Best treatment for eyebag and festoons? (Photo)

Radical treatments product unpredictable outcomes.  You don't want an unpredictable outcome.  The injection of tetracycline or even the use of electrocautery should be considered experimental.  In my opinion, you should avoid these treatments.  Put your finger on your "bag".  What you are feeling is your bony orbital rim and not herniated lower eyelid fat.  That means standard lower eyelid surgery is not going to help this. Options that are very powerful for helping this are carefully performed fillers or lower eyelid chemical peel.  The filler treatments will last for about a year before benefiting from being topped off.  The chemical peel will last more than 10 years.  Weigh your options carefully.  Getting the right filler service is challenging.  You are asking the injector to sculpt you and they don't teach that in medical school.  I have folks who fly to see me in Beverly Hills from all over the world for filler service.  That should give you an idea of how difficult it can be to find the right injector.  The hyaluronic acid fillers are removable.  Start there.

Thank you for your question about non-surgical treatment of under-eye bags.
There are many ways to tackle under-eye puffiness, lines, and/or dark circles.  There are some skin care products you can use.  Some laser treatments such as ErYag lasers can tighten skin under the eyes and help reduce fine lines.  Platelet Rich Plasma (PRP) microneedling can also tighten the skin and help promote collagen production.  Finally, you can camouflage under eye bags by placing fillers such as Juvederm Vollure or Voluma, or Restylane Defyne in the area.   

To be sure, see two or more experienced, licensed and board-certified providers in your area for a complete evaluation to make sure you are a good candidate and that it is safe for you to have treatment. I hope this helps.

Dear Monika,It appears from your photos that you have both lower eyelid bags and eyelid festoons.These conditions can make a person appear tired, sick  and older even thought they feel fine inside.For the lower lid fullness, surgery to remove or relocate the fat is this area can be helpful.For the festoons, I've had success using lasers to improve both lower eyelid festoons and malar mounds. I'll include a link below to learn more.I hope this was helpful. 

A combination approach will give the most improvement. Fillers, lasers, and microneedling/PRP can improve under the eyes. My patients try to get non surgical treatments to avoid surgery. We use PRP and stem cells there often. I suggest consulting with an expert to develop a treatment plan best suited for your short and long term goals. Best, Dr. Emer

It appears from the picture that you have excess fat with an indentation in the jugular groove. You have the option of doing a trans conjunctival blepharoplasty with fat grafting. If you choose to not have surgery you can have Dermal fillers  Such as restylane or volbella  which would make the  bags  less noticeable. Whatever choice you make you have a great option! 

The best treatment for eye bags, I believe to be the lower Bleparoplasty. The best treatment for festoons would be micro-liposuction / skintyte.

You may see some improvement of the festoons with the use of lasers.  For the under eye area, you may want to consider beginning with fillers.  They are temporary, lasting approximately 9-12 months, but they have the benefit that they can be dissolved if you are unhappy with the result.  I encourage you to meet with a board certified plastic surgeon in your area to discuss your concerns and together you can design a treatment plan that is best for you.

Fluid bags under the eyes can be a very frustrating issue.  These are usually cosmetic and not harmful, but when severe they can cause mechanical ectropion.  Ectropion is when the eyelid is pulled away from the globe surface creating a gap between the eye and the eyelid.  This can cause considerable irritation.  Many methods have been tried, with varying success, to improve these fluid bags.  Modalities tried have included chemical peels, laser peels, radio-frequency or electrocautery ablation, enzyme injection, and direct excision.  A study published in the Ophthalmic Plastic Reconstructive Surgery journal showed benefit to injection of tetracycline antibiotic into the area of swelling with moderate success without any complications.  Dr. Burroughs has used tetracycline injections for ocular surface swelling with good success when the problem couldn’t be improved under the care of other physicians.  Dr. Burroughs thinks this will be a potentially useful, safe, and repeatable tool for future use.  Another relatively new tool is to use radiofrequency thermal energy under the skin to collapse the fluid bag area and try to scar it under the skin to prevent recurrences.  I have been using Inmode's RFAL device ("facetite") for this and have had some good success.  Fat bags can be masked and made to look better with dermal filler injections (e.g. Belotero or Restylane), and have had high success in the right patients.  Surgery can also be done to sculpt and reposition the bags to smooth the lower eyelid cheek convexity that should typically be present in young patients.  Fillers can, however, worsen the fluid bags, so be cautious and go with a filler that is reversible with an enzyme (hyaluronidase).  Best regards on improving your concern.

Based on the pictures, the best long-term solution is a lower eyelid blepharoplasty with fat repositioning. Fillers may give a temporary solution. 

Excellent question -- from your photos it seems the best treatment would be lower eyelid blepharoplasty performed from the inside of the eyelids. Fat needs to be removed very conservatively and some fat repositioned. In my opinion there is no role for lasers here.  Fat grafting is not required either. Festoons are very difficult to improve and any reputable surgeon would warn you of the challenges in improving your cheeks (which have mild malar mounds). Fillers can be a possible adjunct to your procedure in my opinion.  Whatever you decide, you and your surgeon should be on the same page as to your goals and expectations. Please make sure to see a board-certified, fellowship-trained Oculofacial Plastic Surgeon with specific expertise in cosmetic eyelid surgery. Avoid doctors who do eyelid surgery part time. You are young and beautiful -- so choose carefully as you want this done right the first time. Best of luck in your search.
Damon B. Chandler, MD
Harvard-Penn Trained Oculofacial Plastic Surgeon