Options for under eye hollow pockets/bunching & nasolabial folds? (Photos)

Question

I used to get Botox to treat my eye wrinkles, although it worked it still didn't fix the hollowness and bunching from underneath my eyes when I smile. I would love for it to be filled in and flat so my eyes don't get so small looking when I smile. Is there an alternative to under eye filler? I'm definitely afraid of going that route due to the risk. I would love to hear if there are any more options! I always thought maybe I just have high set cheek bones so when I smile it makes the skin bunch. Also my nosaliables are DEEP. Like, suuuuuper deep. Is there another treatment option other than filler for this area? I don't want to have a monkey effect or the area to look too tight and plasticy, I would just love if I could treat the lines!

Tim Neavin, MD · Answer

Thank you for your photos.  Botox around the crows feet could help.  In addition to this, fat transfer can improve the facial shape and restore volume to the region below the eyelids.  Fat transfer works well in the nasolabial fold but some of the fold depression is related to tissue descent in your photos.  While a mid-facelift may be a little more invasive than you would like, it would be a powerful way to lift the cheek while reducing the fold.  A mid-facelift does not remove skin so you do not need to worry about looking pulled or like a monkey.  It internally lifs the cheek.  I often combine fat transfer with mid-face lift.

Marc Polacco, MD · Answer

Thank you for your question. There's a bit to unpack here, but in general a good alternative to under eye filler that would also help alleviate the nasolabial folds would be a SOOF lift. This is a surgery that uses an incision on the inside of the lower eyelid, allowing access to a fat pad that we suspend from the inferior orbital rim. This repositions that fat to where it once was, filling the tear trough while simultaneously taking pressure off the nasolabial fold. My fear with filler or fat transfer would be that it could make the "bunching" worse. However, a reasonable amount in the nasolabial fold region would be effective for reducing the depth of the lines. I hope this information is helpful, and I wish you all the best.
-Dr. P

Mats Hagstrom, MD (license on probation) · Answer

When we smile the zygomaticus muscles lifts your cheek up constricting your eyes and this is going to form wrinkles. Smile lines due to the pull of the zygomaticus muscle Will not be corrected with Botox. When doing Botox for crows feet lines we weaken the orbicularis oculi muscle and it’s weakening of this muscle only that lessens the cross feet lines. The lines will still form when smiling. Blocking the zygomaticus muscle from moving it’s not appropriate.

Fillers can be an excellent next step. As with everything who does the procedure is the biggest and most important variable. I recommend choosing providers carefully by having multiple in person consultations.  Check out the work being done by David Mabrie MD in San Francisco to see world class work done using only fillers. He has lots of pictures available on his website. Even if you opt for someone else to do your procedure you will get a reference of what quality work looks like.

Best,

Mats Hagstrom MD

Options for under eye hollow pockets/bunching & nasolabial folds? (Photos)

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Options for under eye hollow pockets/bunching & nasolabial folds? (Photos)

Answers (3)

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Recommended reading

Everything you need to know about Facial Fat Transfer

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