I'm 25 years old and as far as I can remember and see in photos ive always had this issue. I have very prominent "bags" above my cheekbone/under my eye. I'm not sure if it would classify this as a lower eyelid issue because it's not in the typical spot that I see when I look at before/after photos of eyelid surgery. If I squint my eyes it affects my vision and if I have allergies my eyes feel heavier than they normally do but antihistamines dont reduce them. What can I do to fix them?
Fat Pocket Above Cheeks? Lower Eyelid Problem? (photo)
Doctor Answers 4
Fat above cheeks/below eyes
It appears that you may have malar bags rather than lower eyelid fat. A consultation with an experienced doctor would be recommended. If they are malar bags, the treatment I would suggest would be an injectable filler below the fullness to try and soften the depression beneath it.
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Festoons or eyelid bags
These appear to be festoons and are very difficult to treat. Make sure your allergies are under control with antihistamines, cortisone nasal sprays, allergy testing, etc. Fractioned laser would be of some benefit to try to reduce the interstitial fluid retention inside them. A blepharoplasty will be of no benefit
Puffines of cheeks just below eyelids
From the picture it looks like you have a degree of superficial swelling of the upper cheeks. This is often confused with the herniation of fat that can be corrected with a blepharoplasty procedure, but this type of surgery will generally not help your problem. The superficial puffiness may be related to an underlying conditions such as allergies, or sinusitis and may improve with treatment of those problems. I think these so called "malar puffs" are very difficult to correct and may be best left alone. You might want to see what decreasing the salt in your diet accomplishes.
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The bags that you see below your eyelid at your cheek junction are called festoons. These are one of the more difficult problems that we deal with and there isn't a perfect way to get rid of them. Repeated swelling due to allergies could be the underlying problem, creating loose connective tissue with poor lymphatic drainage of fluid.
Fillers may improve the situation, but sometimes can lead to a "boggy" looking eyelid. Laser resurfacing might be your best option in an attempt to cause tightening of the layer of skin just underneath the surface.
An inperson consulation is necessary to see if you are good skin type for this.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.