Fat Pocket Above Cheeks? Lower Eyelid Problem? (photo)

Question

I'm 25 years old and as far as I can remember and see in photos ive always had this issue. I have very prominent "bags" above my cheekbone/under my eye. I'm not sure if it would classify this as a lower eyelid issue because it's not in the typical spot that I see when I look at before/after photos of eyelid surgery. If I squint my eyes it affects my vision and if I have allergies my eyes feel heavier than they normally do but antihistamines dont reduce them. What can I do to fix them?

A.J. Amadi, MD · Answer

The bags that you see below your eyelid at your cheek junction are called festoons. These are one of the more difficult problems that we deal with and there isn't a perfect way to get rid of them. Repeated swelling due to allergies could be the underlying problem, creating loose connective tissue with poor lymphatic drainage of fluid.

	Fillers may improve the situation, but sometimes can lead to a "boggy" looking eyelid. Laser resurfacing might be your best option in an attempt to cause tightening of the layer of skin just underneath the surface.

	An inperson consulation is necessary to see if you are good skin type for this.

Michael I. Echavez, MD · Answer

It appears that you may have malar bags rather than lower eyelid fat. A consultation with an experienced doctor would be recommended. If they are malar bags, the treatment I would suggest would be an injectable filler below the fullness to try and soften the depression beneath it.

Monika Soni, MD · Answer

Thank you for your question. I believe you will get the most improvement with a combination of fillers, lasers and microneedling/PRP. If this approach does not work then you will need to have alower lid blepharoplasty. I recommend having a consultation with an expert to discuss your concerns and to determine the best treatment plan for you. Best of Luck!

Kaete A. Archer, MD · Answer

Puffiness under the eyes can be caused by many things (multifactorial).  I agree with you - it looks like your area of concern is malar edema/festoons (swelling) rather than classic lower eyelid fat pads/bags. 
Malar edema can be caused by a number of issues including genetics, aging, fluid retention, salt retention, lifestyle, alcohol, allergies, sleep, and unknown reasons.  Without a doubt, malar edema is a difficult problem.  Traditional lower eyelid lifts (blepharoplasty) do not fully correct malar edema and can make it worse.  Injections with kenalog (steroid) or 5-FU and taping may help but I have not seen them completely treat this area.  Fillers can sometimes blend and camouflage the area but this treatment is variable.  Direct excision of the festoon is the best definitive treatment but you are trading the puffiness for a scar.  Usually that is reserved for more prominent festoons.  The scar can be camouflaged, thin, and the pinkness will fade.  You have to consider how much the area bothers you and discuss this with your surgeon.    
I would consider a consultation with your primary care doctor to evaluate any underlying conditions that can cause salt retention or fluid retention.  If you have bad allergies, you may be a candidate for allergy treatments beyond an antihistamine.  I also recommend a consultation with a qualified surgeon for an exam to discuss your options.

William Portuese, MD · Answer

These appear to be festoons and are very difficult to treat. Make sure your allergies are under control with antihistamines, cortisone nasal sprays, allergy testing, etc. Fractioned laser would be of some benefit to try to reduce the interstitial fluid retention inside them. A blepharoplasty will be of no benefit

John Q. Cook, MD · Answer

From the picture it looks like you have a degree of superficial swelling of the upper cheeks. This is often confused with the herniation of fat that can be corrected with a blepharoplasty procedure, but this type of surgery will generally not help your problem. The superficial puffiness may be related to an underlying conditions such as allergies, or sinusitis and may improve with treatment of those problems. I think these so called "malar puffs" are very difficult to correct and may be best left alone. You might want to see what decreasing the salt in your diet accomplishes.

Fat Pocket Above Cheeks? Lower Eyelid Problem? (photo)

Answers (6)

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