What are these dents under my eyes, on my inner cheeks? How can I fix them when filler hasn't?

Question

I have had juvederm voluma injections to my cheeks and when I smile I have 2 large dents in the inner corners beside my nose. I had the dents filled 14 months ago and they are back. They are not present when my face is at rest, only when I smile but I don’t want to keep filling it because I’m afraid of over Injecting the site. Please help, I never had these dents before. What is cause these dents to appear when I smile and how can I fix it?

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.

Louis W. Apostolakis, MD · Answer

Hello,You have tear-troughs.  Tear-troughs are primarily a bone shape issue and secondarily a soft-tissue problem.  Tear-Trough implants are an excellent way to effectively produce a change to the shape of the bone.  They are permanent (but removable).  They look and feel like normal, you can not move them or tell they are there (except when comparing to pre-op photos).  Soft tissue fillers can help, but not nearly so much as an implant.  If you are going to continue using injections, only inject hyaluronic acid products (Restylane/Juvederm) in that part of the face.  Products such as Sculptra should never be used there.  Fat transfer may also be helpful, but is inconsistent and will change significantly with weight gain/loss.  Fat will also change with age and is not readily removable.  The implant will be consistent for the rest of your life, maintaining good shape even as your skin and soft tissues age over the top of it.  Regards,Dr. A

Shaun Patel, MD · Answer

Based on these photos alone, it is unclear to me if you are a good candidate for tear trough filler treatment. I see some swelling under the eyes which suggest you may not be. Filler injection to the anteromedial cheeks may help with your concerns. The best thing to do is schedule an in person consultation with an experienced aesthetic physician to determine an appropriate treatment plan for your cosmetic concerns.

Habib Khoury, MD · Answer

Hello. It looks like your fat pad is separating. This is normal with aging. Filler can temporarily fill it, but it will dissolve over time. You could try Sculptra in the area for longer results.

Leonard Grossman, MD · Answer

In my opinion tear troughs are best treated with autologous fat grafting. Find yourself a plastic surgeon who is well-versed with fat grafting techniques. I hope this helps and good luck from New York City

What are these dents under my eyes, on my inner cheeks? How can I fix them when filler hasn't?

Answers (5)

Answer: Cheeks

Answer: Cheeks

Answer: Treating genetic tear troughs

Answer: Treating genetic tear troughs

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Everything you need to know about Dermal Fillers

Our mission is to create a world where every investment in modern beauty is Worth It.

What are these dents under my eyes, on my inner cheeks? How can I fix them when filler hasn't?

Answers (5)

Answer: Cheeks

Answer: Cheeks

Answer: Treating genetic tear troughs

Answer: Treating genetic tear troughs

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Recommended reading

Everything you need to know about Dermal Fillers

Our mission is to create a world where every investment in modern beauty is Worth It.