Nobody can give me answers on this facial dent, what is this? How is it fixed? (Photos)

Question

I have this dent in my face, that is honestly worse when the filler goes down. From my own research it seems it is the zygomatic ligament showing (yes I have researched because nobody can fix it or give me answers and honestly it makes me insanely insecure). I have gone for a consult who told me to just let the filler go down but when the filler go down it’s 60% worse - so truly why would I do that. Be great if a Dr from NY who knows how to fix this is here.

Jason Emer, MD · Answer

For unique cases where a variety of modalities could be used to treat the condition, I would suggest an in person or virtual consultation to develop a custom and effective treatment plan.  It is difficult to precisely define the best option without collecting the same information. I suggest reaching out to an expert for a consultation with surgical and non-surgical methods to get a comprehensive option. Best, Dr. Emer.

Eric M. Joseph, MD · Answer

Your assessment is spot on! When lower eyelid grooves extend down to midface depressions, these may be from ligaments that travel from your cheek to your skin. In our experience, midface depressions are difficult to eliminate with filler, unlike under eye grooves which tend to fill readily. We have seen modest improvement with Silikon1000 injections, but not complete resolution. In fact, overaggressive filling can lead to a fuller cheek, but a persistent indentation, and a more noticeable appearance. I'm not aware of any reliable "fix" for your midface depressions, so please proceed with caution - especially with fillers. Thank you. Dr Joseph

David M. Kowalczyk, MD, MBA, FACS · Answer

Good Morning! I believe your research is correct in identifying this as a retaining ligament. These can be notoriously difficult to improve without cutting them for example by performing a facelift. Filler can work to create temporary improvement, though the filler often spreads above or below the ligament. Morpheus8 microneedling RF can tone the surrounding collagen and may be a good option. I would advise against anything too aggressive in order to avoid creating a deformity. Hope this helps!

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