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What treatment would you suggest for my saggy under eyes and cheeks?

Dr. Dean Kane Q & A Q. I have horrible sagging from under my eyes to my cheekbones. I have had voluma in my cheeks and it has made no difference. I express my area of concern but for some reason the doctor has not addressed this. Can fillers help or do I need a facelift? I would like to know if there is anything that can be done for this area at all. I can’t keep wasting money on treatments and still look the same. I would really appreciate some good advice. Many thanks. A. Fillers for under eye bags are a reasonable camouflage approach as they will not physically improve the structural changes which I see in your photos. Whereas surgical options may give you the best and longest lasting results, I appreciate the concern for budget. Below are other options to discuss with a Board Certified, Plastic Surgeon or Facial ENT or Dermatologist to improve skin firming and tightening. Facial wrinkles and folds are created from 4 different layers of the skin, fat and muscle. 1. The top layer or stratum corneum of the epidermis is the rough, pigmented layer of the skin; creating most of the depth of the wrinkle. Exfoliation is best for this using
  • microdermabrasion,
  • Retin-A (ZO Obagi Skin Health System), which also renews and regulates improved function of the deeper epidermis,
  • some lasers and chemical peels.
2. The second layer is the dermis which thins with aging. The natural collagen, elastin and hyaluronic acid (which hydrate and toughen the skin) are thickened by the use of:
  • fillers (Restylane and Juvederm), or
  • Retinoids (ZO Obagi Skin Health System), which also renews and regulates improved function of the deeper dermal skin cells.
  • Sculptra properly managed is the latest sensation in stimulating firming and thickening of the dermis
3. The next layer or fat also thins or droops with age and maybe:
  • filled (Restylane and Juvederm), fat grafting or
  • redraped (threadlift, short-scar, traditional, endoscopic face / neck / brow lifts)
4. Finally, the muscle which creases the skin into wrinkles and folds is weakened and rebalanced with Botox or similar injectable muscle relaxers like Dysport or Xeomin. In your case, I would recommend you consider a mini-face lift , mid-face lift, and/or lower lid lift. Everyone needs one or more layered improvement and in personalized combinations to achieve their optimal result. I hope this has been helpful. Good luck!
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