Does cheek filler improve under eye area & can it lift the lower face? (Photo)

Question

I've been advised to have Voluma filler into my cheek apples to decrease the appearance of my under eye darkness, because I'm told the slight puffiness in that under eye area could actually worsen if tear trough filler is used. Does cheek filler actually improve under eye appearance, and if so, does it also help to lift the lower face (I have some lower face sagging). I’m 53, 130lbs, fair skinned.

Nima Shemirani, MD · Answer

Hi @angeldoc.  I recommend Morpheus 8.  Morpheus8 is a non-surgical treatment for full body skin resurfacing, skin tightening, and fat reduction of stubborn areas. It uses minimally invasive fractional radiofrequency energy (RF) to penetrate the skin deeper than other microneedling devices, triggering the skin’s natural healing response to promote skin 
tightening and lifting.

Nick Slenkovich, MD · Answer

Hi, I’m Lauren, the aesthetic injector here at Colorado Plastic Surgery Center.

Yes, cheek filler — especially Voluma — can absolutely improve the appearance of the under-eye area and is often the preferred approach for many patients. As we age, the fat pads in the midface naturally descend and lose volume, which can lead to a hollow, dark, or even puffy appearance under the eyes.

By restoring volume to the cheeks, we can create a smoother transition between the lower eyelid and the cheek. This helps to reduce the appearance of under-eye shadows and puffiness, often without needing to treat the tear troughs directly.

Of course, every face is unique. The best way to determine what’s right for you is to schedule a consultation with a skilled provider who can assess your individual anatomy and goals and create a customized treatment plan tailored to you.

Stanley Okoro, MD · Answer

Thank you for the question and photo you provided. Based on this one photo, I would agree that filler have a role in improving your facial aesthetic. However, filler would be the last piece of the puzzle. Here is what I recommend in order:
1. Morpheus 8 skin tightening
2. Lower blepharoplasty to address the excess fat and loose skin under your eyes
3. Filler to the cheek.
Good luck, make sure you consult with a board certified plastic surgeon.

Jason Emer, MD · Answer

Facial sculpting and contouring can be created with well-placed fillers (Voluma, Countour, Radiesse, Bellafill) and Sculptra, which would give improvement in facial balance. Fat or implants are alternatives. I recommend getting a formal evaluation with a facial sculpting expert. Best, Dr. Emer

Jonathan Kulbersh, MD · Answer

Hello, and thank you for your question. Just to clarify, filler used for the cheeks does not mean the product is exclusively used for the cheek area. Most fillers are designed to treat multiple areas of the face. That said, fillers can help rejuvenate your eye area and your lower face. Dermal fillers like Restylane and Juvederm can dramatically improve the appearance of deep tear troughs.

These fillers are made of hyaluronic acid, a substance that is naturally produced in the human body as a building block for collagen and healthy skin tissue. When injected into the treatment area, hyaluronic acid provides volume and lift to the skin. HA fillers may also be used to restore lost volume in the lower face, contour the jawline to create a sharper profile, and reduce the appearance of jowls. It is best to schedule an in-person consultation with a reputable injector with extensive experience in a wide range of injectable treatments. Your provider can do a proper evaluation of your skin, discuss fillers and their benefits, and ensure the best possible outcome.

George Yang, MD · Answer

Hi angeldoc, UNDEREYE DARKNESS- People with hollowing of their lower eyelid area have a lid/cheek junction which separates the lower eyelid to the upper cheek. If the junction itself is not elevated and the cheek is plumped up more, it will not help the hollowed area very much, unless the injector is actually filling the lid cheek junction to blend the “eyebag” into the upper cheek. The concern your doctor has is that in order to fill this area some filler would need to be placed over the eyebag area which they worry it will make the eyebag larger. But if the filler is placed over the orbital septum it will press the orbital septum down, which should flatten the lower edge of the eyebag. If the injection is performed deep or under the orbital septum, this will inflate the eyebag and balloon out the orbital septum causing the eyebag to become even bigger yet not actually fill out the lid-cheek junction due to the orbital retaining ligament. One issue that may happen that I see in your photos is that your left cheek had a malar crescent/festoon. Sometimes this technique can cause the malar festoons to get puffier, so that is another consideration. LOWER FACE LIFTING- The amount of filler needed on the apples of the cheeks would need to be an inordinate amount. You currently have 3 convexities. The lower eyelid is convex between the lower eyelashes to the tear trough and life cheek junction. Your cheek and nasolabial fat pad is convex from the lid cheek junction to the paranasal and nasolabial fold. And your upper lip area would be another convexity. Current filling strategies tend to fill already convex areas and make them more convex. When I look at peoples younger faces, I don’t see giant apple cheeks and huge lips, instead I see smooth gentle convexity from the lower eyelashes down the cheek past the nasolabial fold down to the jawline. So if we like how we look when we are younger, the strategy would be to fill the concave areas to blend them into the convex areas and make the multiple sections blend smoothly into a more uniform highlight. Fillers fill, so do we fill concavities or do we plump convexities even more while ignoring the concavities. Fillers in the eyelid area appears to last many years before wanting a small touch up. Patients are not completely refilling the same area over and over again every year. The results are quite stable over the years. My longest patients without a touch up are 6-7 years and counting. To keep realistic expectations, I tell patients they can expect 18-24 months before considering a touch up in the eyelid area assuming they are not over exercising and trying to treat facial fat as an enemy. Hope you found this helpful. Good luck on your facial rejuvenation journey. Best, Dr. Yang

Vibha Gambhir, MD · Answer

Hello, and thank you for your question! I do agree with the recommendation that you were given. I believe that the cheek filler would be a better first approach rather than the under eye filler. The cheek filler will indirectly help the lower face by slightly lifting up. While this may help there still might be a need for lower face filler as well.

Camille Cash, MD · Answer

From your photo it appears you will have the best result from a combination of treatments.  Fillers can be used for the cheeks and under the eyes to give a lift as well as smooth facial contours.  Morpheus8 can be added to improve overall skin tone and texture.

Robert T. Buchanan, MD (retired) · Answer

I suspect that this is a matter of miscommunication. Your injector is correct in two things you have stated. Injection of the tear trough itself frequently worsens the problem. The correct filler to improve the area is Voluma placed deep on the bone or muscle below the orbital ligament. While not what most people call the "cheek," it is technically that. The cause of the under eye problem is loss of volume in the molar area of the cheek and correction is adding volume there. not superficially above the ligament like about 90% of fillers do. (It was how we started filling the area before we learned the problems and anatomy. Unfortunately, most injectors, including many teaching others, never learned the newer techniques.)

Does cheek filler improve under eye area & can it lift the lower face? (Photo)

Answers (9)

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