Am I not a good candidate for under eye filler because my mid face is flat? (photos)

Question

A doctor told me that I'm not a good candidate for fillers because I technically don't have hollowing, but rather a negative orbital vector and mild midfacial hypoplasia. He said there is no hollowing to fill and I would wind up looking puffy. The orbital rim is too recessed and the midface too flat for filler to work according to him. Is this true? What are my options? I would like to get rid of my under eye darkness mainly and reduce how much my eyes bulge (no medical issue whatsoever).

Harold J. Kaplan, MD · Answer

Hi Max.  We're guessing that this was the evaluation because your physician wanted to perform surgery.  We would disagree and you are an appropriate candidate for tear trough (under eye) injections with Restylane.  We have done this many times for patients in your situation and have achieved improvement for both the color and shape of the under eye area.  In the naso-juvial groove, you have an opportunity to create a smoother contour and by adding volume, we can normally achieve an improvement in the darkening.Finally, the small veins are also very noticeable and this is something that can also be improved with laser treatments (we use a Laserscope Lyra long pulsed Yag - 1064).  To see before and after pictures of other Los Angeles under eye injection patients, click on the link below.

Toby Mayer, MD · Answer

You may be a candidate for Voluma to your mid face. I need to examine this to give u an informed answer.

Mehryar (Ray) Taban, MD, FACS · Answer

While what you have heard is partly true, it doesn't mean you shouldn't get benefit from under eye filling.  Perhaps not as much as if you didn't have the midface problem but still you should get benefit.  That's my opinion from looking at your photos.  Personal examination is needed for more accurate answer.

Kristin M. Baird, MD · Answer

Based on your photos I feel you are a good candidate for filler to the mid cheek/tear trough area.  You are flattened in your mid cheek which can be addressed with a more robust filler, such as Voluma, which has nice lifting capacity. Just giving you more volume to your mid cheek will help with your under eye hallowing. I would use Restylane to address your tear troughs. This will reduce the "darkness" under your eyes. A significant reason for this discoloration in the loss of volume in the mid cheek/tear trough area. Please consult a board certified dermatologist or plastic surgeon with experience in aesthetic facial injectable treatments. Best wishes.

David Reinstadler, MD · Answer

The other doctor is correct that fillers are used to fill hollow areas. You may get some benefit in the medial portion of your tear trough. It is possible to inject along the orbital rim but this will not give the same amount of support as the natural bone. One of the main issues is the 'darkness' as you put it. You have very prominent vasculature under your eyes and this gives the area a dark coloration. This is not something that will be fixed with fillers. You may get some benefit from a vascular laser which can shrink the size of the blood vessels, but sometimes others come back in their place.Best of luck

Carlos Castaneda, MD · Answer

If darkness it's what is bothering you, a skin lightening cream could help a lot. I agree thet the hollowness in minimal, very little filler can help, however it has to be performed by someone with a lot of experience to avoid lumpiness. But most importantly, if you decide to do it, stay away from permanent fillers.

Am I not a good candidate for under eye filler because my mid face is flat? (photos)

Answers (6)

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