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I recently had filler under the eyes for eye bags. What should I do next?

shutterstock_86444608Dr. Dean Kane Q & A. Q. About 5 weeks ago I had Restylane filler under the eyes (1cc) but I do not think it’s really helped.. I have darkness under the eyes which obviously won’t be helped with filler (from what I have read) but this comes and goes depending on lifestyle and allergies, however the puffy bags are still very much there. From the photo, would you recommend some more filler to smooth things out, surgery to get rid of the fat pads (if that’s what it is) or something else? I appreciate your comments. A. Thanks for sharing your photo! Pigmentation or dark circles under the eyelid may come from any combination of the following.   1. Eyelid bags and laxity with shadowing 2. Cheek laxity and shadowing 3. Thin eyelid skin with a reflection of the underlying muscle ​4. Eyelid veins. 5. A separation of the eyelid structures from the sagging cheek structures Many options are available depending on the problem above. 1. Eyelid lift 2. Injection of fillers, either into the skin or deep under the fat for volumizing using Restylane, Perlane, Juvederm, Voluma or fat ​3. Vein ablation ​4. Mid-face lift, a lift of all the structures of the cheek with a eyelid lift 5. Facelift   In properly selected patients, ​I find that shadowing of the nasojugal fold / tear trough is best approached with fillers deep and just superficial to the zygomaticus muscles and their overlying fat compartments. Heavier fillers such as Voluma and Perlane project the tissues forward and fill the separation of these compartments. ​Mid-projecting / volumizing fillers such as Juvederm and Restylane will be helpful to balloon the loss of volume in this compartmentalized layer of fat cells. ​Fine line injection with Silk, Belotero and other more fluid fillers above the orbicularis muscle may leave the patient with the depressed hollow of the tear trough. It may also highlight the bluish discoloration, the “tindle” effect rather than diminish it as with the deeper injections. Sub-orbicularis filler injection may help smooth the trough and camouflage the eyelid bags but rarely does it reduce discoloration. ​You may need layered filling to achieve your filler goals. ​Consider a mid-face lift which suspends these tissues and brings them together surgically rather than fill the hollows. ​Transconjunctival fat bag removal has a significant tendency to leave the lower lid hollow if not properly suspended using a trans-cutaneous skin removal and lid-cheek lift. ​In all options, it is best to consult with a well experienced, Board Certified Plastic Surgeon, Facial ENT or Oculoplastics Surgeon who has expertise in all procedures for your best evaluation and recommendations. ​I hope this has been helpful! All the best!
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