Under-eye and mid face rejuvenation options? (Photo)

I would recommend beginning with a lower blepharoplasty with fat release. At the same time, you may want to do some fat injections to the cheeks to make them a little more prominent.

Best Wishes,

Gary Horndeski, M.D.

With weight loss and aging, people may lose midface volume. The volume can be restored with fat grafting, or temporarily with fillers. If there is skin laxity or sagging, then a cheek lift or facelift can restore, reposition, and rejuvenate the midface. Restoring the cheek volume and position will help with the under the eyes. If lower eyelid excess orbital fat, lower blepharoplasty/ eyelid surgery with addressing the excess fat.

You would be wise to consult with an experienced, board certified cosmetic dermatologist filler expert. At least from the photos, it would appear that the proper use of an appropriately robust HA volumizing filler for the cheeks would not only be able to contour a more youthful, feminine, heart-shaped oval face, but would likely significantly improve the hollowness under the eyes (since the upper cheek is a major support for the under-eyes). In experienced hands, treatment should not take more than ten to fifteen minutes and yield immediate, on-the-spot results that typically elicit a big smile and a "Wow!" reaction. Hope this helps and best of luck.

The mid face does not descend vertically with aging process, but loses volume. For a temporary augmentation, consider fillers in the midface. For a permanent augmentation, consider cheek implants.

Midface facial aging is somewhat complex and you may find different providers have different opinions on how to approach this.
There are often two dynamic variables that show the signs of aging in this facial region.
In a youthful, attractive face, the contour of the lower eyelid is typically snug And tight with immediate plump fullness in the beginning of the mid face.
With facial aging the two areas reverse in contour.
Bulging and fullness develops in the lower eyelid as the fat pads under the lower eyelids begin to show due to weakness of the Peri-orbital septum at the same time patients may begin to lose volume in the upper part of their midface.
Sometimes bulging fat pads in the lower eyelids is the primary cause other times a lack of volume in the midface is primary, and sometimes it simply 50-50.
In your case, I think loss of volume which is primarily based on facial, skeletal structure, is more of the primary cause than bulging fat pads in the lower eyelids.
Restoring midface volume can be done, using fillers, fat, transfer, using implants or a mid facelift.(very different than regular facelift.)
Of these options fillers are probably the best in regards to being precise, predictable, and highly forgiving if patients don’t like the outcome.
The biggest drawback is the lack of permanence.
This can, however be a blessing patient don’t like the outcome of a treatment. I recognize the Baybridge in the background of your picture. Based on that I recommend you take a look at the website of Dr. David Mabie MD in San Francisco.
He is a facial plastic surgeon whose work is devoted exclusively to only working with facial fillers.
His work using fillers is the best I’ve ever seen, and in my opinion is work is the gold standard of what can be achieved without surgical intervention.
His work doesn’t come cheap, but his work is in my opinion the best I’ve ever seen.
I typically don’t recommend people get a flight and fly across the country to have fillers done but for those who live in the area, it may be a very legitimate option.
If nothing else, looking at his results, can give you an idea of what well done volume restoration is able to accomplish.
Some of his results are absolutely stunning.
Best,
Mats Hagstrom, MD