Under eye circles after midface lift. What could I do to smooth this? (Photo)

Question

Hi I had a subperiosteal midface lift through my temple and intraoral. I’m 8 months out and have these strong crescent shaped lines under my eyes. My eyes are deep set. What likely caused this and what could I do to smooth it? Fillers make me nervous because I’ve heard surgeons talk about migration into under the eyeball, tyndalling, and with longer use it causing pouches. Should I have opted for a transconjunctival blepharoplasty instead? thanks!

John Michael Thomassen, MD · Answer

You may undergo a fat grafting procedure along the tear trough and orbitomalar groove to soften this area.  Pros are that it a very natural correction.  Drawback is that it may need to be repeated due to loss of the fat graft over time.

Kenneth D. Steinsapir, MD · Answer

The challenge with filler is that the treatment you need is fussy. I know it seems like everyone and their sister is doing hyaluronic acid filler and the is true. Unfortunately getting a great treatment really requires considerable knowledge and an artful eye. That is a frustratingly difficult combination of skills to find in an injector. I have patients who fly to me from as far away as London and Dubai. That do not do that because I am conveniently located for them. They come because I am fussy and able to treat difficult situations. First you likely did have an untoward result of midface surgery. From your photos, your lower eyelid margin seems to ride in an okay position but your lateral canthal angle appears disinserted making the eye seem small. You have a very prominent under eye circle. Restylane is the preferred fill for this location. Tyndall is possible but is not a particular serious problem. Migration of filler is much more problematic. That is the result of using a runny filler like Belotero or Juevederm. I also do a midface surgery with a custom carved orbital rim implant that can be helpful. What will be right for you is something that can only be determined on the basis of a personal consultation. Your eyes can be your best feature.

Gerald Wittenberg, MSc, DMD (retired) · Answer

In order to achieve natural fullness/contour under the eyes, the tissue has to be 'lifted' vertically; rather than 'angled' as towards the temple area. A SOOF lift will provide long term contour change by lifting vertically. This lifts the cheek fat vertically

Under eye circles after midface lift. What could I do to smooth this? (Photo)

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