Would you recommend surgery, fillers or something else for my hollow under eyes? (Photos)

Question

I’m 35 and have had hollow under eyes my whole life. Now with the addition of volume loss, wrinkles and loose skin it’s time to seek treatment. From what you can see in my pictures, would you recommend surgery or fillers to address my under eye area? Thank you

Michael A. Persky, MD · Answer

Hello H,
I would recommend adding volume, not surgery.  In patients who prefer 100% natural volume we use EZ-Gel which is platelet rich fibrin (prf) and albumin which are made from your own blood with nothing else added.  In other patients with can revolumize the face with the biostimulator Sculptra or hyaluronic acid products.  Most importantly choose your treating physician very carefully, the undereye area is delicate and unforgiving.  Good luck and be well.
Michael Persky, MD
Encino, CA

Nelson Lee Novick, MD · Answer

Before jumping into the expense and potential complications and irreversibility of blepharoplasty surgery, you might wish to explore the use of a robust HA volumizing filler cheek augmentation. The upper mid-cheek is a major support area for the under-eyes, and when there is volume deficit in this area, the under-eye hollows can become a significant aesthetic issue. The appropriate choice of an HA volumizing filler propery injected by an experienced, board certified cosmetic dermatologist can not only contour a more ideal feminine Ogee Curve to the cheeks, but secondarily improve the hollows under the eyes. What's more, the results of treatment, which, in experienced hands, should take no more than about fifteen minutes to perform, typically produces immediate results and usually engenders little to no significant downtime. And, unlike surgery, or the use of permanent fillers or fat injections, this approach allows for reversibility by dissolving the filler should the need arise. Hope this helps and best of luck.

Mats Hagstrom, MD (license on probation) · Answer

There are several possible operations to improve this area.
This area is pretty complex and can be challenging to treat accurately.
Options for restoring mid face volume include fillers, fat grafting, implants, or a mid face lift.
All of these procedure procedures can give good results. Each of those procedures can also leave patients disappointed.
Instead of trying to focus on which procedure I recommend you focus on finding the right provider, which is in the end going to be the most important variable.
Bring pictures of yourself to use as a reference during each consultation.
 During each consultation, ask each provider to open up their portfolio and show you their entire collection of before, and after pictures of previous patients who had similar facial characteristics for whatever procedure they recommend.
This will get you an idea of what results are going to look like as well as how many of these procedures to surgeon has done previously.
 A sufficiently experienced provider should have a lot of before and after pictures for you to look at.
You should be able to get access to the before, and after pictures of at least 10 to 20 previous patients. 
Plan on scheduling several consultations before selecting a provider.
Fillers are probably one of the most precise and forgiving(if you don’t like the results) options.
Best,
Mats Hagstrom MD

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