Why does my under eye/cheeks have such a big wrinkle/dent? (photo)

Question

it's so noticeable in certain pictures and it just kills me. My eyes also kind of protrude out and I already have wrinkles forming... The skin right under my eye and where the "wrinkle/dent" I'm pointing towards in my picture feels really flat as if there is nothing but just skin under it. I just want to know if it's something like not having enough fluids or sleep or maybe my diet? I just turned 19 so it confuses me as to why my face looks so sunken in and aged.

Jason Emer, MD · Answer

These are mild festoons or malar bags. At your age, fractional nonablative (clear and brilliant, Faxel) or radiofrequency (sublative, viva), co2 resurfacing and microneedling/prp will give great results without the need for surgery.  Fillers in this area help as well IF placed appropriately.  Please see someone with experience in treating this area. Best, Dr. Emer.

Adam Scheiner, MD · Answer

Dear Patient from NC, You seem to have what is referred to as a Malar Mound or festoon.These result from natural swelling above the deeper ligament in this region of the face.I've had success using lasers to tighten these from the outside.I'll include a video below. I hope this was helpful.

Gilbert Lee, MD · Answer

You are correct that at age 19 your under eye bulge is not due to aging. It appears that you have an anatomical condition called a "tear trough deformity" and it is caused by a "negative vector orbiit".  Because the eyeball projects further than the underlying cheek bone, there is a hollow that can be corrected with the insertion of tear trough implants. Using undereye fillers will, in the long run, get very expensive because of the need to re-treat. I perform a large number of tear trough treatments including fat grafting and injectables, but it appears you may be an excellent candidate for implants. These are easily inserted through a lower lid blepharoplasty and the results are amazing.

Why does my under eye/cheeks have such a big wrinkle/dent? (photo)

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