Under eye wrinkles versus malar bags ? What procedure could I have to reduce these wrinkles? (Photo)

Hello, here are some potential solutions to assist you.
Botox: Because it relaxes the muscles behind the eyes, Botox can sometimes make malar bags look worse, even if it can be useful for avoiding wrinkles, as you have experienced.
Fillers (Juvederm Ultra, Restylane Silk, and Restylane): These help smooth out creases around the eyes and add volume. If not positioned appropriately, they can also draw attention to malar bags because increasing volume can make that area appear more full.
PRP microneedling: This may help with under-eye wrinkles by improving skin texture and stimulating collagen formation, which may lessen the appearance of fine lines and wrinkles without adding volume.

Morpheus8 may be a good option to treat the areas that are concerning to you. The combination of microneedling and radiofrequency will reduce the appearance of the fine lines around the eye by helping build collagen and external resurfacing. I have also seen improvement with reduction of under eye bags/dark circles in many of our Morpheus patients.

Thank you for sharing your questions. The festoons you have can be improved with erbium laser treatment and precise placement of fillers. See an oculoplastic surgeon for evaluation and treatment guidance. Good luck.

Plasticjesus,
Your wrinkles are likely due to the muscle underlying the region pulling on the skin. Weakening this muscle with botox would likely make a big difference for you. Once that has been performed, if there are any residual wrinkles that still bother you, the individual wrinkles could be filled in with filler.
Hope this helps!
-Joshua Halka MD

Nice photos and questions. Unfortunately it is common to see similar concerns in my practice. What you are seeing is is the delineation of facial compartments as the scaffolding aka zygomatic ligament starts to show. Here are the most beneficial treatments I've seen in my experience: Avoid botox lower in the cheek as this weakens the muscles that are pumping fluid out of this cheek compartment shown, which is also referred to as a festoon or malar mound. Restoring deflated volume with fat grafting is most helpful. Other tools include a midface lift, skin pinch and radiofrequency microneedling modalities such as morpheus. Hope this helps.

Best approach would involve laser resurfacing and conservative botox. Filler to the cheeks would only make the edema worse.

You have crow's feet from contraction of the orbicularis muscle. Neurotoxin will diminish the muscle contraction and resultant wrinkles.

Thank you for your question and photos. Botox is a good option for minimizing the wrinkles you’re referring to. Increasing volume in this area with dermal fillers or a facial fat transfer can also create a smoother transition between the lower eyelid and upper cheek. Your results can be further optimized with RF microneedling or laser resurfacing to improve your skin’s quality, texture, and elasticity.
I recommend scheduling an in-person consultation with an experienced, board-certified facial plastic surgeon or expert injector. They will be able to review your treatment history and evaluate your concerns to determine the treatment plan that may work best for you.

Fillers like Belotero, Volbella, and Restylane Silk are good for improving under the eyes, but keep in mind that a combination approach will give the most improvement. My patients try to get non-surgical treatments to avoid surgery, so we use fillers, lasers, microneedling/PRP and stem cells. I suggest consulting with an expert to develop a treatment plan best suited for you. Best, Dr. Emer​​​​

You might want to look into getting Ulthera treatments. Using the 1.5 transducer would reduce the wrinkles in the area while also reducing the appearance of the Malar bags.