Eye Bags Treatment: Q&A
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Malar Bags - Festoons. What Do You Recommend? (photo)
I see differing opinions about lower bleph for this. How visible are the scars? One doc recommended a lower bleph w/ an extended incision that runs length of lower lids & about a cm along a smile line in outer corner of eye. Also discussed with another, an arcus marginalis release, fat transposition and canthopexy with a separate skin muscle flap? I have also read about laser tx's. Some say a lower bleph could make problems worse? I've already tried fillers.
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12 Doctor Answers |
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sylvanr
+3
Festoons (malar bags)
Festoons (aka malar bags) are a common annoying problem of the lower eyelid/cheek junction. They can be mild to severe. There are different types of festoons, namely fluid filled, fat filled, excess skin, or combination of the above. Treatment options vary for each but complete resolution of festoons are unlikely, especially if fluid component present, and you should expect improvement not complete resolution. In your case, the lower eyelid incision with skin-muscle flap is...
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Malar bag, festoon treatment
Thank you for your question. As you may have guessed by the number of different opinions expressed here, this is a very difficult problem to treat. Direct excision may improve this problem but many times it only results in an improvement not a complete elimination of the problem. The down side to doing this is that it leaves you with a significant scar on your cheeks. Arcus marginalis release, fat transposition and canthopexy with a separate skin muscle flap is an excellent...
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Malar bags - festoons
Festoons are not removed with a traditional lower blepharoplasty. A canthoplasty will help with some of the excess lower lid retraction present and scleral show, however, not all of the festoon material will go away with just a canthoplasty. Direct incision is probably the only way to surgically remove true festoons, but the festoon removal should be done as a secondary procedure after a canthoplasty is performed. Fillers will not help with this problem.
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Festoons
Put me down as one in agreement with Drs. Meyer and Kabaker; direct excision is safest and surest way to good result. External laser combined with lateral canthopexy (to prevent ectropion or lower lid rounding) could be considered in experienced hands. Conservative approach is safest.
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Cheek festoons ("water bags"): what's the solution?
Yes, those pesky collections of 'fluid' beneath the lower eyelids can come and go, but never really completely go away. Do salt, hormone levels, stress and aging make them worse? I agree with Dr Mayer and Kabaker that direct excision offers the most straightforward method of achieving a reduction and improvement in these pesky bags of annoyance. If surgical healing is routine, the small scars seem like a good tradeoff to the persistent puffiness!
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Festoons
As you can tell by the number of different options presented to you, that this is a difficult problem to address. The more techniques available for a problem, the harder it is to fix!!
The best way to remove them completely is to excise them directly which will leave a scar.
All other options [blepharoplasty, laser, etc] will likely improve to some degree, but not resolve completely.
Your case is mild-moderate, so a blepharoplasty with orbicularis suspension may...
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Malar Bags - Festoons. What Do You Recommend?
Thanks for the questions and posted photos. I agree more with Dr Mayer on direct excision. But recently have used Smart Lipo directly on the "festoons" with some success. Just a thought, very minimally invasive and if you get a 50% reduction can be repeated.
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Malar bags/festoons per photo
Interesting responses from non-plastic surgeons.
The key to such problems is identifying what the problem is, what procedure would correct it, and what the trade-offs are. Lower eyelid/malar bagging is a combination of fat pads, stretch and sag of overlying skin, and descent of the upper cheek/malar tissues. A standard lower lid blepharoplasty would address the fat pads but not the stretched and excess skin with an incision in the usual subcilliary location (or transconjunctival)....
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Festoons
Lots of options for FESTOONS: The standard direct festoonectomy and transconjuntival internal plication approaches will work. However, don't forget about internal & external laser applications and possible serial adrenocorticosteroid injections, etc.
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Malar festoon surgery
There really only two ways to deal with these and first off, you'd probably want a few consults with Facial plastic or Oculplastic surgeon. How do you get ride or improve these?
1) Direct excision. The scar fades but it looks a lot better than what you had.
2) Trans-blepharoplasty malar festoon plication. You'll want to see an experienced Oculoplastic surgeon for this one.
The pexies and other things recommended won't do much for you....
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