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.