How Do I Reduce the Appearance of the Bags Across my Cheeks?

At your age and the sudden appearance, I would make sure that there is no underlying condition which could explain the early onset.
You may want to evaluate any thyroid or metabolic disorders which could contribute to localized swelling or fluid retention. Most likely you will be in good health.
OPTIONS:
From a non-surgical standpoint, you can consider:


options which are purported to tighten the skin such as radiofrequency modalities or chemical peels. But these will not likely provide you with long term solutions
camouflage procedures which enlarge the cheek prominence and mask or blend the junction of the fold with the cheek. Perlane or Radiesse are commonly used for these procedures
I would recommend caution with Botox as this may aggravate the appearance. You will note that if you squint, your bags wll likely improve. IF they worsen, then Botox may be an option.


From a surgical standpoint:


Minimally invasive procedures such as lipoinjection to the cheeks could be of benefit
Suture suspension of the face has not been generally useful for longterm management
Eyelid procedures that use a combination of differentially treating the skin, fat, and muscle and support of the lower eyelid are most likely to achieve the best results.
More aggressive approaches through the lower eyelid such as a cheek lift with repositioning of the malar fat pad or SOOF may produce a satsisfactory outcome.
Other methods of cheek lifts or suspension are available that can be completed through the hairline or the inside the mouth.


Many other options are available and would best be determined after reviewing your goals and evaluating your anatomy.
I hope this helps.

 Sleep, hydration, allergies, lifestyle habits, skin and soft tissue characteristics are amongst the major factors that can affect formation of under eye bags. A thorough evaluation by a facial plastic surgeon who can assess you for all surgical and nonsurgical options including detmmal fillers, skin tightening or resurfacing modalities will be the best starting point. 

Dear Anon,Those areas can be difficult to treat, but in patients in their 30s, I would recommend Voluma or RadiesseIt can be injected in a certain manner to create a nice looking resultI would also look into diet and lifestyle changes such as salt and alcohol intakeYou need to find an experienced injector because this is not something that is easy to do/figure outBest regards,

Dr. Nima

Member, American Academy of Facial Plastic and Reconstructive Surgery

Board Certified Facial Plastic Surgeon

Board Certified in Head and Neck Surgery

 

You are correct that your description does sound like cheek festoons. We would need a physical exam to determine the tissue plane that is affected. The orbicularis oculi muscle is the sphincter muscle around the eye. This muscle can become thinned and redundant (you are young for this, but with enough sun damage it can happen), which can lead to this issue. Fat can also prolapse and fall. This can be orbital fat or the mid cheek fat pad. It is important to delineate the cause so that it can be corrected appropriately.
In my opinion you should see a facial plastic surgeon, get a good facial analysis, and consider fat grafting vs. filler to transition this area.
Hope this helps.
Best of luck,
DrC

You are probably right. By the information you provided, these are most likely malar festoons. These can be very difficult to fully eradicate. I recommend patients try a low salt diet and even antihistamines (Claritin, Zyrtec, etc.) as occasionally this will improve their appearance. I have injected a steroid solution under the skin in this area and have had some patients respond to this treatment. Otherwise, surgery would be indicated.
At your age, direct excision would not be recommended as the resulting scar would be more eye catching than the festoon. My personal recommended treatment technique would be a transblepharoplasty midface lift. Through an incision just under the eyelashes, the underlying muscle is released from the cheek bone, elevated and secured in a higher position, excess skin and muscle is then excised. This usually does an excellent job in creating a smoother cheek, however, the resulting scar to the side of the eyelid can take a few months to become inconspicuous. By the way, an endoscopic midface lift would NOT improve this condition.
I recommend you see a surgeon with extensive experience with this technique as resulting potential complications, such as pulling of the lower eyelid, can be very difficult to correct, and prevention of this is key.
I hope this helps.