Solutions for Deepset 'Sunken' Eyes and Flat Cheeks?

Hi.

1)  I would start with fillers, which in these areas are very long lasting.  Very good technique is required.  Restylane is useful under your eyes (in tiny quantities, injected deeply, under the muscle).  Juvederm can really enhance your cheeks, where you need upper fullness.  You will have to repeat these  treatments every two or three years.

2)  We do not use cheek implants anymore.  They are associated with significant risk of complications and unnatural look.

3)  Eventually, you will become a good candidate for a mid face lift, which really fills up your upper cheeks, and smooths the transition between your lower lids and your cheeks.  Fat injections can be done at that time.

The best treatment for you is a surgical correction.  Some of your orbital fat can be used to fill in the hollowed out areas.  The muscle can be re-suspended laterally ant some of the malar cheek fat can be resuspended laterally as well.  This would be the best way to  get rid of the hollowness and make the dark circles less noticeable.  The darkness is due to the shadowing caused by the hollowness.

Flat midfacial area or sunken cheeks may be treated via multiple methods.Several cosmetic options are available to improve volume loss in the cheeks or midface. Volume loss is a natural progression seen with facial aging, or present at young age due to inadequate bone structure. Midface volume loss may also be seen earlier with genetic predisposition, medical conditions, severe weight changes, or medications too.

Treatment obviously is to add volume, typically. Injectable fillers with hyaluronic acid, Restylane, or Juvederm may be appropriate. Alternatively, longer acting facial fillers such as Radiesse or Sculptra provide longer-term improvement of the cheeks. All these injections are office procedures.

Other options include fat injections, which have been used for decades for facial rejuvenation. Fat injections have the potential for long-term cheek enhancement. Lastly, cosmetic surgery with a silicone implant or midface lift may be more appropriate in selected patients. Silicone cheek implants are a good option for permanent cheek enhancement.

There isn't one best treatment for facial plastic surgery procedures. Only after a comprehensive evaluation by a plastic surgeon specialist can he/she help determine appropriate options for you for natural cheek enhancement. Best of luck.

Dr. Chaboki

based on the photographs, your cheeks appear to require more volume and this can be done effectively with sculptra. it appears that this will help the flatness of your midface. you also could use sculptra in you pre-auricular area. the hollows under your eyes can be improved with restylane into the tear trough in combination with sculptra into you upper medial cheek areas. you exact facial anatomy is difficult to ascertain from the limited photographic views but i think these two products would work nicely to improve many of the areas that you are concerned about.

Dear Vicki4449,

Sunken eyes and flat cheeks may be improved with a combination of fillers (Restylane, Juvederm, Radiesse, Sculptra), fat grafting, cheek implants, tear trough implants, eyelift (blepharoplasty), and/or cheeklift.

Dark circles around the eyes can be a separate problem and may be due to thin skin, prominent veins, or pigmentary issues. Topical medicines, laser treatments, and/or fat grafting may help.

It is very difficult to make a meaningful assessment from the photographs. I would consult with a Board Certified Plastic Surgeon.

Warmest wishes,

Larry Fan, MD

These photos are almost non-contributory because the side and oblique views are not really side and oblique. The frontal view it is out of focus and cuts off in the middle of the lower eyelids. You can't really make any recommendations from this set of photos and cannot really see the tear trough. I suspect there is more of a lower jaw issue than a midface issue but cannot know for sure from these photos.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

The flat cheeks can be augmented with simple small silastic cheek implants.  This works quite well to augment the flat cheek area.  The incision for this is placed in the intraoral area above the upper tooth roots and they are placed directly over the bone.  There is really nothing that can be successfully done for hollow lower eyelids.