Best treatment for volume loss in mid face and under eye bags? (Photo)

Question

I have had Botox 1-2 times per year since 2020. I had less than one syringe of under eye and cheek filler in 2020. I had one syringe of cheek and under eye filler in May 2023. I am 35 with history of heavy sunbed use for about 6 years through college. Experiencing some major loss of volume in mid face and under eye bags. Wondering if filler would address this, or if another route is better.

Anna Chacon, MD, FAAD · Answer

At 35, some loss of midface volume can certainly make the under-eye area look more hollow or accentuate bags, and your previous sun exposure may also contribute to changes in skin quality. The important distinction is whether you're primarily dealing with volume loss, a true tear-trough hollow, protruding lower-eyelid fat, skin laxity, or a combination. These can look very similar in photographs but require different approaches.

If there is genuine volume deficiency in the cheeks, midface/cheek filler can be a reasonable nonsurgical option. In fact, restoring some volume higher in the cheek can sometimes improve the transition beneath the eye without putting a large amount of filler directly into the delicate tear-trough area. Midface volumization is recognized as an important component of treating infraorbital hollowing.

I would be more conservative about simply adding more filler directly underneath the eyes. The skin there is extremely thin, and HA filler can occasionally produce persistent puffiness, malar edema, bluish discoloration, or contour irregularities. These issues can sometimes appear months or even years after treatment.

Your history of having filler in the cheeks and under-eyes in 2020 and again in 2023 is also important. Before adding additional product, I would want to establish how much of the previous filler is still present and whether the current appearance is actually from volume loss. HA fillers can last considerably longer in some individuals than expected, particularly in areas such as the midface.

If the "bags" are primarily caused by protruding orbital fat rather than a hollow, adding filler may actually make the area look heavier. In patients with more pronounced bags or laxity, surgical options such as lower blepharoplasty with fat repositioning can sometimes provide a more definitive correction than repeatedly adding filler.

At the same time, your age does not automatically mean surgery is necessary. If your main issue is volume deficiency with relatively good skin quality and minimal fat protrusion, a conservative midface approach with carefully selected HA filler may give a very nice improvement.

I would also separate the issue of volume from skin quality. Your history of significant tanning is relevant because sun exposure can contribute to collagen and elastin damage. Filler can restore volume, but it won't correct sun-related texture, fine lines, pigmentation, or laxity. Those concerns may benefit from a separate skin-rejuvenation strategy.

So, rather than trying to fill every hollow, I would think of this as restoring the overall cheek-to-under-eye transition. Sometimes a relatively small amount of strategically placed cheek volume can accomplish more—and look more natural—than directly filling the bags. The under-eye area deserves particular caution because, although filler can be effective, it is anatomically unforgiving and carries uncommon but potentially serious vascular complications.

Randy Lindgren, MD · Answer

For volume loss in the mid-face and under-eye area, hyaluronic acid fillers like Juvederm Voluma are a great option. Voluma is specifically designed to restore volume and structure to the cheeks and under-eye area, helping to smooth out hollows and reduce the appearance of under-eye bags. If you’re looking for a more long-term solution, Renuva might also be worth considering. Renuva is an adipose (fat) tissue-based injectable that helps restore volume by stimulating your body’s natural fat regeneration, providing a more permanent solution for volume loss without the need for traditional fillers.
I recommend consulting with a board-certified provider who can assess your facial anatomy and discuss the best options for your concerns. They can help tailor a treatment plan using the most appropriate products for your needs, ensuring natural-looking and long-lasting results.

Nelson Lee Novick, MD · Answer

If the problem is one of age-related volume deficit and depletion, then restoring volume is the answer. These days there are a number of robust HA volumizing fillers, which, if properly matched to the area of treatment and administered by an experienced injector in the appropriate fashion can restore volume in order to improve facial contours and create a more feminine, oval, heart-shaped face, diminish under-eye hollows and tear troughs, define and straigten the jawline and create better chin projection so as to harmonize the projections of the nose, lips and chin in profile view. Botox is NOT for volume, it is for treating dynamic wrinkles, i.e. those that are accentuated by the expression movements of the underlying muscles. And be very cautious when evaluating the advertising hype and social media buzz surrounding all kinds of expensive, energy-based, "bells and whistles" gizmos, like fraxel lasers, RF devices, etc. , since the hard science to support the use of these devices lags well behind the hype. So,"buyer beware" is good advice when considering any of these. You would be wise to consult an experienced, board certified cosmetic dermatologist filler expert and best of luck.

Camille Cash, MD · Answer

HA fillers are a great way to help address volume.  The longevity will depend on the filler selected.  Another option is Sculptra which works differently than HA fillers and can provide longer lasting results.  We also recommend using medical grade skin care products like Transform MD and wearing sunscreen every day.  I've included a video that I hope you find helpful.

Leonard Grossman, MD · Answer

There’s nothing better than using your own fat and restoration of facial Volume loss. When fat grafting is being done by an expert fat grafting specialist, the results should be beautiful, natural and practically permanent. I have been doing photographing for over 30 years and have created a technique Which produces consistently good results   Typically my patients look 20 years younger after a fat grafting procedure. I hope it helps and good luck from New York City Plastic Surgery.

Cengizhan Ekizceli, MD · Answer

Hello, thank you for your question, we recommend stem cell included fat injection to face.
If you want to check the doctor's Instagram page, I added the link, you can take a look and have an idea about the surgery.
We can offer you a virtual consultation for a better evaluation, please send us your full name and phone number on our email: hi@estherianclinic.com. We will contact you as soon as possible.
Hope it helped!

Best treatment for volume loss in mid face and under eye bags? (Photo)

Answers (6)

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