Malar bags/Festoon removal (Photo)

Question

Hello, I have malar bags or festoons, not sure exactly which one but from doing research it seems that filler is not a good option for this issue and because I am brown skinned, co2 lasering might not be the best option either. I did see some studies on doxycycline injections but it seems very new. Can anybody tell me what procedure would best treat this issue?

Raffy Karamanoukian, MD, FACS · Answer

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser.  Melarase AM, Melarase PM, and Melapads can seriously improve surface sun damage and UV related pigmentation. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.  
Best,
Dr. Karamanoukian 
Realself100 Surgeon

Nelson Lee Novick, MD · Answer

At least from the one photo provided, volume deficit in the central cheeks appears to be the major issue making the areas under the eyes appear to be excessively protruding. So, if this is indeed the case, then volume restoration would appear to be the quickest and simplest approach to addressing this. There are HA volumizing fillers that can contour the cheeks, which thereby can secondarily improve both the smile lines and the under-eyes and also create a smoother, more gradual transition between the upper cheek and the lower lid regions.  In the hands of an experienced, board certified cosmetic dermatologist injector treatment typically takes about fifteen minutes and with immediate, on-the-spot, results that typically engender a "Wow!" reaction. 
Besides the concern about dyspigmenation issues, particularly when treating skin of color, he hard science to support the use of expensive, "bells and whistles" fraxel lasers (and RF devices) unfortunately lags woefully behind the heavy marketing hype and social media buzz that surrounds promoting them. So, "buyer beware" when considering these. And one further piece of advice. You would be wise not to go into a consultation asking for a particular treatment or device because, to your likely later frustration and disappointment, you are likely to get what you ask for. Hope this helps and best of luck. You would also be wise to make sure to consult with an experienced, board certified cosmetic dermatologist filler injector.

Malar bags/Festoon removal (Photo)

Answers (2)

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