Cheek filler or Resylane, Juvederm to help eye bags ??

Thank you for your question. You submitted several very good photos and state you saw a surgeon about possibly using Restylane for your under eye bags but the surgeon recommended you get filler in your cheeks to treat the under eye bags, so you ask if that would be beneficial for you.

I can certainly assist you with this question. I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island for over 20 years. Under eye bags are probably the most popular procedure or issue in our practice, and there are more options to resolve them than there were 10-20 years ago.



First, some guidance in understanding why you have under eye bags. Under eye bags are generally a genetic trait that often runs in families, which can occur as young as in the teen years. I have patients who have come to me who said, whether they are in their 30s or older, that they’ve always had bags under their eyes and they progressively got worse. What their under bags represent are fat pockets that pushed forward and created these bulges. Looking at your photo, you may be asking yourself, you have a thin face, so why do you have fat around your eyes? It’s unfortunately a reality of genetics - some people will have fat prolapse that creates this bulge under the eyes that creates a perception of looking tired.



When hyaluronic acid fillers like Restylane were first introduced, the concept of helping people soften the appearance of under eye bags gained momentum, particularly among non-surgeons. The challenge is how much filler can you really apply before it makes things worse, which is an element of your question. You mentioned a filler like Restylane, but from my experience and what I see in your photo, I don’t think Restylane would be effective.  If Restylane was used to fill the tear trough, well how much volume can you place before it actually adds to the volume of the under eye bags? I see patients from around the world who come to me after having injectable fillers, and it is my job to get rid of the filler so we can see their real anatomy. And that brings me to the next issue.



With due respect to your doctor, my perception is, in order to hide those bags it would take a fair amount of cheek volume to blend with the under eye bags. Respectfully again, this may be a look you would be happy with. The nice thing about injectable hyaluronic acid fillers is they are temporary and reversible. However, when I look at a thin face like yours, I ask myself if the fairly significant volume added to that area will look natural? Or does it make you look swollen?  I think in your situation, it’s more likely you would look swollen.



I review photos with patients in a way to help them understand that although their focus may be the under eye bags, very often they also have a relevant amount of hollowness in the adjacent eyelid-to-cheek junction. When I address under eye bags in a situation like yours, I would typically do a transconjunctival blepharoplasty where I would actually reduce and sculpt the fat from the inside of the eyelid so the fat is no longer herniated or pushing forward. Once that’s done, you may actually expose some anatomy that would benefit from some volume enhancement.



It is a very subjective issue. Often people have the bags removed and they are happy because they no longer have bags and they’re done. Other times, the reduction of the under eye bags reveals a little of the rim of the bone, especially for a person who is very thin, so a strategy has to be applied to soften or improve that appearance. I would argue you would use much less injectable filler to soften that area than you would to augment it and keep the bags. I always explain it’s kind of a paradox - you’re reducing volume in one place while supplementing volume in another.



I think you should consider meeting with other doctors about the option of surgical intervention of the under eye bags. This is a recommendation based on the absence of a physical exam, but by looking at your photos, I am fairly confident that my recommendation to reduce the fat pockets and then consider fillers and other options to enhance this area if appropriate. There’s always a change in the architecture and perspective once a more definitive procedure is done. Learn more about your options and see what is comfortable for you, then move forward. I hope that helpful, I wish you the best of luck and thank you for your question!

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In your photos you appear to have protruding under-eye fat pads and relative tear trough hollowing and relatively flat cheeks. The answer to your questions depends on how your  doctor defines tear trough and cheeks. Your shadows are mostly in your tear troughs but the upper and mid cheek are continuous with this area.  If you've ruled out surgery to reduce the fat pads, you would benefit from filler in the tear trough (Restylane works well here) and in the upper cheek.  Both will help to smooth the transition from the under-eye bags to the cheeks.

Thank you for sharing your question. For mild bags, Restylane injection is a good treatment option. The tear troughs can be filled in order to hide the shadows created by the bags. See a specialist in this delicate area.  Good luck,