What is the best long term/ permanent solution for sunken eyes?

Question

I am 32 and lost volume underneath my eyes. It makes me appear tired. I currently have juverderm vollbela under my eyes. I like my results with the filler. This picture is before the filler. The PA who did my filler stated that blephorplasty might not even address my concerns as I only have volume loss and not fat bulges. She only said I need one syringe. I am looking for a permament solution. What are my options?

Zoran Potparic, MD · Answer

People with smaller cheek bones (malar hypoplasia) have a tendency to show signs of lower eyelid/cheek aging sooner than regular population. That usually manifests with deep tear trough crease as early as adolescence! Correction of TT deformity by means of transconjunctival lower blepharoplasty, possibly conservative fat grafting of cheeks, creates significant improvement. Good luck.

Jonathan Kulbersh, MD · Answer

Thank you for your question and photos. It’s great that you are satisfied with your filler results, but I understand the desire for a more long-term solution. A lower blepharoplasty procedure can tighten loose muscles and reposition fat below the eye to add volume and create a firmer, more youthful appearance. 
The results from this minimally invasive surgery generally last for 10 years or longer. I recommend scheduling an in-person consultation with an experienced, board-certified facial plastic surgeon who can assess your cosmetic goals and help you develop the best treatment plan for you.

Kenneth D. Steinsapir, MD · Answer

There are of course surgical options but they do really require a thoughtful and through in person consultation. I have colleagues who attempt to answer these questions with an "on-line" consultation. Please understand that this is a marketing strategy that is designed to benefit the surgeon. It should not be acceptable to you as a potential patient. The surgeon is trying to by-pass a detailed in person assessment. That is not helpful for you as the potential surgical patient. There is simply no substitute for having your face and eyelids assessed hands on. Regarding the filler you are getting, Juvederm is a runny hyaluronic acid filler that does not hold where it is placed. It is preferred by inexperienced injectors because lumps and bumps that are make by the injector disappear after a couple of days. The problem is that you need a high G prime filler like Restylane to address these under eye circles. Your eyes can be your best feature.

Darryl J. Blinski, MD · Answer

At best based on the 2 posted photos doing 2-3 times a year HA filler injections to your tear troughs is NOT a very difficult process? Or maybe nano fat grafting could give more longevity to the results, that fee would be $4,000. Otherwise finding a more permanent solution would be your quest for the Holy Grail..

Robert T. Buchanan, MD (retired) · Answer

If the pictures are from before the Volbella, you are very lucky as it is almost certain that the Volbella was injected superficially above the orbital ligament. This method, though what most injectors do, can cause significant problems as evidenced by all the people on this site having filler dissolved. The best way to inject this area is with a high G-Prime (heavy) filler like Juvederm Voluma injected deep beneath the orbital ligament. Although you can do this with fat, I rarely do so any longer as I have had Voluma last well over 5 years. Although there are surgeries that can correct the problem, they have a high problem rate and I have given them up.

What is the best long term/ permanent solution for sunken eyes?

Answers (5)

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