Genetic festoons and malar edema tear trough treatment options? (photos)

Question

I am a 33 year old non smoker, I don't spend much time in the sun and have had these small squishy(water bag like) above my cheek bone for as long as I can remember. They tend to change size day to day. I watch my salt content but it does not make a difference. I've always been extremely self conscious about it. I tried filler once with a minor result. I am afraid of my eye shape changing with surgery( blepharoplasty). Any input would be very appreciated.

Jason Emer, MD · Answer

For unique cases where a variety of modalities could be used to treat the condition, I would suggest an in person or virtual consultation to develop a custom and effective treatment plan.  It is difficult to precisely define the best option without collecting the same information. I suggest reaching out to an expert for a consultation with surgical and non-surgical methods to get a comprehensive option. Best, Dr. Emer.

Nima Shemirani, MD · Answer

Hi @Beautyresearch. I suggest you consider Morpheus 8. Morpheus8 is a non-surgical treatment for full body skin resurfacing, skin tightening, and fat reduction of stubborn areas. It uses minimally invasive fractional radiofrequency energy (RF) to penetrate the skin deeper than other microneedling devices, triggering the skin’s natural healing response to promote skin tightening and lifting. Best of luck, Dr. Nima!

C. Blake Perry, MD · Answer

Festoons are a difficult entity to treat as they can often reoccur. First you need to make sure all the filler you have in the area is dissolved as certain fillers can block the lymphatic drainage and cause worsening edema. Treatment options then include skin tightening options (ie laser) or surgery. Surgery typically involves an extended blepharoplasty which helps tighten the underlying facial muscles. In certain cases direct excision is also used. Best to see an eyelid expert.

Sam Naficy, MD, FACS · Answer

The short answer is that there are no good treatment options for festoons. At times, if there are coexisting factors that are making the festoons more visible (such as fat loss from the cheeks or loss of skin elasticity) then those conditions can be treated (typically with fat grafting and laser resurfacing) to help reduce the appearance of (but not eliminate) the festoons.

David M. Kowalczyk, MD, MBA, FACS · Answer

Good Morning! This is a very difficult area to treat. Diet can sometimes help but not always. Filler may mask the area, but again, not always, and may create more inflammation. Morpheus8 RF microneedling may be an option. This provides energy and can help tighten the skin. We've seen some improvement, though not complete correction, in areas similar to yours. You may want to investigate this as a possible way to proceed. Hope this is useful!

Richard Ort, MD · Answer

Thank you for submitting such excellent photographs. In my hands, I would suggest starting with fillers to the cheek hollows below the area of the edema as well as in the tear trough. (Restylane Lyft and Restylane). I would start conservatively and add more over time to try to achieve the desired result. I would stay in a deep plane to avoid causing any puffiness. With a blunt cannula the treatment would typically be non-invasive with little recovery. Please see an experienced injector for an in person evaluation first. 
Regards,
Dr. Ort

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