally different entity. If you were to present to my clinic, I would likely start by dissolving all of the current HA filler in your lower lids to get an idea of what we are working with and then go from there. I would recommend an in-person evaluation with a skilled oculplastic surgeon in your area with extensive filler experience. Good luck!

Thank you for your question. You’ve described a series of challenges you had with injectable hyaluronic acid fillers around the eye area, where you had them injected, and then had to have it dissolved. Now you’re concerned about the appearance of malar bags so you are looking for augmentation options to improve the way they look.To give you a bit about my background — I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon, practicing in Manhattan and Long Island for over 20 years. The use of hyaluronic acid fillers is a big part of my practice, particularly when addressing cosmetic concerns of the eyes and face.The challenge with fillers lies in the concept of volume correction in soft tissue. While it does make sense to fill in hollowed areas, what is limiting most of the time is the structural integrity of the tissue. What many dermatologists do is try to achieve smooth-looking skin by aggressively overusing fillers. As a result, their patients tend to look soft, lumpy, and irregular.Keep in mind that a person’s skin is not designed to take that much material, and can’t stay in the specific configuration that they want at the same time. At 58-years-old, you’re already dealing with certain elements of facial aging, such as volume loss, which begins at the structural level of the face where you lose bone, muscle, fat, and soft tissue.In order to help someone like yourself, I would consider something I call structural volumizing. This method of using the more solid structure of the face — the bone structure and muscle layer to support the volume of filler, instead of having skin and soft tissue try and support it. We call this procedure the Y Lift™.The Y Lift™ is a procedure that makes use of hyaluronic acid fillers, but instead of placing it at the skin level, it is placed under the muscles and just above the bone structure. It is a very specific and elegant procedure that restores volume and definition to the cheeks, jawline and chin in a more global way. Now, when you have specific areas that are more structured, then the under eye hollowing becomes less of a concern and you can afford to be more conservative when treating that area.Usually, the traditional way of using of fillers when it comes to addressing facial aging is to chase and fill in hollows or lines. However, with structural volumizing, the need to micro-manage these small signs of facial aging actually diminishes, because you’re addressing the issue on a more global level. I think there’s certainly something of value here that is worth considering. Ultimately, I think you’re on the right track and I think there is benefit and opportunity in trying something different.I hope that was helpful and I wish you the best of luck!This personalized video answer to your question is posted on RealSelf and on YouTube. To provide you with a personal and expert response, we use the image(s) you submitted on RealSelf in the video, but with respect to your privacy, we only show the body feature in question so you are not personally identifiable. If you prefer not to have your video question visible on YouTube, please contact us.