Are the festoons and what are my treatment options? (18 year old male). (photos)

Hi SMC,
Based on the photos and details you provided, it looks like these are in fact festoons. This is an area that has received a lot of attention by the plastic surgery community recently because it is a difficult problem to fix. Traditional modalities have included laser, steroid injection, direct excision and others. Some festoons (like yours) are present at childhood, and others come about later in life especially after face/eye surgery or treatments such as botox or filler. There are new experimental treatments (tetracycline/doxycycline, other injectables, lower lid surgery) that have shown promising results if the correct type of festoon is diagnosed and the treatment is performed by someone very experienced. If you are having difficulty finding someone who specializes in festoon treatments, I suggest you seek out a well-trained plastic surgeon in your area who can steer you in the right direction.
Thank you very much for your question. 
Mark G. Albert, M.D.

I WOULD TRY FILLERS BEFORE GOING IN AND DOING SURGERY , THE DIFFERENCE BETWEEN FAT TRANSFER AND FILLERS ARE FILLER ARE LESS INVASIVE AND CAN LAST 6-9 MONTHS SOMETIMES UP TO A YEAR DEPENDING ON WHICH ONES. FAT TRANSFERS ARE USUALLY SURGICALLY DONE WITH LIPO AND TRANSFERRED TO ANOTHER AREA OF THE BODY. A FAT TRANSFER CAN ALSO BE DONE THROUGH A LOCAL AFTER SURGERY FOR A REPEAT FAT INJECTION. FAT INJECTIONS OR TRANSFERS ARE USUALLY MORE PERMANENT. THIS IS SOMETHING THAT YOU MAY WANT TO SPEAK TO YOUR DOCTOR ABOUT IN A CONSULTATION AND SEE WHAT YOUR OPTIONS ARE.
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These appear to be small festoons or malar bags. A combination approach will give the most improvement. Fillers, lasers, and microneedling/PRP can improve under the eyes. My patients try to get non surgical treatments to avoid surgery. We use PRP and stem cells there often. I suggest consulting with an expert to develop a treatment plan best suited for your short and long term goals. Best, Dr. Emer

Dear Kansas City,It does appear from your photos that you have a congenital form of malar mounds/ eyelid festoons. These can wax and wane and often have a basis in past sun exposure but can appear in certain individual at and early age. Keeping the skin protected from the sun can help prevent them from worsening. Otherwise to improve them requires the body to create new collagen and elastic fibers in this area. This is possible by selectively injuring the tissue and allowing the healing process to tighten the area as it heals. I've had success using lasers to tighten and improve festoons. I'll include a link below. I hope this was helpful 

I'm glad that you are controlling your salt intake, as this will help to minimize worsening of swelling in the area under your eyes. Allergy control is important too, but realize that pollen levels are now at a moderate to high level in your area so things may be getting worse because of that. When you are ready, you may want to consider and injection of filler in the area. I have found that fillers soften lines in this area beautifully and there is little to no downtime! Sometimes, no matter what you do, genetics takes over and you need a little help from one of your friendly neighborhood plastic surgeons or dermatologists :)

Thank you for positing your question and photos.  Malar bags or festoons can be tricky to treat.  I would consider conservative treatment with a skin peel and/or dermal fillers to the area to create a smooth natural contour.  See a specialist to learn more and best wishes.  

You may want to look into laser treatment.  There are different types of lasers on the market and you want to be sure the treatment you select is for this concern.  I encourage you to meet with a board certified plastic surgeon in your area for a consultation and discussion of a treatment plan that's right for you.

Before undergoing surgery- you might benefit from judicious placement of filler along the medial cheek and tear trough. Often, this is all that is needed to give you a great result to get rid of the under eye bags appearance. 

Festoons are very difficult to treat with surgery.  In my opinion the best option is dermal filler injection. To learn more please read below: