Which procedure can help minimize the appearance of festoons and malar bags? (photo)

Question

I have a big problem with festoons/ malar bags. Do you have any idea how to remove it, please? I'm feeling really deprest now, and I can't even look on myself.

A.J. Amadi, MD · Answer

With all due respect to my dermatology colleague, all hyaluronic acid fillers are hydrophilic to some degree, so if you are already experiencing malar bags, aka festoons, HA fillers will only WORSEN the bags!!!
As a matter of fact, in todays "Overfill Pandemic", the most common cause of festoons are in fact HA fillers! So if you have had any filler....ever...and I mean even if it was 10+ years ago, your first line treatment for festoons would be hyaluronidase- the enzyme that dissolves HA fillers. If you have NEVER had fillers before, then it becomes a bit more tricky, as true festoons are challenging to fix:
Surgical excision of a festoon  is the most predictable and successful treatment, but with the unfortunate side effect of leaving a scar. So if your festoon is mild to moderate, this might not be your best options. I would say that based on your photo, I would not choose excision as your first option.

The following are all potential options to improve, but not necessary cure your festoons:
1. RF microneedling in combination with deep RF treatment (i.e. Accutite)
2. Laser or Chemical Resurfacing
3. Injection of tetracycline or doxycycline
4. Aggressive skin/muscle flap lower blepharoplasty with malar ligament release....the most risky of all the treatments. 
Seek a surgeon that has tried some or all of the options listed for an unbiased experience.

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.

Selcuk Inanli, MD · Answer

Hello! Thank you for your question.As far as I can see from your photos you have extra saggy skin both under and above your eyes. Also you mid face area is very downward. For making more upward, fresh and elegant look I suggest upper and lower blepharoplasty and endoscopic mid face lift. If you can provide photos with better lighting, from the side of your face and 1 meter away I would be able to make a proper evaluation.Best Regards!

Nelson Lee Novick, MD · Answer

Hang in there. Help is on the way. From the photo there appears to be significant volume deficit in the mid-cheek region that is responsible not only for the prominent smile lines and marionette lines below, but for emphasizing the malar bags above. The appropriate use of a robust HA filler injected to augment the upper and mid cheek will likely not only create a smooth transition between the upper cheek and the current malar bag regions, but secondarily improve the smile lines and to some extent the marionette lines. You would be wise to consult with an experienced, board certified cosmetic dermatologist injector. And, once again, no need for despair. Best of luck.

Which procedure can help minimize the appearance of festoons and malar bags? (photo)

Answers (4)

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