29 Year old female, former smoker, former tanning bed devotee. What are options for volume loss in periorbital area? (photos)

I am a 29 year old female. Former smoker, former tanning bed devotee. In the past 12 months, I have experienced what appears to be a loss in volume under my eyes and upper cheeks. This is most pronounced when I smile and gives a hollow appearance. It also causes the skin to bunch up into fine wrinkles. These are dynamic in nature but I fear they will become static (these are not traditional crow's feet.) What are my treatment options? Thanks!

Doctor Answers 4

Options for Volume Loss in Periorbital Area

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You are correct in stating that there is a dynamic versus static appearance for the face. It appears that your malar fat pad which constitutes the cheek volume has declined. Your upper cheek is flat and begins to create the naso-labial fold that frames the mouth. You can have what is known as a “Midface Lift” where the malar fat pad is raised and suspended via small incisions in the scalp. If you are not ready for this surgery, you can use structural fat grafting to add your own fat into the cheek area or use fillers such as Voluma. The fillers will provide correction for a limited period of time.

Philadelphia Plastic Surgeon

Tear trough filler

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Your best option at this point is a hyaluronic acid filler such as Belotero or Restylane.  You notice it more when you smile because the muscles are animating and your cheeks get raised exacerbating the appearance of the depression under your eyes (tear trough).  At 29, you would do best with a filler to add volume to this area and give you a smoother lid/cheek transition.  Find a skilled injector in your area and you will likely be very happy with the results.

Sirius K. Yoo, MD
San Diego Facial Plastic Surgeon
5.0 out of 5 stars 28 reviews

Young with hollowed eyes

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Your problem is unfortunately not unique.  You have what is referred to as a tear trough which causes the bags under your eyes and exascerbates the wrinkling of your lower eyelids.
A combination of fillers - Juvederm, Restylane, etc - and well placed Botox can help minimize both of these problems, and is a great first step for many of my younger patients with these problems.

Jason J. Hall, MD, FACS
Knoxville Plastic Surgeon
5.0 out of 5 stars 12 reviews

You will do great with cosmetic botulinum toxin and hyaluronic acid fillers.

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The key with these services is finding the right injector.  There is no substitute for an artistic and experienced injector.  It is important that the botulinum toxin service does not freeze the forehead or cause unwanted recruitment lines.  You can read about my patented microdroplet method on my website.  For the under eye area, there is no question that Restylane is the best treatment option for many.  Again experience is the key to these services.  You have to find the right injector.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

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.