Can more filler fix this shadow? Had Restylane 2 mo ago and have been left with unsightly shadows from the fat pads

Question

I had under-eye filler (Restylane) two months ago and have been left with these unsightly shadows from the fat pads in my cheeks popping out. I went back to the same plastic surgeon but she didn’t feel that she could do anything to help it (we actually dissolved some of the original filler and I waited another month to rule out swelling). It really bothers me! Does anyone think that filler at the drop-off point would improve these shadows/bags? Please help. I’m so bummed.

Jason Emer, MD · Answer

A touch-up may give some improvement, but keep in mind, a combination approach is needed to get the most improvement under the eyes. Fillers, lasers, and microneedling/PRP can improve under the eyes. My patients try to get non surgical treatments to avoid surgery. We use PRP and stem cells there often. I suggest consulting with an expert to develop a treatment plan best suited for your short and long term goals. Best, Dr. Emer

Kenneth D. Steinsapir, MD · Answer

Your plastic surgeon over filler a zone between the orbitomalar ligament and the mid cheek groove.  The filler and the water associated with it is creating a festoon. Floating more filler into the mid cheek groove might elevate this groove.  However, the overall effect will be to leave an unnatural bulkiness to the cheek.  What one wants is a natural result with the least amount of volume. Slamming more volume into the cheek is not the right answer.  The volume that is in the wrong place should be removed and a correct service that provides volume just where you need it will create a more youthful appearing cheek without the disturbing malar festoon volume. Remember when you get filler, you are asking someone to sculpt the face.  Some injectors just have not feel for this.

Nelson Castillo, MD · Answer

Thank you for sharing your question and photographs.  It appears that additional fillers placed into the front and apple of your cheek should soften the transition that worsened after your lower eye filler.  Hope this helps.

Monika Soni, MD · Answer

Thank you for your question! It appears that additional fillers placed into the front and apple of your cheek should soften the transition that worsened after your lower eye filler. Best of luck!

Val Lambros, MD, FACS (retired) · Answer

there are several thigs going on. One is the step off of the cheek, which you mentioned. The other is a border of skin texture, color, and pores with the border at the same location. Being able to see you in person is important,  but in other people with similar configurations I have removed all the filler and started over. I think adding more filler will make the area look too big. Fortunately restylane is the easiest HA filer to dissolve. You will still have the color border.

Can more filler fix this shadow? Had Restylane 2 mo ago and have been left with unsightly shadows from the fat pads

Answers (5)

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