Is there a non-surgical way to reverse or improve under eye cheek dents? (Photos)

Question

I recently began to notice under eye cheek dents on both sides of my face. I'm 27, and they're not wrinkles because there's no facial expression I make that dents my cheeks in that way. I would love to do something about these (ideally non-surgically). I'm not sure if it caused by fatigue, age or if it has anything to do with my contacts and the way I might pull on my face. Is there a topical cream I could use to improve this? Is it just a question of getting more sleep?

Brett S. Kotlus, MD, MS, FACS · Answer

What you are describing (and showing in your photos) are malar mounds, a more subtle variation of malar festoons.  You have a fullness over the cheek bone that is causing a shadow below.  The fullness can be caused by fluid being held in this area by the underlying zygomatic ligament or it may simply be your natural fat pad.  As you lose facial fat, the ligamentous attachments can become more noticeable.  These mounds can be challenging to treat.  Injectable fillers may improve (but often not fully eliminate) the issue.  A combination of laser skin resurfacing and fillers may provide further improvement. These mounds are not likely related to your contact lenses or how much sleep you are getting and it's unlikely that a topical cream will satisfactorily eliminate them.

Philip K. Robb Jr., MD, FACS · Answer

Thanks for your question, Without an in person physical examination, it's difficult to tell if they are tear trough deformity or complications of festoons or something different. Perhaps filler could be used depending on the etiology of the issue. Seek a board certified facial surgeon who you trust. Hope this helps and God Bless!Dr. Robb

Paul L. Hester, MD · Answer

Thank you for the question. You appear to have facial
anatomy that features the soft mounds near the corner of the cheeks. Often you
will see this in relatives with similar fat pad distribution or notice that it
fluctuates in appearance with poor sleep or changes in food/beverage choice.
This is a common concern because it disrupts the smooth curve of the cheek and
creates shadow where you might prefer light reflection. Your contacts are not
likely to make this worse, unless you are experiencing allergy or inflammation.
It is worthwhile to take note of the food or lifestyle choices that make it
worse and avoid them. A dermal filler can be placed in multiple areas around
the mound to lift adjacent skin so that the mound is not distinct from the
curve of the cheek. A structural hyaluronic acid is a good choice for lifting
and is reversible if you decide that you are not happy with the result. This is
a non-surgical solution that requires an experienced injector with an artistic
eye and expert placement to avoid making the mound more noticeable. Health and
Happiness, Dr. Hester

Shaun Patel, MD · Answer

What you are describing is know as malar mounds and tend to be difficult to treat. Some treatment can be expected with filler. Your contact lenses are not the cause of this. Good sleep and healthy diet does help. I recommend you start with a little filler and see if you like the improvement.

Chaneve Jeanniton, MD · Answer

The indentations on your cheeks are malar mounds. This can be a tricky problem to resolve completely. I recommend initiating treatment with an injectable filler (preferably one that doesn't absorb much water). Good luck!

Hardik Doshi, MD, FACS · Answer

Estrock,The dents you are noticing are the results of natural ligament attachments from the bone to the skin. The dents seem more prominent since you have a bit more fullness in the area above the ligament attachments (malar mounds.) Contact lens will not effect the area, but excessive sleep deprivation, excessive sun exposure, smoking, poor diet, drinking coffee, and drinking alcohol can sometimes accentuate the malar mounds causing the dents to look more prominent. The simplest route to camouflage the area is through careful filler placement. Hope this helps!Hardik Doshi, M.D.

Wayne Wertheim, MD · Answer

this is a relatively common problem that many women are bothered by. the good news is that it can be easily corrected with standard fillers. A qualified injector should be able to take care of the issue with one tube of a product such as Restylane.

Anna Avaliani, MD · Answer

Thank you for a great question and providing photographs.  Those little dents are anatomical festoons with fibrous tissue. It's between the eye area and cheek area and it becomes prominent when there is loss of fat support or structural support. Not sure if you lost some weight or it could simply be part of aging process. It is a tricky area to deal with, but the best non invasive and corrective option is to use dermal filler injections.  It may take a few session but they will definitely be much softer and less noticeable.  Always trust an expert. Hope this helps. Best, Dr.Avaliani

Alexis Parker, MD - Account Suspended · Answer

You have a natural fat pad that protrudes interrupting the arc of your cheek.  Using a filler to blend this malar mound may help distract and disguise it.  A hyaluronic acid filler would be a good place to start because it can be dissolved if you do not like it.

Oleh Slupchynskyj, MD, FACS (retired) · Answer

Hi, The line is created by the delineation between the SOOF (Sub-Ocularis-Oculi-Fat pad) and the Malar fat pad. This area is not easy to treat , as it is anatomically dileneated with fibrous tissue. However, it can be softened with an injectable filler.Best,Dr.S.

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