Katarzyna Ostrzenska, MD

Microneedling is a low complication procedure. Depending on how deep the procedure is the results may vary. I tend to be more aggressive with the depth.  I would also highly recommend PRP injections after the Microneedling, I find that helps attain results quicker.   You can also try some Retin A with Hyaluronic acid to help to reduce some of the pigment in the scars to make them blend in with the skin better

Looking at your picture I think you are a great candidate for PDO threads. It would take all of the droopiness and lift it into your cheeks. There is a down time of a few days after the procedure. I rarely fill cheeks with dermal fillers any longer, threads have become my to go to for cheek volume loss.  

It is a bit difficult to see but I would probably do a tretinoin/kojic acid cream to start. I find starting with non invasive treatments is always best. PRP injections with Microneedling would also probably help in the appearance of your skin.

Malar edema is a problematic side effect of fillers. The pressure of fillers in some individuals decreases lymphatic drainage causing under eye swelling. The PRP alone usually does not cause this side effect. I would recommend placing direct pressure on the effected area and use local heat to see if you can improve drainage and decrease the swelling. If it persists you can have the filler dissolved if hyaluronic acid was used.  If the swelling is due to inflammation, the heat will help to resolve it as well.  Rarely there is a problem with infection but if the area remains warm and swollen you may need antibiotics. Good luck!

I absolutely love to use PDO threads to lift cheeks, then to fill the remainder with fillers. I find this gives the face a much more natural appearance. :-)