Malar Edema/Festoon - how can I improve this area? (Photo)

Question

Ive had under eye/cheek filler done first in 2019, then again in jan 2024 which I feel made my malar edema worse I think, I never really noticed it before. After that I was told she probably placed it too superfiasuperficially. Ive since had dissolver done about 5 times with no success to remove them. This past june 2026 i went to have more dissolver in hopes it would help but he ended up adding cheek filler to mask them, which did help for a few months but now I notice them again. Unsure next steps I can do to fix this.

Anna Chacon, MD, FAAD · Answer

Malar edema and festoons can be particularly frustrating to treat, especially when they become more noticeable after under-eye or cheek filler. Based on your history, it is possible that the filler contributed to the swelling, but the underlying cause needs to be assessed before deciding on the next step.

The malar area sits where the lower eyelid transitions into the upper cheek. This region has delicate tissues and lymphatic drainage pathways, so filler can sometimes contribute to persistent puffiness by attracting water or interfering with fluid drainage. Filler that is placed too superficially may also create visible irregularities. However, festoons can have other causes, including skin laxity, weakening of supporting tissues, and age-related changes, so removing the filler alone may not fully resolve them.

The fact that you have undergone hyaluronidase treatment approximately five times without satisfactory improvement is important. If the original filler was hyaluronic acid-based, hyaluronidase can dissolve it, but the response depends on the product, location, amount remaining, and individual tissue characteristics. Persistent swelling does not necessarily mean that filler is still present. Repeated dissolving treatments without confirming the cause may not help and can sometimes contribute to additional tissue irritation or contour changes.

I would be cautious about adding more cheek filler simply to camouflage the swelling. Although adding volume may temporarily improve the appearance, it can also increase fluid retention or make the area more difficult to assess and treat over time.

My recommendation would be to pause further filler and dissolver treatments until the area has been properly evaluated. Ideally, see a board-certified dermatologist, oculoplastic surgeon, or plastic surgeon experienced in managing filler complications around the eyes. They can assess whether the problem is residual filler, fluid-related malar edema, true festoons, skin laxity, or a combination of these. In selected cases, ultrasound imaging can help identify residual filler and guide treatment.

Treatment depends on the underlying cause. Mild fluid-related swelling may improve with conservative measures and management of contributing factors, while persistent festoons caused by structural changes may require a procedure such as a carefully selected laser treatment or surgical correction. Unfortunately, there is no single treatment that reliably resolves every case, and some festoons are quite challenging to treat.

If you develop sudden or worsening swelling, significant pain, redness, warmth, fever, or any vision changes, seek prompt medical evaluation.

I understand why you are looking for a lasting solution after several unsuccessful treatments. At this point, the most useful step is to identify exactly what is causing the recurrent puffiness rather than continuing to add or dissolve filler. That will give you a much better chance of choosing a treatment that addresses the problem rather than temporarily masking it.

Camille Cash, MD · Answer

Malar bags can be difficult to treat.  In many cases filler can make them appear worse.  Some patients have improvement with Morpheus8.  This treatment combines RF technology with microneedling and improves overall skin tone and texture.  I've included a video I hope you find helpful.

Malar Edema/Festoon - how can I improve this area? (Photo)

Answers (2)

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