Do I have festoons? I'm 21 years old and would rather fix them now than watch them get worse. (photos)

Question

I have had these puffy things under my eyes for aslong as I can remember. No matter how much makeup I put on, they will always show. I am feeling so insecure about them and really looking for help on how to get rid of them permanently! I am only 21 but would rather try fix them now than watch them get worse as I get older :( please help

Adam Scheiner, MD · Answer

Dear    CCute ,
It appears that you have evidence of festoons/malar mounds on the cheek. These changes can make a person appear tired, sick and older even when they feel fine inside. 
Festoons and Malar mounds are a medical condition in which the skin of the lower eyelid becomes significantly damaged, usually by the sun. This damaged skin can result in folds in the lower eyelids and can lead to swollen mounds on the cheeks. They often occur with age and are more common in people with lighter skin types. In some families they can appear at a younger age. 
Festoons occur in many people seeking lower eyelid rejuvenation and if not corrected at the time that lower lid surgery is performed, the condition can become exacerbated and make the lower eyelids look worse after surgery.
The reason then why many people are dissatisfied after undergoing lower eyelid surgery to improve the appearance of their lower lids is the result of two main issues:
Swelling that occurs in the face after lower eyelid surgery often accumulates in the lower eyelid region and can take a while to resolve.
The subconscious brain constantly looks for balance in a face, and when lower eyelid fullness and festoons exist they are seen to belong together, as both are usually age-related phenomena. When only one is then corrected (usually the lower eyelid bags), the other is seen in even greater contrast.  The subconscious brain then focuses in on this condition and tells the conscious brain the face is out of balance.
Festoons and malar mounds have been a frustration for surgeons for many years. Thanks to the initial work of Dr. Sterling Baker (a person with whom I trained) and my own improvement and refinement on that work over the last decade, I now have a sophisticated, technically-challenging but effective treatment for festoons and malar mounds.
Many people don’t fully understand or recognize the differences between these two conditions. The first difference is in their cause or etiology; festoons are a result of sun-damaged skin on the lower eyelid and on the cheek and are believed to be affected by underlying contrasting muscle forces over the years of a person’s life.
In contrast, lower eyelid bags are due to age-related fat protruding through the skin in the lower eyelid region. New research has shown that fat can grow and atrophy during our lives in asymmetric ways. The growth of fat in the orbit around the eye along with atrophy of fat in the facial regions around the eye, as well as weakness in some of the orbital containing structures, contribute the fullness we see in the lower eyelid with age.
For some individuals, this fat shows up at a very young age and this is believed to a result of genetic changes in the development of the eye area in those individuals.
The second difference is the location on the face where they form. Lower eyelid festoons can be seen primarily on the cheek with some presence in the lower eyelid region.  Lower eyelid bags are located directly below the lower eyelid lashes and are noticed to become more prominent when someone with these bags looks upwards.  Conversely, festoons are minimally affected when a person looks upwards.
The third difference is the feel of these conditions when they are touched. Festoons are squishy and can be made to move side to side. Lower eyelid bags are firmer, deeper in location beneath the skin and can’t be moved easily side to side when touched.
 It is important to understand the differences between these two conditions. The best rejuvenation and most natural results occur when both eyelid bags and festoons are corrected simultaneously.
I'll include some links below.
I hope this was helpful.

Goretti Ho Taghva, MD, FACS · Answer

Thank you for your question.  Looking at your facial anatomy, it'd be a better option to use fillers/ fat transfer to augment your midface area, rather than treating the festoon itself.  Your festoons are mild, but are accentuated by the hollowness in the surrounding area.  Filler to the cheeks would be the simplest option, fat grafting to the face would be another longer lasting option.   Both can produce natural results if it's performed by an experienced injector.  Good luck!Goretti H. Taghva MD FACS

Samir Undavia, MD · Answer

I think a physical exam would be helpful to decide if it’s a festoon or just your anatomy. But I don’t see a good surgical correction at this time. Instead the better correction and more reliable solution is to use fillers in that area to camouflage the contour irregularity. Using them above and below the prominence will help to disguise the area. Good luck!

Camille Cash, MD · Answer

It does appear from your photo that you have mild festoons.  You may see some improvement with fillers.  Lasers also will sometimes improve the appearance of festoons.  See an expert injector in your area to learn more.  Be sure to use sunscreen every day.

Do I have festoons? I'm 21 years old and would rather fix them now than watch them get worse. (photos)

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