Under eye holes - options? (photo)

Question

They form Especially when I laugh. I had fillers in my cheek a couple of years ago they might be pushing up and Making the problem worse. I also lost some weight and my skin might need tightening . Is a facelift at the age of 41 an option ? Can the fillers be removed ? Jets a picture

Vincent N. Zubowicz, MD · Answer

Judging from the photographs alone it looks as though filler could be a significant aesthetic improvement. If ever your lower eyelids are done the fat can be redistributed to obviate the need for filler in the future.

Vaishali B. Doolabh, MD, FACS · Answer

Hi  myselfonly.  Thanks for the pic.  Your tear troughs may benefit from filling with fillers.  Removing some of the lower eyelid skin may be useful to reduce the fullness under the eyes.  Neither of these should be done if your appearance is normal when not smiling b/c you will look abnormal with every other expression or no expression.  Be sure to see an ABPS certified PS that is an expert injector so that you can learn more about surgical and nonsurgical options.  Best wishes,

Zoran Potparic, MD · Answer

It would be very hard to give you best advice based on this photo; in-person evaluation would help. However, it appears that you may have tear trough deformity along lower eyelid/face junction which exaggerates when your are smiling. An eyelid surgery by means of  transconjuctival blepharoplasty (scar is placed inside of lower eyelid) with fat transfer may correct this deformity. You should seek a consultation with a board certified plastic surgeon with good reputation in facial rejuvenation and eyelid surgery. Good luck.

Mark Berkowitz, MD · Answer

Myselfonly  Thank you for the question and photograph.  An in person consultation is necessary to coordinate your best course of action.  I believe you are asking about the space between your lower eyelid and cheek.  this tear trough area can be corrected  with:Surgery, implants or fat transferfillers like bellafill, belotero or volbellaFrom your pictures alone a face lift is not necessary for this correction.  I would suggest discussing fillers with your cosmetic surgeon. All the best Dr B

Angela Keen, MD · Answer

Your eyes are lovely! I can see why you want to take good care of them! It's important to know that some "bulges" are actually youthful and natural and any treatment that might try to change natural anatomy can lead to very unnatural results. I perform a lot of filler for lower eyelids in people of all ages and my favorite treatment for lower eyelids in people with loose skin is facelift surgery. Bringing with you to your consultation photos of a time when you were happy with your face is very helpful. The technique used for either filler or surgery is extremely important so you really need to interview your surgeon and make sure they have before after photos of patients with similar issues. Not all facelifts are created equal!!! If you don't like your filler result, it's highly likely that you could have that filler dissolved. Eyelid filler tends to last an extremely long time. I hope this helps!!

Cain R. Linville, MD, FACS · Answer

I doubt that whatever filler you had before is still there, and it does not move around like that.  What you're describing is what happens to all of us as we age - cheek descent due to gravity combined with atrophy of mid face fat pads, resulting in an overall aging appearance.  Most commonly, I use filler to help transition from the lower lid to the cheek which helps smooth this out and adds volume back to where it was lost.

Brooke R. Seckel, MD, FACS (retired) · Answer

A face lift will not solve the problem. The depression beneath your lower eyelid is accentuated by the hyperactive bulging lower eyelid muscle when you smile.  Botox in the lateral one third of the lower eyelid muscle may help soft in this.  The other option would be a trans-conjunctival lower eyelid blepharoplasty with arcus marginalis release and fat grafting.  This will improve dark circles and depressions while her face is at rest.  However when smiling the overactive eyelid muscles will bunch and accentuate that depression beneath them. For more information please read below:

Jon A. Perlman, MD (retired) · Answer

It's difficult to give you a fair evaluation and opinion from a photo taken while smiling, however it seems to me that your weight loss and not your prior fillers plus some aging is the cause of your concern. Consider having fillers such as Juvederm or Restylane injected into your tear troughs and see if this provides a nice non-surgical improvement for you. Best wishes,

Jon A Perlman MD FACS

Certified, American Board of Plastic Surgery

Extreme Makeover Surgeon ABC TV

Best of Los Angeles Award 2015, 2016

Beverly Hills, Ca

Jon A Perlman MD FACS

Certified, American Board of Plastic Surgery

Extreme Makeover Surgeon ABC TV

Best of Los Angeles Award 2015, 2016

Beverly Hills, Ca

Val Lambros, MD, FACS (retired) · Answer

the picture is  smiling, Are they present in repose?  it appears that you have deep set eyes. Because they are deep set and the cheek gets pushed up when you smile, I think that  filling will only make you eye more crowded when you smile and probably not look good. That's why you need an in person consult.

Under eye holes - options? (photo)

Answers (9)

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