24 years old & have festoona; what can I do to lessen the appearance? Is there a permanent and/or temporary fix? (Photos)

I have festoons under both eyes, the left eye is noticeably worse. I assume they are genetic because my father has them, his have worsened with age and I'm afraid this is my fate as well. They look their worse when I first wake up. Also makeup, sometimes, makes them appear to be worse, especially makeup that makes my eyes water. What can I do?

Doctor Answers 4

Genetics and facial form

I agree with the previous comments that this is largely a genetic issue.  Looking at your eyes, you have a little less support from your cheeks and what we call a negative vector or downward slant to the eye axis.  It also seems that your cheeks appear to have less prominence and are slightly flattened.  This contributes to the saggy appearance of your lower eyelids.I agree for your age and desires, a facial filler may be the best option.  Hylauronic fillers such as Voluma or Restylane Lyft for the cheeks can provide some support.  This is a temporary product that resorbs over time so it may be an option for you to try and see if you like it.  It can also be dissolved if there is an immediate concern or you don't want to wait for it to dissolve.

The well meaning surgeon who suggested a work up for allergies is barking up the wrong tree in my opinion.

Unless your eyes are constantly itching and tearing and causing you to continuously rub your eyes, it is very unlikely this is an allergy problem.  There are folks who chronically rub their eyes and eyelids and I can assure you that is not a good think to do.  However it this does not sound like you, save your money and don't have a work up for something that is most likely a genetic issue-thanks Dad.  For your age and issue, the best option in my opinion is a carefully done filler treatment.  These services are expensive and fussy.  However, the results are remarkable.  You need to really do your homework to find an injector in your area who really understands the lower eyelid and mid face.  This will be an oculoplastic surgeon who a vast experience with under eye fillers.

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon
4.9 out of 5 stars 23 reviews

Swelling over cheeks at age 22

Thank you for asking about your lower lids.
  • You do not appear to have what I call festoons - but swelling over the cheek bone.
  • This is not related to the eye lids - but usually to the sinuses.
  • They may also be related to make up. and air pollution, among other irritants.
  • I suggest you see an ENT specialist for a full evaluation of your facial sinuses -
  • It is possible that the drainage passages of your sinuses are too narrow and if opened, the swelling will subside.
Always see a Board Certified Plastic Surgeon. Best wishes  - Elizabeth Morgan MD PHD FACS

Treating festoons

It is difficult to tell from photographs but you have an interesting issue.  It does look like you may have a festoon or what we call a malar bag.  This can often be improved with different modalities.  Often I will use Radiesse rather than hyaluronic acid fillers in the lateral cheek to support the cheek and reduce the appearance of the festoon. Hyaluronic acid fillers tend to absorb water and can sometimes make festoons worse.  We've had very good responses in many patients with devices such as Ultherapy and ThermiRF.  Surgery is usually reserved for patients that won't improve with these other devices since it usually involves potentially creating prominent scars . Thermi RF is now my preferred treatment for malar bags in most patients but you need a thorough consultation to determine which treatment would be most effective in your case.
Best of luck!

Joseph A. Eviatar, MD, FACS
New York Oculoplastic Surgeon
4.8 out of 5 stars 62 reviews

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