Is surgery the only option for the bags, cheek loss? (photo)

Do fillers help? Or is surgery the only option for my eye bags, loss of cheeks?

Doctor Answers 8

Under eye concerns

You can consider using fillers to help improve the under eye area.  Fillers are placed in the hollow areas giving a smoother overall look.  For a more complete result, it is a good idea to combine that treatment with lasers and/or microneedling to also improve the skin texture.  Lower lid surgery is a more permanent option and would work by redraping the fat, and removing excess skin for an overall improvement.


Houston Plastic Surgeon
5.0 out of 5 stars 29 reviews

Fillers or Surgery around the eyes?

Thank you for your question. It is difficult to make any determination without a personal examination but there are somethings to know about fillers versus surgery around the eyes. The eyes are not independent of the rest of the face and patients concerned with their eyes often have underlying changes in cheeks that can assist with an overall improvement. Fillers can be used to provide volume to the cheek and support of the lid. In addition fillers can be placed along the rim of the eye to mask eye bags. Fillers do not address dark circles. The issue with fillers is that they are hydrophilic meaning that they attract water and cause significant swelling around the eye that can last weeks or months. This swelling can be unpredictable and often vary day by day. Furthermore, fillers only last approximately one year depending on the filler used, meaning that you will have to get repeat treatments. Looking at your picture, initial glance, surgery combined with fillers (whether fat or HA) to your cheeks will provide you with the best and longest lasting result. You should also consider significant resurfacing to help with fine wrinkles and pigmentation of the area. Best of Luck!

Anthony J. Wilson, MD
Portsmouth Physician
5.0 out of 5 stars 6 reviews

Lower lid fat pads

You have a few options to improve this.  YOu could do a lower lid blepharoplasty with fat repositioning where the fat is moved down into the tear trough.  Your other option is to do some filler which is put in the tear trough just below the fat pad to smooth out the area.  Some laser on top would also help to improve the skin texture.  

John J. Martin, Jr., MD
Coral Gables Oculoplastic Surgeon
5.0 out of 5 stars 25 reviews

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Options for bags

Thank your or your question.  Based on the photo provided, there is some bulging of the lower eyelid fat.  There is also evidence of volume loss and descent of the cheeks that occurs with time.  Non-surgical treatment would include dermal fillers to the area of the tear trough, which is the depression between the lower eyelid and upper cheek, for the purpose of creating a smoother contour to the area.  This can also be performed in conjuction with a lower eyelid blepharoplasty to remove the excess bulging fat in the lower eyelids.  Ultimately, an in-person clinical examination with a specialist would be necessary to determine the best treatment options for you.  

Paul Nazemi, MD
Newport Beach Oculoplastic Surgeon

Dark Circles, Eyelid Wrinkles/Bags -- Restylane or Belotero, Laser C02/Erbium Resurfacing, Microneedling, Viva/Intensif, Fraxel

This can be improved with surgery but if you want to try and avoid it, consider lasers, fillers, microneedling/PRP, skin care and peels.  Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.9 out of 5 stars 167 reviews

Filler may help

Your photo shows some wrinkling of the eyelid skin in addition to the "bag" and adjacent trough. A filler could correct the trough and create a single plane between the eyelid and the cheek, correcting the trough, making the bag seemingly disappear, and smoothing out the contour in that area. The wrinkles will not be corrected by the filler. Laser resurfacing would be my first choice for you there. Good luck.  

Elba Pacheco, MD
Annapolis Oculoplastic Surgeon
4.0 out of 5 stars 5 reviews

Nonsurgical options for lower eyelid bags and empty cheeks

While surgery would be the best option – lower blepharoplasty with fat transfer to cheeks plus laser – fillers are also a great option most cases.

Creating a meaningful shape change with your degree of deflation requires more than a few syringes of filler. In cases like yours, I do a fixed-rate procedure, using as much filler as necessary, plus special cannula techniques to create structure.  For your area of concern, known as the midface, the  cost for a procedure like that is $3500  

For more details, please see the website link.  I have also attached a video of a smaller-scope procedure that is an excellent example of the same concept. 

Laxmeesh Mike Nayak, MD
Saint Louis Facial Plastic Surgeon
5.0 out of 5 stars 171 reviews

Surgery and/or fillers can be helpful

In many cases, laxity of the skin under the eye and "bags" due to fat herniation are best treated surgically. However, all patients can benefit from just the use of fillers for camouflage if surgery is completely out of the question. In some cases, a combination of surgery and fillers produces the best results. Most of us surgeons can offer you a "spectrum" of improvement depending on your personal desires and needs. The key to is have an open clear discussion with your surgeon so she or he can find the best combination of treatments to meet your expectations.

Diana L. Elias, MD
Saint Petersburg Plastic Surgeon
4.7 out of 5 stars 16 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.