Q: I have had 2 consultations and I was told 2 different things. I don’t like the puffy dark bags or the wrinkles under my eyes. Or would Ultherapy help? Please any suggestions.
From Realself member stst630 (https://www.realself.com/question/buffalo-mn-good-candidate-blepharoplasty#1806051)
Answer: In my opinion, based on the photos, your problem is a lack of volume at the lower eyelid/cheek junction.
It appears that you have a combination of findings, a flattened lower lid/cheek complex and descent of the cheek fat. As the fat of the cheek descends it can leave the bony rim of the eye socket more apparent through the relatively thin skin of the lower eyelid, and cause deflation and abnormal shadowing that makes you appear older or tired. In most this occurs with age but it can be genetic (the so-called “negative vector” cheek).
Additionally the thin skin of the lower lid is somewhat translucent to the muscle underneath it, and that’s why it appears like dark circles (imagine placing a wet paper towel on a raw steak — you’d be able to see the darkness of the muscle through the thin paper towel).
Injectable dermal fillers are expensive and temporary but safe. In the lower lid the procedure is technician-dependent so find someone reputable. You can try this approach to see how you like the result, but repeated injections would have to be performed every 9-24 months thereafter so you may wish to consider a technique that lasts longer.
You could consider autologous fat transfer to the problem area. Fat transfer is safe and can be performed under local anesthesia with oral sedation. My chief concern would be potential irregularities of the contour of the skin afterward, and a potential temporary result.
In my opinion the best solution to give you a lasting result is surgery. Through an incision just below the eyelashes, the fat of the upper cheek may be mobilized and sutured into a higher position to add volume to the lower eyelid and help the dark circles fade. Though it should not be considered a permanent solution, this approach should give you a durable improvement over 15 years or more (before you start to see the same issues appear again). You can see photos of patients who had this procedure on the website.
Malar (cheek) implants can be considered as well.
Lastly, I have not been impressed with the results from Ulthera in this region.