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

Question

I have a few different issues. In the first few pictures, I don't know what is causing this puffiness! I went to the eye dr (as my eyes are always red and itchy) and was given allergy eye drops. No help. Could be these are malar mounds, festoons, or tear trough issue? They do get less puffy as the day goes on. Could it be fluid retention? They never go completely away. The second issue is the actual eye bags/wrinkes under my eyes. I have big sleep issues, could that be causing this?

Brian M. Derby, MD, FACS · Answer

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.

Sheila S. Nazarian, MD · Answer

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

Earl Stephenson, Jr., MD, DDS, MBA · Answer

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.

Elliot M. Heller, MD · Answer

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.

Edward E. Dickerson, IV, MD · Answer

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.

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

Answers (7)

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

Answers (7)

Answer: Eye bags

Answer: Eye bags

Answer: Treatment For Eye Bags

Answer: Treatment For Eye Bags

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Recommended reading

Everything you need to know about Eyelid Surgery

Our mission is to create a world where every investment in modern beauty is Worth It.