Thank you for your question. You are asking how to treat under eye bags, malar festoons, and cheek volume loss at the young age of 23. You’ve tried antihistamines, cutting back on alcohol and sodium, and improving sleep patterns, but say nothing is helping you. I can certainly guide you in the absence of a physical exam, and with just your photos for reference. I’m Dr. Amiya Prasad. I’m a Board Certified Cosmetic Surgeon and Fellowship-trained Oculoplastic Surgeon. I’ve been in practice in Manhattan and Long Island for over 20 years. I do treat eye bags, festoons, and cheek volume loss every day in my practice. From the picture you submitted, it is difficult to see if you have under eye bags, but a festoon, or malar edema can be seen. Malar festoons are caused by small, multiple pockets of fluid, which make them difficult to treat. A cause of malar bags that you didn’t mention is smoking, but I’m not aware if you are a smoker. It is possible to blend the appearance of malar festoons and treat cheek volume loss at the same with cheek filler placed at the bone level with a technique called Structural Volumizing. However, at age 23, you shouldn’t be experiencing significant cheek volume loss due to aging. More severe malar bags that are accompanied by under eye bags can be treated with surgery, but I would not advise it at your age and severity, and it’s unclear from your picture if you have under eye bags. Treating festoons can be difficult, but they can be improved. I suggest you meet with doctors who specialize in the lower eyelids and cheek area for a proper physical exam and diagnosis before more specific recommendations can be made. I hope you found this information helpful. Thank you for your question.