Radiesse or Restylane for Bags Under the Eyes and Dark Circles? (photo)

I have dark circle and bags under my eyes since I was a kid. (I am 32 now). I consulted a plastic surgeon and he proposed some cheek implants, he said my middle face is deficient. He told me that I have the option to use Radiesse (3 syringes) for my cheeks but didn't mention Restylane and I read online that Restylane is better for the lower eyelid. What would be the best option ? Cheek implants or fillers ? Radiesse or Restylane or both ?

Doctor Answers 5


It is all about mid-facial volume while protecting any preexisting medical conditions such as dry eyes or blepharitis (irritation).  Injectables are simpler, but cheek implants are permanent (yet reversible).  Please discuss your options with an experienced Cosmetic Surgeon. 

San Diego Facial Plastic Surgeon
5.0 out of 5 stars 12 reviews

Cheek implants or fillers to treat the lower eyelids

It may be just the pictures, but your eyes look red and irritated.  If you have a chronic allergic condition or an irritation of the eyelid (blepharitis) this should be addressed first.  Assuming that is not the case, another way to address volume deficiency of the cheek is with a fat transfer.  I personally prefer this to cheek implants and the results last longer than with injectible fillers.

John Q. Cook, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 12 reviews

Your Dark Circle Problem

After reviewing your photos, I agree that you have a some what depressed malar area which translates into a significant exposure of your lower eyelid anatomy which in turn translates into the folds (dark circles) that you are concerned about.  My recommended treatment would not be a lower lid blepharoplasty, primarily because of your age.  I would suggest a less aggressive treatment which would include a microfat augmentation of the cheek and restylane or microfat to the lower border of the protruding fat pad. This would result in a smoother transition from lower eyelid to the cheek and a significant improvement of the folds and shadows that you are concerned with.  Hope this helps and good luck.      

Joseph Rucker, MD, FACS
Eau Claire Plastic Surgeon
4.7 out of 5 stars 20 reviews

Midface/cheek lift will improve your look significantly

Your deficient meidface and lid cheek junction could be improved by an extended lower blepharoplasty with cheek lift. You can see some examples of patients who have had this procedure on my RealSelf page. The publication describing the operation is the url below. Some surgeons might instead perform a malar implant. Each operation has its risks and benefits, but I prefer not implanting a foreign body that can move or cause other problems later.

Jeffrey Schiller, MD
Edison Oculoplastic Surgeon
5.0 out of 5 stars 11 reviews

There is an expression that when you are a hammer, the world looks like a nail.

Meaning that some surgeon propose certain solutions because that is what they are most comfortable with.  A cheek implant is well described to make your issue worse rather than better.  Due to pricing considerations, doctors may make more profit on the Radiesse so in some office this can influence it being recommend for treatment consideration.  I personally prefer Restylane for filling the under hollows.  Unlike Radiesse, which can not be adjusted if it lumps or bumps, Restylane can easily be adjusted with the enzyme hyaluronidase if needed.

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.