Sagging/puffy face, malar/cheek creases, eye bags, what can be done for me? Any doctors in the NYC area? (photos)

Question

I am 24 and have these malar creases for quite a while, but I am noticing them even more so over the past year, coupled with extensive facial sagging. I eat healthy, exercise, and drink plenty of water. I use several expensive anti-age serums, moisturizers and face masks every day. I don't smoke or drink alcohol. What can be done for me, any doctor recommendations in my area? I live in NYC and want to look my best. I feel so self conscious lately, and finding myself covering my face constantly.

Adam Scheiner, MD · Answer

Dear NYC,It appears from your photos that you have lower lid fullness and festoons which can make a person appear tired, old, or drunk even when they feel fine inside. These usually appear with age but can occur in certain individuals when they are young. The fullness is best addressed with surgery to remove or relocate the fat pushing forward into the lower eyelid region in this area. The festoons are difficult to treat and are related to swelling in the lower eyelid and cheek region. I've had success using lasers to improve this condition.I'll include some links below.I hope this was helpful.

Jonathan Kulbersh, MD · Answer

Under eye bags can be permanently corrected with surgery or temporarily camouflaged with fillers.There are great non-surgical options to fill in under eye depressions and hollowness. Using dermal fillers, a liquid eye-lift can be performed. A dermal filler such as Restylane would be placed in the cheek and tear trough to hide the depression or bag underneath your eye.
Surgery would require a fat-repositioning lower lid blepharoplasty. In this surgical procedure, fat from the eye area is moved into the tear trough depression filling the actual depression. 
I hope this helps!

Jason Emer, MD · Answer

A combination approach will give the most improvement. Fillers, lasers, and microneedling/PRP can improve this. My patients try to get non surgical treatments to avoid surgery. We use PRP and stem cells there often. I suggest consulting with an expert to develop a treatment plan best suited for your short and long term goals. Best, Dr. Emer

Houtan Chaboki, MD · Answer

Thank you for you question and photographs. Diet and exercise may not adequately address congenital appearance of the face. Patients who may have been born with a "puffy" face and eye bags may consider the following surgical options: cheek implant, chin implant, buccal fat reduction. Lower eyelid surgery may or may not be an option. Fillers to augment the upper cheeks is a good option for those who don't want surgery. Read more on link below. If you haven't already, then you can speak with a facial plastic surgeon who performs a variety of procedures to help determine appropriate options for you.Best,Dr. Chaboki

Aldo Guerra, MD · Answer

Thanks for your question. You need a formal consultation with an in person examination. Here’s what you can consider: Dermal filler: tear trough, cheeks and laugh line folds! Lips are more optional. Consider Restylane Lyft, Define, and Restylane.Surgical a Buchat Fat pad excision might be reasonable too. See an expert! Dr. Aldo

Camille Cash, MD · Answer

You are doing the right things by taking care of your body, but this issue is likely genetic and environmentally based.  You will see the best results with a combination of treatments.  Fillers work well to disguise contour irregularities.  Lasers, chemical peels, and microneedling (Skin Pen) help to improve skin tone and texture.  I recommend speaking with an expert injector in your area to determine the treatments best for you.  Remember to use sunscreen every day as well.

Amiya Prasad, MD - Account Suspended · Answer

Thank you for your question. You’re 24-years-old, and noticing your malar creases are getting deeper over the past year or so. You describe your lifestyle as being generally healthy, which includes eating well and not smoking. You’re looking for some suggestions on what to do to help this area.
I can share with you how I would have a discussion about this type of situation, which pretty much occurs every day in my practice. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island for over 20 years. Helping people with facial appearance, whether it’s from just genetic or aging changes, is a core of what I do in my practice every day. 
In a situation like yours, I look at the balance of facial anatomy. When someone is young and concerned about a relative deficit in an area of their face, it’s obviously not due to facial aging, but a genetic trait. It’s not anyone’s goal to make everyone look the same, but when someone has a concern about an area, I take photos, and review with them the elements of the facial anatomy that contribute to this appearance. Everything we do in the practice of aesthetics has to be based on a foundation of anatomy.
When I look at someone who has a concern in the malar crease area,  we refer to this is as a midfacial deficiency. That doesn't mean there’s anything wrong, but it’s an area where there is a deficit of bone and and soft tissue projection. When it comes to possible ways to improve this area, my goal is to discuss different types of injectable fillers and different methods. 
One of the things that gets a lot of people confused as they do research in this area is they get barraged by the name brands of different types of injectables, and find themselves looking for the best injectable. Without any reservation, I would state that it is not about the best material, but about the doctor who uses the material, and their judgement applied in placement of the material. 
In my practice, we overwhelmingly use fillers from the two major filler brands: the Restylane, and Juvederm families of fillers. In a situation like yours, I would apply some of the same methods and principles I use for facial aging. 
Facial aging is a combination of different areas of volume loss, in particular, bone loss. When someone has facial aging, I employ a technique called Structural Volumizing that uses the principle of correcting volume deficit at the bone level, using a long-lasting and robust filler such as a Juvederm Ultra Plus or Juvederm Voluma. 
Placement of material, level of placement, and volume of filler used all matter. When I place volume in the midface at the structural level between the bone and the muscle, the skin doesn't look like it’s ballooned or puffy. A lot of people come in who are very concerned about not looking like, choose the celebrity you don't want to look like, who has a rounded appearance. Even though they are healthy and very lean, their face looks pillowy. When you do Structural Volumizing placing filler at the structural level of bone, you’re not going to get that kind of result, and it will look more natural. 
Is there a potential value in placing volume in the soft tissue, or the area below the skin at the fat cell layer? Of course there is. This is an art, and it’s basically sculpting with placement of filler. I would place the material at the bone level as well as the soft tissue level to try to achieve a nice, natural contour so it doesn't look like someone had a procedure. People are always critical of fillers, particularly in the midface because they feel like everyone looks very rounded. I always respond when they say that, is you don't really notice it when people had it done well, because it looks natural. 
For your question about the crease, it’s a reflection of a relative volume deficit, and an attachment to the skin called the ligament. Without going into the technical details, I think it’s just important for you to understand some basic principles of correction, and finding a doctor who is skilled with this type of approach. I think it’s important for you to consider that as a way to address this issue with the goal of improvement, but not to change your character of your face too radically so you avoid it looking obvious. 
Meet with qualified, experienced physicians, learn about your options, and learn about what your desired outcome will be, then see how that works out for you. In my practice, I routinely have my patients come back two weeks after injectable fillers so I can see how they look, and see what volumes and placement areas worked best for them, as well as opportunities to make the areas look even better. I hope that was helpful, I wish you the best of luck, and thank you for your question.

Justin Harper, MD - Account Suspended · Answer

Hi whiteagle18, We actually receive a lot of these cases at our Manhattan location. We call this tear trough treatment and we use fillers to fill the hollowness. The procedure is fast - barely 15 minutes and the results are immediate. We typically use 1 syringe of Restylane Refyne because this filler produces the least swelling. If there is residual darkening under the eyes, we use lasers. For the cheeks, we use fillers of thicker consistency, not just to replace volume, but also to provide a lift.All the best,Justin Harper, M.D.

Sagging/puffy face, malar/cheek creases, eye bags, what can be done for me? Any doctors in the NYC area? (photos)

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