Deep under eye circles and bulbous nose? (photos)

Question

Hello Doctors, I've always been unhappy about my under eye circles and nose. I get comments all the time about how tired I look even AFTER I put concealor under my eyes which gets frustrating. I'm 26 but I think this ages me a few years. As far as my nose I don't think it looks too bad until I smile then I notice it is triangular and bulbous toward the mid-bottom area. What would be the best thing for these issues? I'll include a couple pics but they are a bit blurry, sorry about that. Thank you

Gabriele C. Miotto, MD · Answer

Hello Crysti, your questions are common among our patients. Dark circles are stubborn but can be improved.  Usually we need to treat either the skin discoloration or the skin thickness, and sometimes the two components that cause the dark circles. We usually use medical grade skin care products, fillers or nanofatgrafting.

For the nose you will likely need a tip rhinoplasty to make it more balanced with your face. Looking at your eyelid skin and nose in person will be very important to decide what is the best procedure for you and to talk about the details and what to expect from it. Have a great day!

Steven M. Denenberg, MD · Answer

You're right: the photos are a bit blurry. But I tried to fix 'em up and make a morph anyway.Click on the "Web reference" link, just below my response, or go here:

FacialSurgery.com/RealSelf/RealSelf_crysticadbury.html

I made a computer morph of your nose, and an animation of the morph, to show the changes that are possible for your nose in truly expert hands.The two cartilages that form the tip of your nose are strong, and that makes the tip appear wide. When the tip cartilages are strong, they usually push the tip downward, too, like in the short video I posted just above. So I tried to simulate elevating the tip as well as narrowing it in the morph. I'll bet that your profile view shows that the tip sits low and could benefit from elevating the tip. If you want to submit some profile views, I'd be happy to evaluate them.

You should understand that the changes I demonstrated in the morph require advanced techniques, techniques that most plastic surgeons cannot handle.  Be sure to read the section in the "Web reference" link on how to stay out of trouble while searching for a rhinoplasty surgeon.

Your nose is also a good example of why computer imaging is mandatory in rhinoplasty. You need to know exactly what the surgeon is planning to accomplish -- what features he thinks he can change, and by how much he thinks he can change them. When you see his goals, you'll know whether he has an eye for a beautiful nose, and whether he shares your opinion of what constitutes a beautiful nose. You'll also know whether the changes he proposes are enough to be meaningful to you, and whether he understands your wishes enough to address all of your priorities. But remember, you're not hiring him for his skills with the computer. The doctor must then show you his before and after photos to prove that he can actually accomplish what he draws on the computer.Concerning your dark under-eye area, the photos don't really give a clue of what that's about. Sometimes the skin is just dark because it's so thin, but sometimes there is something that can be done.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your
photograph, you may benefit from a tip refining rhinoplasty. Your surgeon can
accomplish this by trimming, suturing, and reshaping the cartilage in your
lower nose. You may also benefit from fillers or fat grafting under your eyes.  Make sure you specifically look at before and after
pictures of real patients who have had this surgery performed by your surgeon
and not just a computer animation system. The most important
aspect is to find a surgeon you are comfortable with. I recommend that you seek
consultation with a qualified board-certified plastic surgeon who can evaluate
you in person.
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon

David C. Mabrie, MD · Answer

Hi Crysticadbury and thank you for your question!

Non-surgical Nose Job:

Taking a look at your photos (thanks for those, by the way), I noticed that there is an indentation creating a shadow on the right side of your nose. If you want to make a specific improvement, you might benefit from adding a little more definition to the mid-bridge and the nasal tip. Right now the supra tip (that area of the nose just above the tip) is just slightly more prominent than the tip. This can give the nose a bulbous appearance.

Speaking in general, many "bulbous tips" are actually just noses that have either poor tip definition or no tip at all. The bottom of the nose may be amorphous, or the supra tip is more prominent than the actual tip. This is what causes an optical illusion of sorts that makes the nose look bulbous or round. Non-surgical rhinoplasty uses fillers to add definition to the tip, and can even be used in creating a new tip in some cases.

Under Eye Treatment:

Deep under eye circles is a very common concern of my patients at my San Francisco facial plastic surgery practice.

Here is why deep under eye circles make you look tired: The skin beneath the eyes is very thin and gets even thinner with age. Blood vessels and muscles beneath the eyes may appear as dark circles. There may also be an indentation, — the tear trough — which creates a shadow. That shadow is intensified if "bags" of fat have formed under the eye, creating greater contrast between the areas of light and shadow.

To correct this, I use Restylane to fill in the indentations and minimize the appearance of bags and shadows under the eyes, and Juvederm Voluma to add volume back into the mid-face.

Two caveats you should know about:

1. Find someone who specializes in non-surgical rhinoplasty and under eye treatment, as this is an advanced injection technique that requires specialized skill and finesse.

2. Patience is required. It may take 2 or 3 injections to get your optimal result.

Good luck in finding your solution, and stay beautiful!

William Portuese, MD · Answer

The primary goal of lower eyelid surgery is to remove the herniated fat deposits creating the puffy look. The incision is located on the inside of the island, also known as a trans-conjunctival approach. The dark discoloration will not go away with surgery, since that is skin pigment.   The bulbous tip can be addressed with suture techniques and conservative cartilage mobile with closed rhinoplasty approach by making all the incisions on the inside of the nose. For more information and many before and after examples of eyelid surgery and rhinoplasty, please see the link and the video below

Deep under eye circles and bulbous nose? (photos)

Answers (5)

Answer: You are a Great Candidate for Non-Surgical Treatment!

Answer: You are a Great Candidate for Non-Surgical Treatment!

Answer: Deep under eye circles and bulbous nose?

Answer: Deep under eye circles and bulbous nose?

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Everything you need to know about Rhinoplasty

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Deep under eye circles and bulbous nose? (photos)

Answers (5)

Answer: You are a Great Candidate for Non-Surgical Treatment!

Answer: You are a Great Candidate for Non-Surgical Treatment!

Answer: Deep under eye circles and bulbous nose?

Answer: Deep under eye circles and bulbous nose?

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Recommended reading

Everything you need to know about Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.