Bags, circles and dry eyes, I just want to look rested. What's my best option? (Photo)

I have had restylane injectable twice by a very good doctor due to once the swelling goes away after 3 days it's like i never had it. Mind you i love the way i looked after the injections. The doctor said, he never seen anything llike this. Is it that my body rejects the products? As far as eyebag surgery, i have dry eye and frighten about it worsening. Is there anything i can do to fix theze eyes?

Doctor Answers 8

Tear Trough Correction With Voluma and Juvederm

Hi, and thanks for your quesiton. It looks like there are a few possible reasons for your concerns about the under eye area. The first is that you have some volume loss in the tear trough area - i.e. a hollow has formed under the lower eyelids. This should be correctible with filler injections. I like to use Juvederm that is specially prepared for the tear trough area by my office staff according to my specifications. I used Restylane for a long time, but switched a few years ago. The prepared Juvederm is smoother than Restylane and I have had less issues with uneven contours. I have seen that prepared Juvederm lasts anywhere from 2 to 6 years in the tear trough, depending on the patient. It is also easily reversible with a simple injection of an enzyme. Unfortunately, you also have some dark pigmentation of the skin of your lower lids. This is tough to correct. It is possible to improve it with some chemical peels in some patients. I don't think that your body rejects these products - I have never seen that happen and I have injected thousands of tear trough patients. The third area of concern is your cheek just under the tear trough hollows. I think that you have some volume loss there as well. I would correct that with Voluma - it lasts about a year and a half and it looks very natural. In order to make sure the whole area looks good its important to fill the cheek as well as the under eye. Hope that helps.

Swelling vs. "Going Away"

Hi Asha, it's possible that what you are experiencing is some temporary swelling and this camouflages the fact that you need more product at least during the procedure.  With the pictures you posted, we would start you with 2 syringes of Restylane and you would likely need more.  See the patient at the link below to see what two separate appointments and 3 syringes looks like.  You are an excellent candidate for the procedure so there is no reason why it shouldn't work.  Lastly, before and after images are imperative to gauge your progress.

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
4.5 out of 5 stars 8 reviews

Achieving rested eyes

Thank you for your photos. It is unlikely that your body rejects the hyaluronic acid. It is more likely that you may need more volume injected or possibly a secondary superficial layer to help maintain a nice smooth and blended look once the swelling comes down. You are right to be cautious about undergoing eyelid surgery with dry eyes. From your photos it appears you also have prominent eyes. Baseline dry eyes as well as prominent eyes increases your changes of having worse dry eye and other complications after eyelid or eyebag surgery. Even so, you can still have a excellent long-term result with eyelid surgery but you should have an in-person examination with the proper instruments to determine how to customize your procedure to have a SAFE and NATURAL result. 

Johnson C. Lee, MD
Beverly Hills Physician
5.0 out of 5 stars 12 reviews

Treatments for eye bags

Dear asha060469,
  • It looks like your problem is more undereye hollows than excessive fat bulging
  • If Restylane does not work and you are not ready for surgery, Voluma looks very nice under the eyes
  • Alternatively, a fat transfer looks great under the eyes, can help rejuvenate the skin at the same time
  • If the procedure is done correctly, dry eyes should not worsen after a lower blepharoplasty (especially if the incision is made inside the eyelid)
  • When you are ready, please visit a specialist who can examine you and address your concerns
Best,Dr. Nima

Nima Shemirani, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 68 reviews

Bags, circles and dry eyes, I just want to look rested. What's my best option?

It is very unusual to have filler go away that fast after eyelid filler injection. I recommend seeing an oculoplastic specialist for evaluation. Options include fat injection, filler injection, tear trough implant, and lower blepharoplasty.

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 58 reviews

Why Did My Restylane Go Away After 3 Days & What Do I Do About My Eye Bags?

Eye bags are the common term used to refer to lower lid fat protruding forward secondary to a weak septum orbitale.  The septum orbitale is a cellophane like structure that holds orbital fat in position until the fibers of the septum orbitale weaken and the fat begins to protrude.  The good news is you have minimal fat bags as demonstrated on your 4th picture.  However, you do have orbital skin descending over the orbital rim and present on your cheek, which is one of the unfortunate signs of aging.
Obviously, the gold standard for repairing your lower eyelids would be an inferior lid blepharoplasty with muscle sling.  Short of that, Voluma (a highly cross linked HA) can be injected not in the tear trough, but rather below the orbital rim pushing both your skin upward and your fat backward giving a much more youthful appearance.  The super good news is that Voluma is said to last up to 2 years.  
As to why your Restylane disappeared from the tear trough, I have no idea but one could opine that it went behind the orbital fat increasing pressure on the fat and therefore pushing it forward.  On the other hand, I could be completely wrong.  

Eyelid Surgery

Thank you for your question. Eyelid surgery is the most effective solution for creating well-rested eyes. Eyelid surgery can help remove fatty deposits that accumulate in the upper eyelid, tighten up loose or sagging skin, remove excess skin and wrinkles around the lower eyelid, removed under-eye bags and correct lower eyelid drooping. I suggest that you consult with a single or board certified facial plastic surgeon to address the dry eyes either in conjunction or separate from the eyelid surgery and other procedures.Best wishes,

Ross A. Clevens, MD
Melbourne Facial Plastic Surgeon
4.7 out of 5 stars 94 reviews

Dark Circles, Eyelid Wrinkles/Bags Treatment -- Restylane or Belotero with Cannulas, Clear+Brilliant, Eclipse Micropen, Viva

Fillers, lasers and microneedling/PRP all do well to treat this area.  I suggest you see an expert for a formal evaluation, often more than fillers are needed for a non invasive improvement.  Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.9 out of 5 stars 159 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.