What kind of surgery or treatment should I do for my upper cheek/under eye bags? (Photo)

Question

I have these indents on my upper cheeks bellow my eyes that create a shadow since I was a kid. I tried under eye filler to fill out the indents 3 years ago and I'm not sure it really helps with the fullness the dents are still there. What type of treatment or surgery would be best to help with this ?

Gary M. Horndeski, MD · Answer

A lower blepharoplasty and release of the fat pad may fill out the contour deformity that you dislike.

Best Wishes,

Gary Horndeski, M.D.

Kenneth D. Steinsapir, MD · Answer

I strongly recommend being highly skeptical that the surgeons you interview for this can actually do what they promise. Less is more. I would fully remove the old filler. It is still there. Once the area settles down, it is most likely that a carefully done Restylane service would be all that you need. Surgeons will offer you fat grafting, lasering, lower eyelid surgery, midface surgery. All of these procedures have downsides are not not nearly as good as a well done filler treatment. The challenge is that you are asking for the injector to sculpt your face. I see botched filler patients from all over the planet. You don't fly from Dubai and come to Beverly Hills for a filler service unless you have tried everyone in your area first. The bottom line, is these are fantastic services but fussy. Less is more.

Zoran Potparic, MD · Answer

It is very likely that your condition can be improved with a combination of transconjuctival lower blepharoplasty and fat grafting of the cheeks and peri orbital areas. In person or at least teleconference consultation with a board certified plastic surgeon familiar with these procedures. Good luck.

Nelson Lee Novick, MD · Answer

For malar mounds, such as appear in the photo provided, it is not surprising that the direct under-eye filler did not work. There appears to be volume deficit in the cheek, as evidenced by the flattening (rather than a more outward projection) of the cheek. An in-person examination allowing for direct manipulation and palpation of the cheek would be especially helpful in this case. Generally speaking, however, addressing this volume deficit typically will secondarily improve the cheek contour and create a smoother transition between the upper cheek and the lower lid region, thereby diminishing the malar bulge and improving the entire appearance of the upper cheek You would be wise to consult with an experienced, board certified cosmetic dermatologist. Hope this helps and best of luck.

Bao Ngoc N. Tran, MD · Answer

You have congenital festoons. This puffiness between your lower eyelid and cheeks is caused fat absorbing extra fluid causing swelling. This area called lid cheek junction is a very tight space that house the lymphatic drainage of the lower eyelid. Surgery is the only treatment in this case. Fillers, Botox, laser, sclerosing agents make it worse as it further damage the lymphatic system and not addressing the underlying issues.

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