What procedure is best for my under eye problem? (photos)

Question

I am 24 and over the past year I have noticed a drastic change in my under eye area. I no longer like to smile in photos and my makeup settles and clumps in the area. I'm looking at having something done but I'm not sure which route.

Nelson Lee Novick, MD · Answer

Just yesterday I had a 30 year old woman with exactly the same problems.  While you are correct that your problem is under the eyes, the major aesthetic problems that relate directly to your under eye issues stem from lack of cheek volume in the cheekbone region (zygomatic region) as well as in the area under your eyes closer to your nose (inferomedial cheek). The final issue is the slight hypertrophy of the muscles directly below the eye that give rise to the so-called "jelly roll" appearance, particularly when smiling. Happily, each of these problems, as with my patient, can be easily resolved with the use of  volumizing fillers for the cheekbone and inner cheek regions and literally a microdroplet or two of Botox (or Dysport or Xeomin)  into the belly of the "jelly rolls." In my Upper East Side Manhattan office, I would choose Voluma XC for the cheekbones and Belotero Balance for the upper inner cheeks. (In my Israel satellite facility, where a far greater number of regulatory agency approved volumizing fillers are available, I would opt for Stylage XXL and Teosyal Redensity II, respectively, for these problems.  When vetting potential aesthetic providers, be sure to seek consultation with a board certified aesthetician physician and make certain to ask to see his/her before and after pictures for the treatment of all these problems. Be especially wary of claims for this or that fraxel laser, radiofrequency or ultrasound device treatment, as these relatively expensive approaches will not address any of the primary issues cited above. Best of luck to you.

Ross A. Clevens, MD, FACS · Answer

Thank you for your question. It is a good time for women to seek facial plastic surgery when you have difficulty applying eye shadow in the area. Eyelid surgery can address under-eye bags, which are actually fatty deposits that need to be removed and occasionally will require excess skin to also be removed. I suggest that you move forward and consult with a board certified facial plastic surgeon.
Best wishes,

Benjamin Caughlin, MD, FACS · Answer

You are young and have nice skin. This is likely a combination of sun damage and fluid accumulation. Laser can help slightly but the best thing you can do is to decrease manipulation of the lower lid. That means no contacts, less make-up, careful with make-up removal and treat any allergies.This can make a significant difference. My partner is a dermatologist and I am a plastic surgeon. We are both very interested in this area and have developed a protocol to treat this problem. In some one in your age group I would try and hold off on any surgical intervention if possible. Hope this helps.Best of luck,DrC

Dilip D. Madnani, MD, FACS · Answer

You have some overactivity of the muscles surrounding your eye. Placing some botox in that muscle will improve the tired appearance and make it appear rested and fresh. Its a straight forward procedure and you will do well with it.

Richard W. Westreich, MD · Answer

The fullness underneath the eyelashes is from the over activation of the eye muscle or orbicularis. The orbicularis has 3 parts to it. One part is enlarged, the pretarsal component. Botox or surgical excision of the muscle in that area is the treatment for orbicularis hypertrophy, also known as a jelly roll.

What procedure is best for my under eye problem? (photos)

Answers (5)

Answer: Under eye concerns on smiling

Answer: Under eye concerns on smiling

Answer: Under eye muscle bulge = jelly roll

Answer: Under eye muscle bulge = jelly roll

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What procedure is best for my under eye problem? (photos)

Answers (5)

Answer: Under eye concerns on smiling

Answer: Under eye concerns on smiling

Answer: Under eye muscle bulge = jelly roll

Answer: Under eye muscle bulge = jelly roll

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Recommended reading

Everything you need to know about Eyelid Surgery

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