Under eye bag filler treatment - why are the results so different on both sides? (Photos)

I have gone to 3 diff. doctors in the past 2.5 yrs to use fillers on my under eye area to conceal the bags i started to get.. Doctor 1 was amazing; he even took the time to mold the injections to get the ideal finished product. My bags were gone instantaneously. The last 2 doctors, not so good. When i expressed my concerns and explained what Dr 1 did, it seemed to go on deaf ears. Now i have this complete uneven look. They say they can't go higher up due to lack of bone?

Doctor Answers 4

In filler application, it is best to stick to the doctor who resonated with you and shares your aesthetic sense

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Thank you for your question. I understand you’ve had injectable fillers to address hollowed under eye areas. You worked with one doctor who you felt did a great job; however, you also felt that the two subsequent doctors you went to did not do as well as the first. You felt your concerns fell on deaf ears when you brought up what your previous doctor did, and you also state that one of the doctors you visited explained that they cannot fill beyond a certain level because there is no bone.

I can certainly help you with this concern. To give you a little about my background — I am a Board-certified cosmetic surgeon and a Fellowship-trained oculofacial plastic and reconstructive surgeon, practicing in Manhattan and Long Island for over 20 years. As a surgeon with a background in eye surgery and specialty training in plastic surgery, working with the eyes is certainly a big part of my practice, and I treat patients from all over the world for everything from under eye hollows, puffy bags, and droopy eyelids.

Nowadays, the brand names of injectables and lasers have become the centerpiece of the procedure; however, when you really understand what medicine is about and the nature of these procedures, you’ll realize the true star is the physician who actually performs the procedure.

In your case, you recognized the difference in quality of treatment between your first doctor and the subsequent doctors. I think that the subsequent doctors you met with were certainly trying to achieve comparable results to the first, but probably felt like they were doing the best they could with your situation. Perhaps from their perspective, there was no further benefit to be added, so the explanation of having no bone to fill in the area of your concern may technically be true. Keep in mind that procedures like this entails an understanding between the doctor and the patient who have shared values, shared perspectives, and a shared understanding of desirable outcomes.

There is certainly an art to doing fillers, and regardless of the anatomy, it is about what works for the individual. In our practice, we usually use Restylane or a slightly thicker hyaluronic acid filler with platelet-rich plasma when filling under eye hollows. Platelet-rich plasma is a concentration derived from your own blood and contains healing and growth factors that do wonders for the improvement of skin quality, particularly for the delicate skin under the eyes. According to wound healing studies, the synergy between platelet-rich plasma and hyaluronic acid filler is very significant. The combination works well and is a great way to address volume and skin quality issues at the same time, so this is something you can consider.

Going back to your issue with regard to finding the right doctor who understands the volume correction you need, it is important to understand that when you visit several different doctors, they will give you many different solutions. These are all based on their different experiences and different perspectives when it comes to performing the procedures and using the products. In fact, I have met with patients who received different types of treatments — thermal tightening, injectables, etc. — to tackle the same problem.

Ultimately, you need to find a doctor you are comfortable with. It’s easy for a doctor to look at your photo and say that you need a little more here are there, but it makes more of a difference when you have a doctor who really gets you and understands what you want to achieve. A lot of patients will choose less expensive treatment options, or doctors who are working on a high volume of patients, and they won’t get the kind of results they’re looking for. Rather than chasing the procedure itself, try to do some research and choose a doctor who you feel will be able to resonate with your cosmetic goals.

I hope that was helpful and I wish you the best of luck!

This personalized video answer to your question is posted on RealSelf and on YouTube. To provide you with a personal and expert response, we use the image(s) you submitted on RealSelf in the video, but with respect to your privacy, we only show the body feature in question so you are not personally identifiable. If you prefer not to have your video question visible on YouTube, please contact us.

New York Oculoplastic Surgeon
4.4 out of 5 stars 80 reviews

Poor results following injections of fillers in tear troughs

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Thank you for sharing the bad results you received following your injections with fillers in the tear troughs. This area of treatment requires exact placement of dermal fillers, an asthetic eye and expertise in this area. It is very easy to create a poor outcome if not injected precisely where the regions needs to be treated. Often the area to be filled is not the place where filler needs to be placed. Always have an expert perform treatment for tear troughs.
Good luck,

Dark Circles, Eyelid Wrinkles/Bags Treatment -- Restylane or Belotero with Cannulas, Clear+Brilliant, Eclipse Micropen, Viva

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
you need fillers in your deep medial fat pads to bring pads up and concele your under eye as well as treatment under the eyes.  I suggest you see an expert that knows how to facial sculpt and "layer" fillers.  Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 207 reviews

Your cheek volume needs help.

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
These files persist for years.  The stuff does not just disappear after a year.  The service you have has is not properly shaped.  Worse than that, you need volume close to the eye and not so low in the cheek.  Low cheek volume makes you look older.  I developed a method called Deep Fill, to place volume in the under eye circle.  These services must be sculpted in place.  What you are experience is the reality that many doctors do not really get facial aesthetics.  You are asking them to sculpt the face and they do not get it.  Help is available but you may need to travel for that help.  I see patients from as far away as Dubai, London, and Hong Kong.  That tells me these individuals could not find the help they needed locally and felt compelled to travel to Beverly Hills for help.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

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.