What can I do about the haggard, fleshy, saggy appearance of my face? Nasolabial folds and eye bags (Photo)

Question

I have always had a round face and chubby cheeks. Now that I'm 24 I've noticed how haggard and saggy I'm starting to look despite eating healthy, sleeping well and keeping hydrated. My nasolabial folds seem pretty deep to me, as well as my eyebags. I also think the volume of my cheeks drags my face down, giving me an ugly, brutish appearance. I'm really self conscious about how I look, and I was wondering what can I do to look more youthful and lively.

Hooman Khorasani, MD · Answer

Thank you for the post. Unfortunately the photograph is somewhat unclear. Eye rejuvenation is best addressed with a multimodal approach.  Fractional ablative lasers can be very useful at tightening the skin, removing fine lines and stimulating collagen production.  Combination with microneedling, PRP and fillers can augment and sustain results.  Please see an eye rejuvenation expert for best results and to devise a plan that is best suited for your lifestyle and goals.  I hope this helps!

Raffy Karamanoukian, MD, FACS · Answer

Dark under eye circles can make you look tired and older than you are. I would use a combination protocol that includes topical Melarase creams first, followed by a combination of injectable fillers, fractional laser, and RF to blend out the eyelid hollowness and tighten the skin. 
Recommended Creams: Melarase Brightening Kit
MelaClenz
Melarase AM
Melarase PM
Melapads
Replenish Retinoid Cream
Best, 
Dr. Karamanoukian
Realself100 Surgeon

Jonathan Kulbersh, MD · Answer

Under eye bags can be permanently corrected with surgery or temporarily camouflaged with fillers (Restylane, Belotero, Volbella) which can also help nasolabial folds.There are great non-surgical options to fill in under eye depressions and hollowness. Using dermal fillers, a liquid eye-lift can be performed. A dermal filler such as Restylane would be placed in the cheek and tear trough to hide the depression or bag underneath your eye. 
Surgery would require a fat-repositioning lower lid blepharoplasty. In this surgical procedure, fat from the eye area is moved into the tear trough depression filling the actual depression. 
I hope this helps!

Jason Emer, MD · Answer

I recommend fillers for the folds themselves and under the eyes but also lifting around the mouth and cheeks to build underlying anatomical support. In our practice we combine sculptra with other fillers "layered" on top and lasers, rf treatments, J Plasma and peels to get the most conservative natural look. Please see a facial sculpting expert. Best, Dr. Emer

Camille Cash, MD · Answer

You are being far too hard on yourself.  You are lovely!  There are many options that you have to perk up your look a little.  Skin treatments such as hydrafacial, microneedling, and chemical peels can work to give the skin healthy tone and texture.  Fillers and neuromodulators such as Botox can help with fine lines or hollow areas.  Use medical grade skin care products and sunscreen every day.  See an expert injector in your area to learn more.

Amiya Prasad, MD - Account Suspended · Answer

Thank you for your question. You are asking about what you can do to improve eye bags and nasolabial folds. You add that you are 24-years-old, and always had chubby cheeks, which you believe are contributing to your nasolabial folds.
I can certainly help guide you just based on your photos, and without the benefit of a physical exam. As an oculoplastic surgeon practicing in Manhattan and Long Island for over 20 years, I perform upper and lower eyelid surgery every day in my practice, in addition to filler treatments for things like lower eyelid hollowing, and for correcting issues like nasolabial folds.
Looking at just your pictures alone, and without 3 dimensional exam, it appears you have some puffiness under your eyes. If this puffiness is present all time, and there regardless of sleep, allergies, or sinus issues, you likely have lower eyelid fat prolapse. This is what happens when the fat normally around the eyes to the cushion the eyeball pushes forward, and creates these bulges. Eye bags are a genetic issue, so they have little to do with aging, and can happen in young people like yourself. For slight cases, which you may or may not fall into, camouflaging the transition between the elevation and the ridge below may be done. If filler is applied in more prominent eye bags, it may cause them to look puffier. The more definitive treatment is to sculpt and remove the fat. I do this using the transconjunctival blepharoplasty procedure from the inside of the eyelid, where there is no outside incision, so lower eyelid support and natural shape of your eyes are preserved, and results look completely natural. The more common surgical procedure for eye bags is where an external incision is made below the eyelids, called transcutaneous blepharoplasty. Surgeons performing this technique commonly include some skin removal, which often leads to a skin shortage, causes the eyelids to pull down.  This technique can compromise the natural support structures, so I prefer no external incision to avoid common complications, and to look natural as if you never had eye bags.
As for the nasolabial folds, these most commonly happen due to facial volume loss due to aging. You are a little young to have them, but it may be due to premature aging, or a genetic volume deficiency, which seems counterintuitive to your chubby cheeks. I think a closer exam is needed to determine their extent, and if they warrant treatment. A cosmetic filler can be placed beneath the folds to improve their appearance, but I wouldn’t recommend to someone your age, and with what appears almost unnoticeable, but this can be confirmed upon examination.
I suggest you consult with experienced cosmetic surgeons who do both fillers under the eyes, as well as lower eyelid surgery. You will likely get an unbiased opinion from a doctor who does both, rather than a doctor who can only perform filler treatment. If you decide on surgery, I advise you ask for transconjunctival blepharoplasty by name, and insist that no skin is removed. Your nasolabial folds don’t look too prominent, but require a more comprehensive examination to assess. I hope you found this information helpful. Thank you for your question.

What can I do about the haggard, fleshy, saggy appearance of my face? Nasolabial folds and eye bags (Photo)

Answers (6)

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