Restylane Candidate? (photos)

I've always had dark circles under my eyes. My skin is rather fair. I can deal with that. However, at 58 years old, the sunken look has gotten to me. I look exhausted and ill. Do you think that my skin is too thin at this age and my hollows are too deep for a good outcome? Also, I'm very nervous that some doctors still don't use cannulas and will stick a regular needle near my eye. This photo is with MAKE UP and CONCEALER but it still doesn't help.

Doctor Answers 11

Lower Blepharoplasty

Thank you for sharing your question and photo. While fillers are a good option for some, I believe you would have much better results with a lower blepharoplasty with fat transposition. The herniated fat pads under the eyes causing the “bags” can be re-positioned to be more flattering and also fill the hollowing you are noticing. This procedure does have more down time than dermal fillers, however the results will be more aesthetically pleasing and longer lasting. I recommend consulting with a board certified plastic surgeon who can evaluate you in person without any make up on to discuss your best treatment options.


Los Angeles Facial Plastic Surgeon
5.0 out of 5 stars 60 reviews

Restylane Candidate?

Hello, and thank you for reaching out to us. I recommend an in person consult with ASPS board certified surgeon or expert injector. Restalyne may be the solution or part of the comprehensive treatment plan your surgeon lays out for you. 

Good luck, please let us know how it goes.

-Dr. Constantino Mendieta

Restylane Candidate?

When there is sagging or puffiness in the undereye, it is inadvisable to inject filler as a first-time treatment. It may be wiser to tighten the undereye skin first with radiofrequency laser (e.g. Viora®), and then consider your other options when the eyelid skin tightness is optimized. 

Manjula Jegasothy, MD
Miami Dermatologist
5.0 out of 5 stars 8 reviews

Lower eyelid bags, dark circles and shadowing

Dear jdinn001:

Thanks for sharing your photo. Your eyes and skin are beautiful yet aging has unflattered them. A in-person exam is essential but based on this limited view, consider the following:
  • Restylane and other fillers may help if performed by a expert injector with significant experience and talent. Filler is used to increase volume and may add or exaggerate the fat bags and shadows you present. 
  • A fiber wall normally restrains the fat behind the eye but laxity associated with aging allows the fat to protrude and create a hollow above and a shadow below. Fillers will not help this. 
  • A lower lid blepharoplasty or eyelid lift will help by removing the fat excess allowing the retaining wall to firm up the lower lid and in skilled hands elevate the cheek as well. 
  • Consider botox or brow lift to fully frame your eyes in a positive light. 
Consult with a well experienced and skilled Board Certified Plastic Surgeon, Ophthalmologist or Facial ENT for proper evaluation and your best options. All the best!



Dean P. Kane, MD, FACS
Baltimore Plastic Surgeon
4.8 out of 5 stars 70 reviews

Retylane and tear trough

you have very attractive eyes and the condition you have is amenable to Restylane injection for the hollow. the darkness may not be helped. needles and cannulas achieve the same thing and it is really what the injector is comfortable with. Be sure you are seeing a board certified dermatologist or plastic surgeon and that he is experienced in the use of fillers in this area

Melvin Elson, MD
Nashville Dermatologist
5.0 out of 5 stars 6 reviews

Be careful with tear trough injections with hyaluronic acid.

The dark circles under your eyes become more prominent for two main reasons.  The first is the herniation of fat in the lower eyelids.  This is what is known as "bags" under the eyes.  The second problem is the loss of volume to the cheeks.  It appears that you have a combination of both.  Therefore, you would benefit from a lower eyelid blepharoplasty (I prefer the transconjunctival approach, which is from inside the eyelid) to remove the fat that has herniated out and improvement of cheek volume (I prefer Sculptra to give you a natural look.  FYI, Sculptra is very misunderstood).  I would advise you against injecting in the tear trough with a hyaluronic acid filler like Restylane.  You will regret it.  I would advise you to be evaluated by a board certified plastic surgeon, who is good with both surgical and non-surgical options.  Good luck!

Fillers

First, I think that your herniated fat may be treated with blepharoplasty.  Second, if you want fillers, I feel more comfortable with using sharp needles for injection because I feel that I have more control with them than the cannulas  that are very flexible.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

Under Eye Filler

Thank you for your question. Darkness under the eyes is caused by the thinness of the eye tissue, underlying structures, and shadowing due to hollowness. While I agree with you that you look somewhat sunken, restylane may help but will not give you 100% improvement. Also, because your skin is somewhat thin, there is always the potential that regardless of how deep the filler is placed that it may be either palpable or seen. I perform this procedure with both cannulas and directly with needle injection, and both are safe and effective.

Part of your main problem is that you have fat herniation from your obits. Over time, the fat that is around the eyes can protrude - which can also add to the shadows. Having said this, your best bet may be to learn more about a lower lid blepharoplasty to remove this fat, and to give you a smoother and more youthful contour. Typically, this is done in conjunction with fat grafting or the fat from the lower orbit is moved into the tear trough (the groove that you have that sweeps down onto your cheek) to help smooth out the overall contour. 

I would suggest having an in-person consultation with a Plastic Surgeon to hear more about your options, and to have a more accurate assessment of your lower lids, to assess any skin laxity, and to truly see which option can give you the best result. 

Restylane under eyes

Based on your photos, it looks like there is some extra fatty tissue in your lower eyelids which is best treated with blepharoplasty surgery. If there is still a heavy demarcation between the eyelid and cheek after surgery, I often add some filler to this area after the swelling from surgery subsides. This done to optimize the results and blend the eyelid-cheek junction.

The choice of cannula or needles for under eye injections is doctor preference. I have tried injecting under eyes both ways and get much better results with a needle.

Mitesh Kapadia, MD, PhD
Boston Oculoplastic Surgeon
5.0 out of 5 stars 147 reviews

Will Restylane conceal the bags?

Thank you for sharing your question. Unfortunately, you probably require lower eyelid blepharoplasty. It is best to have an in-person comprehensive evaluation by a doctor to determine if injection of fillers or surgery is best for you. See an experienced Oculoplastic Surgeon for guidance. 
Good luck,

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.