Complete Under-eye Volumetric Rejuvenation (CUVR) Procedure: CUVR bags, lines and circles

As the face ages there is predictable descent of the cheek, which accentuates lower eyelid aging including the deepening of lines, hollowing, and prominence of under eye bags and dark circles. The cheek is a three dimensional structure which is supported by bone, ligaments, and muscle which weaken over time leading to sagging and flattening of the area.

Rejuvenation of this area can be performed surgically and non-surgically. For moderate to advanced midface aging a lower eyelid procedure combined with a midface lift (cheek lift) can predictably rejuvenate this area. Mild to moderate effects of age can be corrected with volume replacement, in combination with skin care.

  • The goal of lower eyelid and cheek rejuvenation is to blend and smooth the lower eyelid and cheek junction.
  • Mild to moderate midface aging: in-office volumetric rejuvenation
  • Moderate to advanced midface aging: surgical midface lift with septal reset lower eyelid blepharoplasty

To effectively rejuvenate the under eye area without surgery it typically will require a comprehensive approach with combination volume replacement for different areas of the lower eyelid and cheek.

Rejuvenation may only require tear trough injections though this may leave the outer cheek to appear flattened and/or lower inner cheek or deep malar area sunken. Specific volume replacement should be performed with regional specific fillers with more cohesive fillers used on the outer cheek like Voluma® or Perlane® (Restylane Lyft) and softer fillers in the lower eyelid like Juvederm® or Restylane®. Deep malar replacement can be calcium based with a biostimulator like Radiesse®, and the lower cheek or sub malar region with a more diffuse correction with a biostimulator, such as Sculptra®.

A combination approach provides a harmonious result when applied correctly and effectively.

  • Facial analysis to define the areas of deficiency: four areas include malar, tear trough, deep malar and sub malar areas
  • Volumetric replacement in an outer to inner direction to help blend the cheek with the lower eyelid
  • Lower cheek and sub malar addition if needed, and can typically be corrected with Sculptra® in the sub malar region and Radiesse® in the deep malar regions which are both biostimulators that promote long lasting collagen growth.

What are my options?

  • Consider surgical correction: lower eyelid blepharoplasty with a septal reset and midface lift (cheek lift) can correct this area with effective and long lasting results
  • Consider incremental replacement with about 1 cc of volume in each region followed by an addition if needed in 3 months.

Frequently asked questions (FAQs) for under eye rejuvenation

  • How long does the procedure take? The injections are done in the office with topical anesthesia and ice. All injections are performed by Dr. Trussler, who has signicant experience in surgical and non-surgical facial rejuvenation. The entire procedure takes about 30 minutes and a consult to determine the areas and amount of volume replacement is needed.
  • What are the risks? Bruising and swelling are the most common side effects, which can be limited with effective injection technique and topical ice. Over and under correction are also risks, though Dr. Trussler would rather add volume in a 3 month period versus dissolve fillers.
  • What is the downtime? Limited downtime is needed after injections with swelling and bruising expected to last about one week, though mild, residual swelling and  bruising lasting 2 to 4 weeks. Make-up can be applied almost immediately, skin care can be resumed that day, and exercise can be resumed shortly after the injections, but may increase bruising and swelling.
  • How long will it last? Results may last up to two years, with long lasting fillers like Voluma® and Perlane® (Restylane Lyft) lasting the longest. Juvederm® and Restylane® may last about one year, but only half of the initial volume would need to be injected at the year point.

Andrew P. Trussler MD is an experienced plastic surgeon in Austin Texas with advanced training in facial aesthetics including non-invasive rejuvenation and surgical rejuvenation with the High SMAS facelift, midface lifts, eyelid blepharoplasty and browlifts.

Dr. Trussler’s Austin plastic surgery office can help guide you in correcting commonly seen cosmetic lower eyelid complaints. A lower eyelid and cheek rejuvenation is a plastic surgery procedure in Austin Texas that should be a smooth and straight forward process that will help improve appearance and self confidence.


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“I’m very happy with my breast augmentation! Dr. Trussler did a breast augmentation and did a fabulous job. A very special thank u to the staff at the clinic as well, follow up visit amazing. Would highly recommend, Andrew P. Trussler, MD - Austin Plastic Surgery if you want the BEST!”

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Suite J200
Austin, TX 78746



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