I'm not sure if I have malar bags or festoons. I have swelling under my eyes on my cheekbones. (Photo)

Im 41 and recently started noticing the swelling. Sometimes it doesn't look bad while other times I look deformed. I want them gone but i have no idea how or where to go. Please help I hate the way it makes me look

Doctor Answers 6

Eyelid Festoons and Malar Mounds

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Dear Patient from the city of Brotherly Love,Your photos do indicate that you have swelling of the lower eyelid and cheek region. These could be festoons and or malar mounds. These conditions are swelling of the lower eyelid and cheek region and often have a basis in past sun exposure. Options include surgically excising them which can leave a visible scar on the face or my preference is to use lasers to improve eyelid festoons.I hope this was helpful. 

Tampa Oculoplastic Surgeon
4.4 out of 5 stars 39 reviews

I'm not sure if I have malar bags or festoons. I have swelling under my eyes on my cheekbones. (Photo)

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You do have what appears to be early festoons, These are very difficult to treat, but they can be improved significantly. First, check with a physician to assess your thyroid status, as well as a good physical exam.

Providing studies are normal, I would start with ThermiSmooth treatments. You may have to graduate to ThermiTight treatments eventually, both of which melt fat and tighten skin. The ThermiTight is one treatment and micro-invasive, and the ThermiSmooth is 3-4 treatments.

Ultimately, as you get older, festoons can be excised.Through the years, I have found this to be very effective, and the scar fades with time  The faint scar is quite an improvement over the festoons.

Thank you for your question and photos..

Swelling in the cheeks

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Thank you for sharing your question and posted photo. It appears you have edema (swelling) of the skin in the cheek region of the face. This can be difficult to treat, but not impossible. It requires comprehensive evaluation in-person for best guidance. For your problem, it would be best to make consultations with a few doctors.
Good luck,

Lower lid/Malar Edema

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Hi martiza4ever75, 
Thanks for your photo and question. Based on your photo, I can appreciate significant malar edema, or accumulation of fluid over the malar region. If you've only recently noticed this swelling and you do not have seasonal allergies, I would ask your doctor to check your thyroid hormone levels. 
The treatment of malar edema can be difficult. We have found that surgical interventions tend to make the swelling worse. We have had significant success with the use of tetracycline injections into the areas of swelling. 
I would certainly seek out a consultation with a skilled oculoplastic surgeon in your area to evaluate the cause of and potential treatments for your malar edema. 
Good luck!

Malar fat pad

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You have large malar fat pads.  Have you had anything injected into this area ever?  Looks like some edema or chronic inflammation that can occur especially after biopolymer injections. 
These are tough to treat.  Sometimes a mid-face lift or bleph can help.  Sometimes laser can help to tighten the skin.  Need to get in person consult to determine what might benefit you.  

John J. Martin, Jr., MD
Coral Gables Oculoplastic Surgeon
5.0 out of 5 stars 31 reviews


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Dear Maritza:
Thank you for  your question and the photos.
I term what I see on your photos "secondary bags" (or "malar bags"). But, whatever you call them, they are certainly of significant concern to my patients who have them. These entities are not completely  understood, but we know that they are not "eyelid bags"--and that they cannot be effectively treated with a lower eyelid blepharoplasty (as the affected tissues are on the cheek, and not in the eyelid--yet, I have had some luck with extended lower lid "lifts", in combination with a mid-face lifting procedure). We do know that the only sure way to eliminate them is with skin and subcutaneous  tissue excision of the sites (leaving a very visible  scar on the face, so this is usually only done in a very "weathered", older face where the scar can be placed in one of the deep, curving crease lines which cross the face there). Using the new fiber lasers (like the "Smart Lipo") might help somewhat, or external application of an RF (radio frequency ) device could possibly help, but I have no experience in those modalities. I would check with a board-certified plastic  surgeon in your area who advertises an RF device in his or her practice, as this "non-invasive" route might be worth considering.
Good Luck!
James H. Scheu, M.D.

James H. Scheu, MD, FACS
Saint Louis Plastic Surgeon
4.5 out of 5 stars 27 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.