Early 30s & saggy under eye - what are my best options?

Good Morning EB,
Hope that you are having a good Independence Day weekend. It appears that you have post hyaluronic acid injection malar edema on your right cheek. I would not add more high cheek filler at this time. Rather I would address the malar edema which would likely involve dissolve some of the previously placed filler along with tightening the tissue with microfocused ultrasound heat. Once the swelling and hollowness are improved, then I would use EZ Gel, a 100% natural injection made from your own blood combining the natural protein albumin with plasma rich fibrin. There is no risk of the problems that you are currently having with EZ gel. I have treated this situation successfully in many of our patients. Feel free to contact my office for an in person or virtual consultation. Enjoy the rest of Independence Day weekend. Good luck and be well.
Michael A. Persky, MD
Encino, CA.
818 501-FACE

I'm sorry to hear that you're experiencing this issue. Sagging under the eyes can be frustrating, especially when previous treatments no longer seem effective. Here are some potential options and considerations you might discuss with your physician or a board-certified dermatologist or plastic surgeon:

### 1. **Reevaluation of Fillers**
- **Higher Volume or Different Placement:** Sometimes, adjusting the amount or the placement of fillers can make a difference. It might be worth discussing with your doctor the possibility of using a higher volume of filler or placing it in a slightly different area to achieve better support and lift.
- **Different Types of Fillers:** There are various types of fillers available, such as hyaluronic acid-based fillers (e.g., Juvederm, Restylane) and others like Radiesse or Sculptra. Each has different properties and longevity, and a different type might yield better results for you.

### 2. **Combination Treatments**
- **Botox/Dysport:** Sometimes, combining fillers with neuromodulators like Botox or Dysport can help improve the appearance of the under-eye area by relaxing muscles that contribute to wrinkles and sagging.
- **Skin Tightening Procedures:** Non-invasive treatments like radiofrequency (e.g., Thermage), ultrasound (e.g., Ultherapy), or laser treatments (e.g., Fraxel) can help stimulate collagen production and tighten the skin.
- **Microneedling with PRP:** Microneedling combined with platelet-rich plasma (PRP) can promote collagen production and improve skin texture and elasticity.

### 3. **Surgical Options**
- **Lower Blepharoplasty:** For more permanent results, a surgical procedure like lower eyelid blepharoplasty can remove excess skin and fat, and tighten the muscles in the lower eyelid area.

### 4. **Lifestyle and Skincare**
- **Topical Treatments:** Using retinoids, peptides, and other anti-aging skincare products can help improve skin elasticity and firmness over time.
- **Sun Protection:** Always use sunscreen to protect the delicate skin around your eyes from UV damage, which can exacerbate sagging and aging.
- **Healthy Lifestyle:** Ensure you are getting enough sleep, staying hydrated, and maintaining a healthy diet rich in antioxidants to support skin health.

### 5. **Consultation with an Expert**
- **Second Opinion:** Since you have already tried several licensed doctors, it might be beneficial to seek a second opinion from a specialist who has extensive experience in treating tear troughs and under-eye sagging. They might offer a fresh perspective or innovative treatments that you haven't tried yet.

### 6. **Addressing Asymmetry**
- **Focus on Right Side:** Since your concern is primarily on the right side, a targeted approach focusing on that area might be necessary. This could involve more precise filler placement or additional treatments on that specific side.

### Summary
Discuss these options with your healthcare provider to determine the best course of action based on your specific needs and concerns. They can provide personalized recommendations and help you weigh the benefits and risks of each treatment.

I have been performing HA filler cheek augmentation for many years. Properly performed, it helps for not only creating a more youthful, feminine, ogee curve, but secondarily improves under-eye hollows. With today's more robust HA volumizing fillers, the results may last up to 18 months. So, the very fact that you are no longer getting long-lasting results suggests the possibility that you are not consulting with experienced physician filler injectors (not every doctor with a license to practice medicine is an expert In filler injections) or they are using simple HA fillers, such as plain Juvederm or ordinary Restylane for your cheeks, both of which would not be expected to give long-lasting results.
You would be wise to make sure to consult with a board certified cosmetic dermatologist filler expert. Hope this helps and best of luck.

The swelling that you see around the lower eyelid area is caused by the fillers that you’ve had in the past. My recommendation to use half the fillers dissolved over a session of 2 or 3 administrations of hyaluronidase. Once the product is all dissolved, how would use fat grafting to correct all of that hollowness that you have which by the way is completely hereditary and most likely obtained from your father‘s side of the family. In the right hands, fat grafting should produce natural and permanent results. I hope this helps and good luck from Leonard Grossman M.D. Organic Plastic Surgery.