Is my lower eyelid / cheekbone puffiness to difficult to get rid of with lower eyelid Blepharoplasty? (photos)

I have puffy lower eye lids/ puffiness around cheekbones. The bags look like there's fluid or fat that hangs over and stops at the cheek bone. I would love to have a smooth non-puffy look around the cheekbone area. I would like to get lower lid blepharoplasty, is my case too difficult to treat since the puffiness falls in and around my cheekbone area. What should I do? I am prone to scarring, would my lower eyelids keloid or scar badly?

Doctor Answers 9

The upper cheekbone puffiness is malar edema, which is a difficult area, but it can be improved with non-surgical treatment

Chronic elevation in the cheek area is referred to as malar edema or malar festoons. Based on your photos, you don’t have festoons. Festoons are like bags that hang over the cheeks. Mostly likely, that area in your cheek has edema or swelling wherein there’s fluid within the tissue. This is mostly caused by smoking, allergies, sinus problems and genetics. The first three causes area manageable. Unfortunately, the type of swelling which is caused by genetics is difficult to address surgically. As a facial plastic surgeon practicing for 20 years, I have seen many methods presented like CO2 laser and cauterization under the skin. However, a lot of those methods can worsen the problem.

There are selected patients where we try different things to try to do shift the focus away from those lines by a strategic use of various fillers. We even use platelet-rich plasma. This is drawn from your own blood which is spun down to concentrate the vascular growth factors. These factors improve circulation of the skin in that area.

Ultimately, it is a matter of how to improve the appearance but not definitively removing the swelling in that area. We are all constantly looking for solutions for this, but if you have any of the previously mentioned risk factors, try to treat them personally. Until then, I would advise that you avoid surgery and meet with some doctors to get some opinions. The thing that we can’t do with photo alone is a 3-dimensional appreciation of the volume and projection of this area and how it impacts on you. So I suggest a good assessment through physical examination for you to know how to address your situation. I hope that was helpful, I wish you the best of luck, and thank you for your question.

New York Oculoplastic Surgeon
4.3 out of 5 stars 59 reviews

Restylane is great for treating dark circles underneath the eyes

Believe it or not, Restylane (a facial filler) is great for filling in the dark circles underneath the eyes. I have done this many times with great results and no surgery!  Therefore, you might want to try this before embarking on surgery.

Kind regards,

Dr. Schreiber

Baltimore Plastic Surgeon

Treatment of Lower Eyelid Bags and Puffiness

Without a full history and examination it is difficult to answer specifically.  However, it appears that a full more blepharoplasty/cheek lift where the arcus marginalis (the connection of the lower eyelid muscle to the orbital rim) is removed, the fat is repositioned and the tissues are suspended laterally from the orbital rim would provide you an excellent result.  Make sure that whomever you see has significant experience in lower eyelid surgery including cheek lifting and that they do not plan to remove any fat.  You need to fat in order to pad the area where you presently have the crease.

Robert T. Buchanan, MD
Highlands Plastic Surgeon
5.0 out of 5 stars 5 reviews

Is my lower eyelid / cheekbone puffiness to difficult to get rid of with lower eyelid Blepharoplasty?

Best to be examined in person, but appears as swelling in the malar area and serious tear trough deformity. Try a filler to the tear trough like Belotero Balance 1 or 2 syringes And RF external to cheek bones like ThermiTight RF external.. 

Lower eyelid surgery or laser treatments will not improve the malar bags

I agree with the comments of the other reviewers.I would place Restylane in the nasojugal groove and a small amount of Voluma over the malar eminence.

Joel E. Kopelman, MD, FACS
Ridgewood Oculoplastic Surgeon
5.0 out of 5 stars 13 reviews

Cheek puffiness

sydneyjones, Although photos are not the best way to evaluate it appears you have what we call malar bags or festoons. Very difficult to improve this with surgery. It is due to interstitial edema and the tendency runs in families. There are some options but none of them are great. Be careful with your choices. 

M. Sean Freeman, MD
Charlotte Facial Plastic Surgeon
4.8 out of 5 stars 44 reviews

Reducing puffiness

Good afternoon!

Looking at your photos, I agree that a lower blepharoplasty alone will not address the puffiness over your malar area (cheekbones).  In my opinion you require something a bit more involved such as a mid face lift. This will elevate those tissues higher on your face and give you a more youthful energetic look.

I hope this helps.

Robert Steely, MD, FACS
Houston Plastic Surgeon
4.8 out of 5 stars 47 reviews

Is my lower eyelid / cheekbone puffiness to difficult to get rid of with lower eyelid Blepharoplasty?

The puffiness I see in your photo is well outside the anatomical boundary of the lower eyelid and would not be affected by a lower blepharoplasty.

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 24 reviews

I can virtually guarantee that you will be disappointed by lower eyelid surgery.

Your issue is much more than a lower eyelid issue.  You have a mid face problem.  Lower eyelid surgery will never adequate address your issue as well meaning as your eyelid surgeon might be.  I think you could do quite well with mid face/lower eyelid Restylane therapy.  These are fussy services and who does your treatment makes a huge difference.  Please be careful out there.

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon
4.9 out of 5 stars 23 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.