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’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.

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.