Would fillers improve my undereye bags and divots? (Photo)

Question

I have always had eye bags my entire life, but they always showed as "puffy". In more recent years, I have a "divot" that really shows when I smile. Trust me, I have said for years that if I had the money, the first thing I would do is have surgery, no matter what the recovery is. Having surgery is still not financially an option for me and I would like to know if fillers would be beneficial, or if my case is too severe?

Kian Karimi, MD, FACS · Answer

Based on your photo it is possible that fillers to your tear troughs may soften the appearance of the bags under your eyes-- a photo of you at rest (not smiling) would be helpful to comment on this further.  You would also benefit from a full laser resurfacing -- I prefer to use Erbium lasers (Sciton laser) and then apply topical PRP which cuts down healing times.  If you do have filler injections to your tear troughs I would make sure this is performed utilizing a microcannula.

Kenneth D. Steinsapir, MD · Answer

You have a surgical problem.  Possibly a phenol chemical peel could also get your where you need to go.  I think it is possible that you might do ok with fillers but you really need an expert injector and that seems to be very hard to find.  Proceed with caution.

Joseph L. Grzeskiewicz, MD, FACS · Answer

Based upon the one picture you show here in a smiling pose, your issue is more one of loose skin and muscle around the orbit and not lack of volume.  It is true that you develop a "divot" or contour irregularity when you smile, but his is only because the loose skin and muscle, which have lost their tone and elasticity, bend and fold under the forces of the smiling muscles, just like your slacks bend in your waist when you sit.  When you stand back up the extra fabric stretches back out and the folds and contour irregularities disappear.  I'm not saying you may not need a small amount of volume there, but in reality the thing that you need MOST is to get rid of some excess skin and muscle, soften the muscle activity, and smooth the surface creases on the skin.  Thus, rather than fillers I would suggest that you consider Botox, Xeomin, or Dysport for the dynamic creases in your crow's feet, an upper and lower eyelid blepharoplasty, and follow that up with laser resurfacing.  This plan can be done very conservatively in you as you don't look like you need a lot, and it will make an amazing difference.  Find an experienced board certified plastic surgeon or facial plastic surgeon in your area who can do a good consultation on you and advise you rationally on your options.  Good luck.

Robert T. Buchanan, MD (retired) · Answer

Fillers are generally a great option for under eye bags. The best fillers for this are Radiesse and Juvederm Voluma and your own fat. These support the area well and last significantly long. They are, however, somewhat more expensive but well worth the extra. see an expert injector.

Would fillers improve my undereye bags and divots? (Photo)

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