How to fix those cheek/under eye festoons (or what are they?)? (Photo)

It looks like you have mild festoons and thin cheeks. Adding volume to the upper part of your cheeks with either Restylane Lyft or Voluma should help make the festoons less noticeable. It is usually hard to get rid of festoons completely, but adding filler around the festoon usually helps.

Dear Boston Patient,You appear to have a common condition of lower eyelid fullness and festoons or malar mounds. The best option would be to correct both the lower eyelid bags and festoons for the most natural result. I've found using lasers to tighten the outside skin can improve festoons and malar mounds. Removing or relocating the lower lid bags can help that condition.I hope that was helpful and suggest you seek help in your area with a surgeon who feels comfortable treating festoons and lower lid bags.

There are many causes of eye bags. Some are shadow issues, some are discoloration issues.  Most people have a multifactorial problem meaning they have more than one problem causing this demarcation. You are young so it is best to be conservative. I am seeing more and more young people with this issue. Often times in your age group we can get away with laser and fat transfer alone but below are the common causes and my treatment protocols. 

1. Prolapsed orbital fat through the orbital septum: treated with lower lid blepharoplasty and fat transpositioning. Can also be helped with fillers or auto fat transfer to the face but the ideal treatment in my hands is surgery for this issue.

2. Eczema: much more common in young people with fair skin. The treatment for this is to hold off on makeup and any manipulation of the lower lid for a few weeks and try some topical anti inflammatory creams. If you have allergies those should be treated also.  A dermatologist is the best person to see for this. We have a multidisciplinary clinic with myself, a plastic surgeon, and my partner, a dermatologist which I think is ideal!

3. Fluid accumulation and/or redundant skin. Could be possible in young patients but would need a good facial analysis and exam to determine. A low salt diet (< 1000mg/day) and a warm compress can help.  I would consider treating with filler/fat transfer, lower lid fractional ablative laser and/or lower lid blepharoplasty.

4. Descent of midface cheek pad. This then causes the nasojugular ligament to become more prominent creating a demarcation and separation of the eye from the cheek subunit. Treated with mid face lift and/or fat transfer.

It is all about the balance of this transition from the orbit to the cheek. There are many ways to treat this and they vary by the underlying cause. I recommend seeing a surgeon who also does a lot of these treatments. This can make a big difference as most people have a combination of the above that lead to the issue.

Hope this helps.

Best of luck,

DrC