I have under eye festoons or Malar bags that I want removed. What is the best treatment? (photo)

Question

I had one doctor offer to remove the fat. Would that be the best treatment?

Adam Scheiner, MD · Answer

Malar Mounds and Festoons are terms used to describe the skin folds and 
swelling of the lower eyelid and cheek which form as a result of years 
of sun damage and underlying forces under the skin caused by contrasting
 muscle action. Festoons, along with lower eyelid bags, can make us 
appear tired or sick even when we feel great inside. Patients with this 
condition often report that others think they are perpetually tired 
based on the appearance of these Festoons and Malar Mounds. It can be 
frustrating for those who feel otherwise fine to be perceived as tired 
when they are not. 
While some people have a family genetic predisposition to Malar 
Mounds and eyelid Festoons, most people develop them as a result of sun 
damage to the fragile skin in the lower eyelid and cheek region. Small 
doses of unprotected sun exposure over our lifetime can be as damaging 
over time to the skin as the few sunburns we had in our youth.
The best way to improve lower eyelid Festoons and Malar Mounds is to 
address the cause, which is the tissue sun-damaged over time.  
Procedures like my RESET procedure for Festoons and Malar Mounds use 
lasers to remove past sun damage and then allow new skin to grow back in
 its place. This new skin has brand new collagen and elastic fibers 
which tighten the skin and this is one of the best ways to improve lower
 eyelid Festoons and Malar Mounds. 
I hope you found this interesting.

Franklin D. Richards, MD · Answer

It appears from your photo that you have a true festoon which is different than eyelid bag fat. There are a number of procedures that can be performed to correct the fulness you have in this area. It is extremely difficult to be able to determine which treatment option would be best for you without an examination. Injecting fillers in an attempt to mask this fullness will not work well unless the festoon is exceptionally small.

Brian S. Biesman, MD · Answer

Malar festoons are tough problem to treat.  They can sometimes be camouflaged with injectable fillers and lower eyelid blepharoplasty and or midface lifting can also produce some improvement.  Aggressive laser resurfacing can also be used.  This is a condition for which I would strongly recommend seeking the opinion of someone who has a great deal of experience

J. Jason Wendel, MD, FACS · Answer

Thank you for your question about eye bags treatment.For correction of your tear trough, injectable filler may camouflage this area.  Lower lid blepharoplasty might provide a more permanent fix.To be sure, see two or more 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 these treatments.I hope this helps.

Paul M. Parker, MD, FACS · Answer

You do not have festoons or malar bags. What you have is a depression along the inner aspect of your lower eyelid known a prominent nasojugal groove. You also appear to have some relatively prominent fat just above it. The depression can be plumped out with injectable filler or an injection of your own fat. If appropriate, the fat can be removed through a procedure known as a lower lid blepharoplasty. Consult a board certified plastic surgeon in your area for an evaluation and to discuss these options.

Richard H. Tholen, MD, FACS · Answer

Your photo shows a prominent tear trough or nasojugal groove. HA filler would be the best option and should be your first consideration, as these injections are straightforward (in expert injector hands) and helpful for 6-12 months. Repeat injection when the grooves become more visible again can always be done. Down-time is none to minimal (slight occasional bruising) and this is truly a lunchtime procedure. If you like the look of the HA filler injections but grow weary of the repeat visits, injections, and cost, you may wish to consider fat grafting.Please take the time to see one or more ABPS-certified plastic surgeons for direct examination and advice. Do not allow fat removal; this is not an excess but a deficiency situation. Best wishes! Dr. Tholen

Alejandro Nogueira, MD · Answer

You have 2 different cosmetic problems overlapping in viccinity:-orbital fat bags hypertrofied, suitable for transconjunctival blepharoplasty (scar less)-malar crescent, a strange condition of unknown cause and with no real efficient treatment of any kindYou are good candidate for the blepharoplasty, and accept the malar crescent, which is associated to a familiar inheritance, some metabolic conditions, smokers, certain drugs and sleep disorders.

Joseph A. Eviatar, MD, FACS · Answer

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 (a collection of fluid). This can often be
improved with different modalities. For example, ThermiRF is a topical or
sub-skin treatment that can be used to dry up festoons if they are due to
fluid. Hyaluronic acid fillers in the lateral cheek and help support the cheek
and reduce the appearance of a festoon. Often I will use Radiesse rather than
hyaluronic acid fillers to support this area because hyaluronic acid fillers
tend to absorb water and can sometimes make festoons worse. If a festoon is a
result of previous injections of products such as Restylane, the first step
would be to inject the festoon directly with Hyaluronidase. This can be very
effective and has also been beneficial in some patients that have not had
injectable fillers around the eyes. So as you can see, festoons can be
complicated to treat but can be treated very effectively. Each treatment
however has to be customized to the patient and needs to be performed by
someone with expertise in this area. Seek out an Oculoplastic surgeon that is
experienced in injectable fillers. Surgery is generally not effective in
treating this type of festoon, in my opinion. It look like, based on the
photograph it might actually make the festoon appear worse. I recommend getting
a second opinion before jumping into surgery which is irreversible. I hope that
is helpful. Best of luck.

Ariel Ostad, MD · Answer

Thank you for your
question. Based on your photograph I would suggest a non-surgical correction
with an injection of hyaluronic acid filler, such as restylane which can dramatically
improve your eye festoons. Surgical correction is another option, however one
has to be extremely conservative in order to avoid hollowness in those areas
upon removal of the fat. A simple ten minute procedure with an injection of a
filler can dramatically fill the loss of cheek fat that was supporting the
lower eyelid crease then now upon its absence is leading to lower lid fat
protrusion.

Robert T. Buchanan, MD (retired) · Answer

You do not have festoons or malar bags. What you have is a tear trough. This can be treated with a filler such as Juvederm Voluma. Removal of fat, except in significant congenital cases which you are not, in the lower eyelid is a bad idea. It will lead to worse problems that are harder to treat in the future. See someone else, preferably a plastic surgeon, with significant experience in eyelid rejuvenation including surgical and non surgical.

I have under eye festoons or Malar bags that I want removed. What is the best treatment? (photo)

Answers (10)

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