Do doxycycline/tetracycline injections for festoons cause scarring?

Thank you for your query. Tetracycline injections can improve festoons caused by impaired fluid drainage when injected as a sclerosing agent. Sclerosis closes off the feeding channels but there are no significant ill-effects on the skin, when done well and at a low concentration. The other options of sub or pre-periosteal lifts address the loose tissues and skin. A careful examination and analysis has to be done before deciding the best option for you. You may need an imaging study to see if the problem is edema of the tissues or loose skin and soft tissues. Please discuss your concerns with a board certified Oculo-plastic/ plastic surgeon who is experienced in these procedures. All the best!

I would simply perform upper and lower eyelid lifts for you. The skin in the lower lids can be pulled up and laterally which will help the festoons and your overall appearance tremendously. Also the surgery can be done under local anesthesia. I think the midface lift is a bit overkill in your situation. But that’s what is taught these days and I’ve seen plenty of problems from midface lifts

It would be hard for me to believe that a single Botox injection a long time ago caused someone to develop malar edema. This condition is poorly understood. I don’t see the benefit of doxycycline injections. I suggest you ask the surgeon if they have before and after pictures or how much experience they have doing this.
It’s difficult to make an assessment based on such a limited picture.
I always recommend multiple in person consultations before contemplating any surgical procedure.
Midface, volume restoration can be restored with a mid facelift, implants, fillers, or fat transfer
Best,
Mats Hagstrom, MD