Treatment for Naso Labial Folds and Sunken Eyes?

Question

I'm 33. The area around my eye orbit is begining to sink in a little. It's not as smooth as it was years back. What is the best solution that won't put a dent in my wallet? I tried botox and it made my problem worse around the eyes. Is that possible?

Umang Mehta, MD · Answer

I would recommend Restylane to treat the "tear troughs" or under-eye hollows. Filling this area can reduce the tired, bags-under-the-eyes look by yielding a smooth transition between the lower eyelid and cheek. One syringe is usually more than enough to correct both sides. The skin under the eye is quite thin and therefore this injection area should only be performed by experienced practitioners. One of the advantages of Restylane is its ability to be quickly and easily dissolved if there is a lump or area of irregularity. For the nasolabial folds, any number of fillers including Restylane, Perlane, Juvederm Ultra, Juvederm Ultra Plus, Radiesse and Sculptra can be used. 

	Best,

	Dr. Mehta

Raffy Karamanoukian, MD, FACS · Answer

Morpheus 8 is a non-invasive skin and soft tissue tightening treatment that is consistently amazing in our patients. We use the Morpheus to exact fractional induced RF into the skin or tissue in order to tighten collagen and stimulate contraction of the tissue. For acne scars, it is quite useful to build collagen in patients who have atrophic scars but is not very productive for ice-pick scars which require TCA Cross. For tissue tightening, Morpheus is ideal for the face and neck and we often combine it with CO2 laser or Ultherapy to further enhance results. Chemical peels and skin resurfacing should be done at least 5 to 7 days after, but can be performed earlier, depending on treatment severity. Avoid exfoliating skin treatments before Morpheus and expect a period of 2-4 weeks for skin contraction to set in.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Nima Shemirani, MD · Answer

Hi @Glow! I recommend hyaluronic acid dermal fillers. Restylane Defyne works great to smoothen out the nasolabial folds. In addition, Restylane and Belotero work great for the tear trough area. Always seek treatments from expert injectors who have the skill and experience to precisely inject fillers into treatment areas and avoid risks and complications. Best of luck, Dr. Nima!

Jason Emer, MD · Answer

I recommend fillers to soften the nasolabial folds themselves and also lift around the mouth and cheeks to build underlying anatomical support. In our practice we combine Sculptra with other fillers "layered" on top and lasers, skin tightening treatments such as Thermage, Fractora, and Renuvion (J Plasma), thread lifting,  and peels to get the most conservative, natural look. I suggest seeing a facial sculpting expert for a formal consultation. Best, Dr. Emer

Michael R. Macdonald, MD · Answer

Yes, it is possible that BOTOX may make a sunken appearance under the eyes more obvious. This can easily be avoided by changing the BOTOX treatment technique, to avoid treatment of the lowest crows feet and the area under the eyes.

	A simple and more effective approach to treating both of these areas would be to use a tissue filler, such as Restylane or JUVEDERM.  These hyaluronic acid (HA) fillers last anywhere from 8-14 months and provide a very natural improvement in both the nasolabial fold and lower eyelid areas, particularly if the problem is only just beginning. 

	A more definitive approach in the lower eyelids would be to move or reposition the fat in the lower eyelids surgically for a longer lasting improvement in the sunken, tired look under the eyes.

William Ting, MD · Answer

Cosmetically sensitive areas such as the tear trough and nasolabial folds will lose volume over time and may appear sunken and darker, accentuated by shadow effects from certain lighting condition. The key is to replenish volume with fillers to minimize valleys and optimal illusion created by the shadow effects. Hyaluronic acid fillers such as Juvederm or Restylane would be the best option for tear trough areas as these are reversible with hyaluronidase in case you come across any nodularity. For nasolabial folds, you have good options of hyaluronic acid fillers or Radiesse.

Harold J. Kaplan, MD · Answer

Hi Glow,
It sounds like Restylane or Juvederm and not Botox would be the right choice for the issues you are trying to address. We commonly use Restylane for sunken eyes and for the nasolabial folds. As far as the pricing goes, Restylane for the under eye area is usually priced between $450 and $750 in Los Angeles. The nasolabial lines depend on how many syringes are used, but a 1 cc syringe averages about $550 in our area and patients require between 1-3 depending on age and correction required.

Scott Trimas, MD · Answer

The sunken eye appearance can occur with the aging process. Botox is not the best treatment since it really is only useful to treat dynamic eyelid lines that result from smiling. Static lines are best treated with a resurfacing procedure like the laser or a medium chemical peel. As far as the sunken areas, those can be filled with injectable fillers like hyaluronic acid such as Juvederm or Restylane. Alternatively, fat can be transposed to that area as a more permanent solution.

Michele S. Green, MD · Answer

The best treatment for a younger person who has a little depression in these areas is Restylane or Boletero. These fillers are easy to fill these delicate areas, especially if the areas are not too deep. Boletero is especially nice under the eyes because you do not run the risk of the Tyndall effect from the hyaluronic acid. Find an experienced board certified dermatologist for these injections. Botox for depression would, in fact, make it worse. I am sorry that you had that experience. Please let me know what happens!

Robert S. Bader, MD, FAAD · Answer

Hyaluronic acid fillers is a great option to treat both of these areas--the smile lines (naso-labial folds) and the hollows under the eyes (tear troughs). Perlane or Restylane can be used, depending upon how deep the smile lines are. Juvederm is an alternative. I would recommend finding someone experienced--it is worth the extra cost, if any! One typically gets 6 months improvement, but results vary.

	Radiesse may be an alternative, but only in extremely experienced hands.

	Botox, Dysport, and Xeomin are not treatments for these areas.

Treatment for Naso Labial Folds and Sunken Eyes?

Answers (15)

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