Fine lines under my eyes/on top of my cheek bones when my face is at rest. Options? (photos)

Question

I have a fine line on both of my cheeks under my eyes. They dissapear when I smile but are always there when my face is at rest. What is this caused by? Would this be fixed by a cheek filler?

Alexander Rivkin, MD · Answer

Hello and thank you for your question.  There are a couple different issues that I can see from your photos. First, there are what we call "malar festoons" or "malar mounds" that are causing the deeper grooves  in the under eye-cheek junction.  This can be easily corrected with fillers such as Juvederm, Restylane or Radiesse.  The other issue are the fine lines directly under your eyes that are a bit more complicated to treat.  I suggest a skin resurfacing laser treatment to help smooth them out.  Lasers such as Fraxel can help with the fine lines and with stimulating collagen to strengthen the skin. A series of 2-3 treatments spaced 4-6 weeks apart will likely be sufficient.  In addition, using a good eye cream as part of your regimen can help maintain and prevent. Botox is another good option for the fine lines around the eyes (crows feet), but cannot be placed under the eye. I suggest seeing an experienced injector who specializes in facial aesthetics for the best care. Best of luck!

Jonathan Kulbersh, MD · Answer

Under eye wrinkles can be permanently corrected with surgery or temporarily camouflaged with fillers (Restylane, Belotero, Volbella).There are great non-surgical options to fill in under eye depressions and hollowness. Using dermal fillers, a liquid eye-lift can be performed. A dermal filler such as Restylane would be placed in the cheek and tear trough to hide the depression or bag underneath your eye. 
Surgery would require a fat-repositioning lower lid blepharoplasty. In this surgical procedure, fat from the eye area is moved into the tear trough depression filling the actual depression. 
I hope this helps!

David Shafer, MD, FACS · Answer

The under eye area is complicated and needs to be addressed in the 3 dimensions.  First, adding filler can help with any contour or volume deficits.  Second, treatment with Botox can help with dynamic lines and also improve the static lines.  Finally, skin resurfacing with laser, chemical peel or other energy technology can help smooth and strengthen the skin.

Nelson Lee Novick, MD · Answer

From the photos provided, I would have to agree with you, i.e. that treating your cheeks appropriately with volumizing fillers would likely substantively improve your under eye concerns. This is supported by the fact that when you smile, these lines diminish--which is likely due to the fact that smiling raises up residual fat deposits that have migrated downward and temporarily repositions them in a more youthful location, and hence the temporary improvement in the lines. Although photos are no substitute for an in-person examination that allows for palpation and manipulation of the skin, it appears that  you would indeed profit from volumizing filler place in the cheekbone and to some extent in the mid-face region. In my NY office, my volumizer of choice for this purpose would be Voluma XC, whereas in my Israel satellite facility, where a far greater number of regulatory agency approved volumizers are available, I would opt for Stylage XXL. It is hard to say from the photos, but you might also benefit from a couple of microdroplets of Botox placed appropriately in the infraorbital region. You would be wise to seek consultation from a board certified aesthetic physician and exercise a heavy dose of skepticism when evaluating claims for this or that fraxel or other so-called energy-based devices, as the claims for these relatively expensive treatments are typically far more heavily supported by device manufacturer backed marketing hype than hard science. Ask to see his/her personal before and after photos before agreeing to proceed. Best of luck.

Catherine Winslow, MD · Answer

Hello! Those fine lines are caused by age, sun damage and movement of your lower lid muscles. Botox helps, but to make them go away skin resurfacing is the most dramatic. I typically offer peels but lasers are an option. A 35% TCA peel around the eyes has the benefit of needing only one treatment with excellent results. If you opt for this find an experienced facial plastic surgeon. Good luck!

Jason Emer, MD · Answer

A combination approach will give the most improvement. Fillers, lasers, and microneedling/PRP can improve under the eyes. My patients try to get non surgical treatments to avoid surgery. We use PRP and stem cells there often. I suggest consulting with an expert to develop a treatment plan best suited for your short and long term goals. Best, Dr. Emer

Shlomit Halachmi, MD, PhD · Answer

There are three different parts, it seems, from the photo and your description.
From top to bottom:
The crepe-like changes are due to skin thinning, but muscle movement can change the "stretch" and make the fine wrinkles more or less prominent.  
The reason  skin is crepe-like is that it is thin (a natural event as we grow wiser in life, and hastened by sun exposure).  Thin skin can be made thicker by triggering the cells to make more collagen.  Devices that heat the skin can do this (Fraxel, Thermage).  
The muscle component would be addressed by reducing the movement of muscles.  This is where Botox comes in - a tiny bit placed in the right location can reduce the stretch and make the skin look smoother.
These two approaches can help a lower lid look less crepe-like.
For the slight groove lower down, resting on the cheek:  The reason your lines go away when you smile is that smiling raises your cheeks, and the fat pad that is in the cheeks goes up - back to where it was when you where you young.  Unfortunately you can't pin it back in place, but you can replace that volume with fillers.  These last 9-12 months and make your cheek fuller -- and lift the skin below the cheek back to where it once was.

Hope that helps!

Shlomit Halachmi MD PhD
DC Derm Docs

Leslie Pickens, MD · Answer

Thank you for your question which is a common one.  For you fine lines under eyes I recommend laser resurfacing and a small amount of a neuromodulator to relax the muscles (Botox, Xeomin or Dysport).  Resurfacing can be done with a radiofrequency device to reduce down time.  Platelet rich plasma (PRP) and/or filler can help with smoothing out the area and replacing lost volume in the area.

Brian A. Pinsky, MD, FACS · Answer

Dear McBrady,I see you as having issues with both volume loss and skin texture.  You look young based on the limited views that you have provided.  You have some early, mild tear trough formation which would correct nicely with dermal filler such as Juvederm or Restylane.  You should also consider addressing your skin as the fine line is a skin level problem.  This can be done with either laser resurfacing or a chemical peel.  I recommend all patients begin a skin care regimen that consists of a topical retinoid which will also help with your skin texture and reduce some of the pigment changes that are present.  I recommend seeing a board certified plastic surgeon to discuss your options in person.  Best of luck.

Nicholas Gentry, MD · Answer

I would agree that fillers are a good treatment based on your photos. I would also consider laser or chemical peels. I also frequently do micro needling and PRP for fine lines.

Fine lines under my eyes/on top of my cheek bones when my face is at rest. Options? (photos)

Answers (14)

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