Would surgery be the best option to correct lumps, flat spots and discoloration in the under eyes and sides of my nose?

Question

Help I have dark spots and lumps under my eyes When I smile the sides of my nose, get these huge flat spots with discoloration. I have filler in my cheeks, but have not done any in my under eyes for at least a year because I don’t do well with filler under my eyes. Any suggestions on how to fix this problem? Do you think and under eye surgery would be the answer?

Lawrence Kass, MD · Answer

Thank you for your question.  I think that you have festoons, or malar mounds, or malar bags, and this is a significant and highly distressing problem.  The treatment of festoons is quite complex.  I believe that treating this condition is solely in the purview of an oculofacial plastic surgeon well versed and experienced in treating this condition.  Avoid general plastic and facial plastic surgeons, the best of whom would or should decline to treat you, in my opinion, as they simply do not have the necessary background knowledge in the anatomy and in the pathophysiology most likely causing the problem.  Without doubt, I would avoid further fillers to your cheeks and tear troughs and would avoid fat transfer too.  First, you should dissolve, perhaps several times, any fillers you have had, no matter how long ago you had them, with hyaluronidase. After this, you could consider radiofrequency microneedling or ablative laser treatments.  Personally, I have had much success treating this with surgery (have a look at the real patients, many of whom travel to me from other states, I have treated on my website), but as with any surgery, there is never a guarantee.  Feel free to contact my office with questions.  Good luck!

Kenneth D. Steinsapir, MD · Answer

Your issue is that someone used a runny filler in your under eye area. I would strongly recommend removing every bit of hyaluronic acid from your face. These products persist far longer than consumers are told. While your injector may try to put in more filler every time they see you, the old hyaluronic acid filler persists perhaps forever. Because product drifts in the face, some areas do benefit from top off. Generally I recommend to my patients to have all of their hyaluronic acid fillers removed every 3-4 years and basically start over. You always want the least amount of filler in the face that get the job done. You are over filled and the top of the cheeks are problematic. Don't get hustled into surgery that you don't need. Remove the bad fillers will take years off your appearance. Generally once that is done, a small amount of the right fillers can be put back in where needed.

Would surgery be the best option to correct lumps, flat spots and discoloration in the under eyes and sides of my nose?

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Would surgery be the best option to correct lumps, flat spots and discoloration in the under eyes and sides of my nose?

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