30 - Would a lower bleph be the best treatment for malar bags/festoons? (Photos)

Question

Hello! I’ve recently turned 30 and have been trying to establish a daily skincare routine since I’m starting to see some changes. I’ve always had a little puffiness under my eyes that after doing research learned they were called malar bags. Over the years they've gotten worse with one side being puffier than the other. After doing my research I’ve learned that it can be a combination of genetics, lack of sleep, inflamation etc that could be the cause . I’m preparing to start an anti-inflammatory diet along with drinking more water and reducing my salt intake to see if it helps. If I dont see any changes between now and the end of the year I’m considering looking into learning more about how a lower bleph could help. Would this be the ideal treatment? I’ve read that filler could make it worse and co2 lasers may not be the best for melenated skin. What would you recommend?

Allan E. Wulc, MD · Answer

Hi there Ravennicoleb1!
You’re asking exactly the right questions.
From what you’re describing, this does sound more like **malar bags (festoons)** rather than typical lower eyelid “bags,” and that distinction is important. Festoons sit lower, at the lid–cheek junction, and are not simply fat that can be removed with a standard lower blepharoplasty. So a lower lid blepharoplasty is often not the ideal treatment for this problem and, in some cases, can actually make festoons more noticeable if they aren’t addressed at the same time.
You’re also correct to be cautious about **filler**, as it can sometimes worsen swelling in this area. Lasers can improve skin quality to a degree, but they generally don’t fully correct the underlying issue and would not be advised in skin types such as yours.
Lifestyle measures&mdash;hydration, diet, reducing salt&mdash;can help a bit if there is a fluid component, but they usually don’t resolve the problem completely.
The key is determining what component is most responsible in your case:
* fluid* skin* or underlying structural supportand if there is an underlying cause such as a thyroid problem, rosacea, or sleep apnea
Treatment is then tailored accordingly and may involve a combination approach rather than a single procedure.
Options include injections with sclerosing agents such as doxycycline or tetracycline, or radiofrequency microneedling.
If this continues to bother you, I would suggest seeing someone with specific experience treating festoons.
good luck!

30 - Would a lower bleph be the best treatment for malar bags/festoons? (Photos)

Answers (1)

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