Festoons and lower bleph - are fillers or fat grafting better alternatives? (Photo)

The photos show evidence of volume deficit in the cheeks. If this is indeed so, then the use of a robust HA volumizing filler for contouring the cheeks (I.e. creating a more ideal, feminine heart-shaped oval face, would also very likely secondarily improve the under-eye areas and reduce the appearance of the festoons. I would suggest that the allergic reaction be dealt with first, as well as the underlying blepharitis. Once these are treated and controlled, then the filler treatment can be performed.
I would not recommend fat injections for a number of reasons. For one, they require two minimally invasive provcedures: one to extract the fat from the buttocks, hips, thighs or abdomen, and a second procedure to inject them in the face. This is a relatively expensive approach, typically engenders significant downtime. Additionally, once injected, fat cannot be dissolved if there is an unwanted aesthetic reaction or adverse reaction. And finally, the injected fat retains the characteristics of the region from which it is taken.This means that if in time the belly fat, for example, develops a midriff bulge, it can happen to belly fat injected into the face. Make sure to consult a board certified ophthalmologist to treat the blepharitis and an experienced, board certified cosmetic dermatologist filler expert. Hope this helps.

This is a difficult problem and you will get incremental improvements with lower blepharoplasty, and fat grafting, but complete resolution will likely require some direct excision of the festoon itself.

One of my favourite lower blepharoplasty techniques blends the orbital fat with the cheek fat and improved the transition between the lid and cheek. The festoon however is below this transition point and will not completely disappear. Fat grafting can also fill in hollowing of the midface and you will see some benefit with that in your case also. But not complete resolution

Nonetheless the festoons will still be present (with some improvement). At that point a direct excision of what remains is required to remove the skin excess at that location on the cheek.

It is a big step to accept a scar on the cheek. It is much easier to accept a scar on the cheek in older people with more rhytids and sun changes that hide the scar. However the scar will fade with time and good skin care. And right now the demarcation causes a major shadow- a fine scar will be far less noticeable.

Hopefully this picture was taken at a point in time when you still had some inflammation that may improve more.

I hope you find this helpful. I certainly have treated many patients with this and it takes time to make sure patients understand what improvements surgery will provide. Having knowledge of the process and a step wise approach, as well as a knowledge of the pros and cons should help you as you choose your path forward.