Thank you for your question!
You submitted several very good photos and you are stating in your question that you
saw a surgeon who you went to about possibly using Restylane for your under eye bags but
the surgeon actually recommended that you get a filler in your cheeks to treat the under
eye bags.
And you’re asking whether or not that would be beneficial for you.
Well, 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 have probably been the most popular procedure in our practice or issue
in our practice to resolve and certainly, it is a time where the question about the
best option continues to be open because there are more options available than there were
10-20 years ago.
So first, I’m going to give you some guidance in understanding what you are dealing with
and why you have under eye bags.
The under eye bags are generally a genetic trait that often runs in families.
It 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 and these fat pockets have pushed forward
and created these bulges.
Now looking at your photo, you may be asking yourself, you have a thin face, why do you
have fat around your eyes?
And it’s unfortunately a reality of genetics.
It just so happens that some people will just get this fat prolapse and it will create this
bulge under the eyes that creates a perception of looking tired.
Now years ago, when the hyaluronic acid fillers like Restylane were first introduced, the
concept of helping people soften the appearance of under eye bags started to gain momentum
particularly amongst non-surgeons.
And the challenge unfortunately is how much filler can you really apply before it makes
things worse and that’s one element of the type of question you’re asking.
So you mentioned a filler like Restylane.
Frankly, from my experience, from what I see on your photo, I don’t think Restylane would
be effective.
And the reason is, if Restylane was being used to fill the tear trough, well how much
volume can you place in the tear trough before it actually augments or adds to the volume
of the under eye bags?
I see patients from around the world who come to me after they’ve gone to have injectable
fillers and it is my job to try to get rid of that injectable filler so that 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 actually hide those bags,
it would take a fair amount of cheek volume augmentation in order to blend with the under
eye bags.
Now respectfully again, this may be a look that you would be happy with.
You know, the nice thing about injectable fillers of course is they are temporary and
they are reversible when you are using hyaluronic acid-based filler.
However, when I look at your face and this is my perspective on how I speak to patients
like yourself, I look at a person with a thin face and I ask the patient and I ask myself,
does volume in that area that is fairly significant look natural?
Or do they look like they are swollen?
And I think in your situation, it’s more likely that you would look swollen.
Understanding that, 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.
So I explain, when I address under eye bags in a situation like yours, I would typically
do something called a transconjunctival blepharoplasty.
What this means is that I would actually reduce and sculpt the fat from the inside of the
eyelid so that the fat is no longer herniated or pushing forward.
Now once that’s done, you may actually expose some anatomy which would benefit from some
volume enhancement.
It is a very subjective issue.
A lot of times people have the bags removed and they are happy.
They are happy that they no longer have bags and they’re done.
Other times, the reduction of the under eye bags reveals a little bit of the rim of the
bone especially for a person who is very thin and then the strategy has to be applied to
soften that appearance or to improve that appearance.
But I would argue that you would actually use much less injectable filler to soften
that area than you would to augment it and keep the bags.
So to me, and I always explain that it’s kind of like a paradox.
You’re reducing volume in one place while supplementing volume in another place.
So I think you should probably consider meeting with other doctors about the option of surgical
intervention of the under eye bags.
This is a recommendation I am suggesting based on the absence of a physical exam but by looking
at your photos, I think that I can be fairly confident that my recommendation would be
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 there’s a change in the perspective
once a more definitive procedure is done.
So learn more about your options and see what is comfortable for you then move forward.
So I hope that helpful, I wish you the best of luck and thank you for your question!