Deep Hollows Under Eyes and Large Malar Fat Pads - Advice?

I am having a very difficult time determining what I need done. I have deep hollows under my eyes, and I also have huge malar fat pads that stick out when I smile. These create lines across my upper cheek. Even when I don't smile they form a droopy strip of fat going from the nose to the jowl. My lips are also downturned at the corners when I smile. I seem to have big lip muscles at the corners of my upper lip. It makes smiling uncomfortable and odd looking. Thanks for any advice you can give.

Doctor Answers 4

Face Anatomy and Plastic Surgery

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Without examining you, it is hard to give specific advice.  However, what you describe is common in many people.  Defining a smooth lid-cheek junction is a goal in maintaining a nice aesthetic to the face.  This can be accomplished through several different procedures and surgeries such as dermal fillers or fat grafting, lower lid surgery or midface lift, or anatomic facial implants.  In consultation with your surgeon, you can determine which procedures or treatments are best for you.  Good luck.

Infraorbital hollowness and malar fat droopiness

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It seems that some of your issues have to do with lack of structural support under the orbit. Your lateral photos suggest a negative vector produced by the hollowness. This contributes to the sagging of the midface soft tissues  There are many approaches to this situation. Some will fill the hollowness with the fat under the eyes or with injectable fillers. Some will use implants in the tear trough and malar regions (there are a wide variety of these implants). Some will suggest a midface lift. Without an indepth consultation, a specific recommendation cannot be made. However, if most of the problems is caused by a structural deficiency, this must be corrected before any meaningful improvement will result.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon

Malar descent and nasojugal grooves

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Smiling photos tend to raise the malar mound. It is hard to say from the photos. Sometimes non-invasive things such as fillers can help soften the areas.  Also facelifting techniques can help.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

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Treatment of tear troughs

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I can see what you describe with respect to hollow under the eye (tear trough) and the nose to jowl line (nasolabial fold). I do not see what you describe with respect to the lips and in my opinion the prominence of the cheeks when smiling is a sign of health. The lines above the cheek prominence when smiling is a different issue. My recommendation would be filler injection to the tear trough and nasolabial folds and botox for lines above the cheek. That is the simplest approach with the best return for you money and the shortest recovery time. The results of filler injections around the eyes are very different between doctors so be very careful choosing the physician who does this for you.

Aaron Stone, MD
Los Angeles Plastic Surgeon

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.