What is causing these dimples under my eyes? Aging? Migrating filler? (Photo)

For unique cases where a variety of modalities could be used to treat the condition, I would suggest an in-person or virtual consultation to develop a custom and effective treatment plan. It is difficult to precisely define the best option without collecting the same information. I suggest reaching out to an expert for a consultation with surgical and non-surgical methods to get a comprehensive option. Best, Dr. Emer.

If you are describing the dents underneath the bulges, this could be from over correction with fillers. It's impossible to know without examining you, so the best advice is to visit a reputable facial plastic surgeon or dermatologist for advice moving forward. I hope this helps! Sincerely, Dr Joseph

Under-Eye "Puffy Pillows," which appear to be the case here can result from obstruction of the lymphatics that drain this area typically as a consequence of the use of an improper choice of filler for the under-eyes and/or too superficial placement of the filler. The "dents" are actually the result of having bulges above them, rather than actually being true indentations. This problem can be quite difficult to treat. However, I have had gratifying results in treating patients who have come to me with this issue using an algorithm of varying combinations, concentrations and amounts of intralesional anti-inflammatory injections to flatten the puffy pillows. You would be wise to consult with an experienced, board certified cosmetic dermatologist with considerable experience in dealing with this troubling issue. Best of luck.

Hi! The under-eye area is made up of hills and valleys. Both of these combined cause the dimples or depressions you see. The valleys are caused by both volume loss, ligaments, as well as accentuated hills. The hills can either be orbital fat herniation as well as filler. To determine this a clinical exam is necessary and possibly an ultrasound. If it is filler, dissolving the filler is one possible solution. An under-eye blepharoplasty would fix the fat herniation and smooth the lid cheek junction. While fillers only last a year or two, a lower lid blepharoplasty is a more permanent solution. Hope this helps!

Good morning! Thank you for your question. I understand your frustration with these pesky divots, as I happen to have them myself. These can come up after filler is injected in the area, if the zygomatic cutaneous ligament is disturbed, or they can simply be seen with aging. It is hard to say what the case is with you, unless you feel they came up shortly after getting filler. Either way, they can be a bit challenging to correct.
If a patient has had filler injected in the under eye/mid cheek area, and this is a concern, I recommend dissolving any potential filler in the area first. If the issue is remedied then we know the divots were due to the filler. If not, then I would use a very soft and flexible filler, like Restylane Refyne, to fill the divots, in an effort to camouflage them when you smile. It is important to be conservative and choose your product wisely for this particular area, because it needs to look good at rest, and at animation. Having appropriate expectations is also key here. Know that they may not be completely erased, but rather softened after treatment.
I hope this information helps and wish you the best of luck.