Please help! Is this eye bags, malar mounds, festoons, tear troughs? (photos)

Thanks for your pictures and questions Lauren. You certainly have evidence of malar edema, or swelling in the SOOF (suboribicularis oculi fat) compartment. The exact cause of the swelling is not known. The redistribution of fluid from your legs to your upper body at night while lying down, that happens to all of us, is likely contributing to the worse appearance in the morning. Similarly if you have a glass of wine or eat a salty meal you may find a similar response. Fillers to camouflage the area would only worsen the situation. Tightening of the SOOF with a lower lid blepharoplasty and muscle suspension would offer you the best opportunity for treating the trough you have, your mild lower lid skin/muscle laxity, and flattening of the swollen fat compartment. I hope this helps. I always recommend that you ensure your Plastic Surgeon offers you the highest credentials of certification. Please ensure he/she is certified, or in the process of certification, by the American Board of Plastic Surgery.

Getting more sleep is going to help with the puffiness. Also, keeping your allergies in check will also improve things. For the "bags", I would suggest a bit of HA filler such as Restylane in the tear trough area. It's what I use on myself and my patients. Schedule a consultation with a board certified plastic surgeon in your area to discuss.
My best,
Dr. Sheila Nazarian
@drsheilanazarian on Instagram

Thanks for your pictures. Your sleeping issues can contribute to some degree but fluid balance seems to be an issue since the puffiness improves with an upright position as the day progresses. If you have itchy eyes and the current allergy medicine is not working you need to return to your ophthalmologist for more solutions.  All theses is need to cleared up prior to entertaining surgery. 

You may want to talk to a doctor to see if fillers may work for you. Maybe talk to them about Belotero, or what other fillers they recommend. this is something that you do not need surgery for unless it is necessary. Lower Blephs. The price for surgery starts at $3,500.

Thank your for the pictures It seems to me that your lack of sleep is a factor but I also notice that fluid balance seems to be an issue since the puffiness improves as the day goes by. If your having irritation on your eyes and redness you should make a follow-up appointment with your ophthalmologist. Fillers will be a good treatment for you as well, before considering any surgery. Please see a board certified PS for evaluation and to discuss your questions.

Hi. In your photos, it looks like you have malar edema and lower lid edema. This seems to improve later the day. This may be an issue with fluid retention due to a variety of causes. Allergies, sleep issues (particularly sleep apnea), fluid balance disorders (kidney issues, etc), as well as other conditions can cause this. Swelling is typically worse in the morning because laying flat while sleeping allows fluid to accumulate in the orbit and eyelids. Blinking and facial movement also helps actively pump fluid back into the lymphatic system (the fluid drainage channels) to recirculate - this does not occur as often while sleeping. The end result is fluid retention around the eyes, which is worse upon waking and improves slowly as the day goes on. Allergic inflammation can potentiate this as well. Since this type of fluid retention can be caused by several different issues, I would start by seeing an Oculoplastic surgeon and probably your primary care physician to evaluate you. Treatment can be guided depending on what the underlying cause is. Hope this helps. Best regards, Ira Vidor, M.D.

Hi lauren28178,Thanks for you questions and detailed photos. Based on the pictures and your history of sleep disturbance and allergies, I would say that the lower lid bags are related mostly to malar edema. This is typically worse in the morning and become especially exacerbated with sleep problems and allergies. The fluid collection creates a deep tear trough that appears to improve with resolution of the swelling based on your final photo. If the malar edema remains stable throughout the day, it may respond well to injections of tetracycline. We have had significant success with this new treatment in our practice. I would recommend an evaluation with an oculoplastic surgeon in your area. Good luck!