I have malar bags (festoons) as well as under eye bags. Can this be treated? Is laser or Blepharoplasty best? (photos)

First, there is no substitute for an actual examination.  Remember what we are doing here on Realself.com is entertainment but you won't feel that way reading answers about your question.  There are many causes for lower eyelid bags.  Doing the wrong surgery will not help you but it will harm you.  The issue you are manifesting in the photos is not actually a lower eyelid bag.  Traditional lower eyelid surgery will not help you.  The feature that is bothering you is called a mid cheek groove.  It is best managed today with carefully performed hyaluronic acid fillers.  Yes it is possible to also perform surgery for this.  The problem is that you need deep buccal fat support and the fillers are the most flexible and efficient method of providing this help.  A treatment for someone your age could last well over a year.Please be careful what you look for.  If a surgeon spend less than 5 minutes examining and discussing your issue, you are in the wrong office.  Good luck and let us know if you decide to have treatment and how it went.

Thank you for the pictures.  You have problems with orbital fat excess, as well as a groove over the cheek that is below the eyelid.  You would definitely benefit from a lower eyelid blepharoplasty performed from inside ( transconjuctival) which would involve some fat repositioning and probably some removal.  For the malar groove ( or festoon)..you do not have skin looseness so I would not advise laser. It can be a very challenging problem, but I have had some significant benefit with some fat grafting into the groove and into the cheek.

There are many causes of eye bags. Some are shadow issues, some are discoloration issues.  Most people have a multifactorial problem meaning they have more than one problem causing this demarcation. You are young so you should be conservative with your decision. With your age group we are often able to make a very big difference with laser and fat transfer alone. Some people also require a blepharoplasty but that is more of a fat pad problem. Below is a list of common causes and my treatment protocol.

1. Prolapsed orbital fat through the orbital septum: treated with lower lid blepharoplasty and fat transpositioning. Can also be helped with fillers or auto fat transfer to the face but the ideal treatment in my hands is surgery for this issue.

2. Eczema: much more common in young people with fair skin. The treatment for this is to hold off on makeup and any manipulation of the lower lid for a few weeks and try some topical anti inflammatory creams. If you have allergies those should be treated also.  A dermatologist is the best person to see for this. We have a multidisciplinary clinic with myself, a plastic surgeon, and my partner, a dermatologist which I think is ideal!

3. Fluid accumulation and/or redundant skin. Could be possible in young patients but would need a good facial analysis and exam to determine. A low salt diet (< 1000mg/day) and a warm compress can help.  I would consider treating with filler/fat transfer, lower lid fractional ablative laser and/or lower lid blepharoplasty.

4. Descent of midface cheek pad. This then causes the nasojugular ligament to become more prominent creating a demarcation and separation of the eye from the cheek subunit. Treated with mid face lift and/or fat transfer.

It is all about the balance of this transition from the orbit to the cheek. There are many ways to treat this and they vary by the underlying cause. I recommend seeing a surgeon who also does a lot of these treatments. This can make a big difference as most people have a combination of the above that lead to the issue.

Hope this helps.

Best of luck,

DrC

Lower eyelid bags and festoons/malar mounds usually appear as we age. In certain young patients though, the orbital septum is set more forward in the orbital rim allowing this normal orbital fat to be seen in the lower eyelid space. These cases in younger individuals can be seen as early as the early teens.This can be frustrating because it can cause others to see us as tired appearing.In your photos, you also appear to have malar mounds/eyelid festoons. As expressed by other doctors, this can be a challenging condition to improve. I myself have had great success using a Dual Pulsed Erbium Laser with my RESET treatment for malar mounds and eyelid festoons. The lower lid under eye bags can be addressed with a very conservative lower lid blepharoplasty or fat repositioning procedure. Its best to address both the lower eyelid festoons and bags at the same time for the most natural result.Its not fair to have to face this issue at such a young age but there are treatment options available for both these conditions.

From the photos you posted it appear you have only "eyelid bags" and not festoons.  However an in person consultation would be the best way to determine a correct diagnosis and treatment plan.However, based on what is seen I would recommend a lower blepharoplasty with the fat re-positioning technique.  The technique will elegantly re-position the eyelid bag (which is fatty tissue) into the deep groove below the bag thereby smoothing the entire area.  (see the link below to see before and after results).Fillers are a non-surgical option but would not give you the result a lower blepharoplasty would in my opinion.  I would use either Belotero or Restylane and use a cannula to inject.I hope this helps.

You have some prolapsed orbital fat which is creating a shadow over the tear trough.  Your tear trough extends pretty fat laterally, just under the malar fat pad.  This is not a festoon, as that would be more over the cheek bone.  If you put some filler into the tear trough you will be able to smooth out this area and improve the appearance for at least at year.  Another option is surgery - but you would need to have the fat repositioned and not removed.  If it is excised you may end up looking worse.   

I would recommend a lower lid blepharoplasty to remove the herniated fat. Some of the fat can be placed in the groove to efface it.  Laser would not fix this. 

Thank you for your inquiry andfor the photos that you included for our reference. Yes, both under eye bagsand malar bags can be treated and there are a number of possible treatments forit. Treating under eye bags and malar bags could be done in surgical and non-surgicalmethods depending on the severity of the bags. If the under eye and malar bagsare mild and soft, these may be resolved with fillers. However, this is onlytemporary and this will not “remove” the under eye bags. Fillers can onlyimprove its noticeability by concealing it. Regular maintenance may be neededto continuously conceal the under eye bags at least one year after the priortreatment. Lasers will not really be helpful in managing under eye bags. If thebags are severe in nature, surgical intervention may be needed. This is whereblepharoplasty will come in. Blepharoplasty can remove the bags permanently,although it may be more expensive and has longer down time.
That said, do not skip seeing a boardcertified plastic surgeon for their detailed assessment and evaluation of yourcase. Your surgeon will be able to proper treatment plan that will workeffectively for your case. Hope this answers your question!

Severe tear trough deformity with excess fat in lowers is what you posted. Best to think about HA fillers and possible lower lid blepharoplasty with release of the retaining infra orbital rum ligaments... 

Thank you for your pictures, they help to clarify the situation.   That being said, you need to pursue in person consultation with one or more local facial plastic or oculoplastic surgeons.  This will help you become more educated and get the best recommendations.  The eye (along with the rest of the face) doesn't age in just one way, so the best rejuvenation will involve different facets as well.  There are 3 main things to consider for rejuvenation around the eye:First, the skin around the eyes is incredibly thin.  It shows aging changes early but it is also very responsive to treatment.  As far as I can see in your pictures, this area is not a major problem for you.  Therefore, laser treatments and chemical peels won't do much for your concerns. Next, volume loss in the tear trough and upper cheek helps to bring out and emphasize the appearance of any bagginess of the eyes.  This volume loss can be readily treated with fillers like Restylane or with fat transfer.  The tear trough (area closest to the nose) *can* be improved during blepharoplasty but the depression in your cheek area will not be corrected by blepharoplasty alone.  A more volumizing product is best for the cheek area like Sculptra, Voluma, etc.  The third aspect to eye rejuvenation  is the bulging of the lower eyelid/orbital septum.  This is corrected by blepharoplasty surgery.  Especially in a younger patient, it is best to want to avoid aggressive surgery as it will leave your eye looking hollow as you get older. One thing you will want to discuss with your surgeon is how much swelling you have on a day to day basis.  If you have major swelling of the lower lid and/or cheek area your recommendations may have to be adjusted.The volume loss in tear trough and cheek show up first as we get older, and as mentioned above, it very much accentuates the lower eyelid.    Many patients are very surprised at how much improvement they can get from fillers in the cheek and tear trough.In summary, it appears your major area of concern is the volume loss in the tear trough and cheek.  You should be able to get excellent results with fillers alone to start with.  If necessary, a conservative blepharoplasty could be done later.