I have these puffy fluid like pockets on both my cheekbones. I believe they are festoons? To me they are very bad. (Photo)

Thank you for sharing your question and posting your photo. You have festoons, which are particularly challenging for doctors to treat. Options include direct excision which can leave a significant scar, steroid injection which can cause atrophy, laser resurfacing which is usually only minimally effective and Doxycycline injections which a few doctors have found to be successful. Make an appointment for comprehensive evaluation and discussion of possible treatment options.Good luck,

Hello, and thank you for your question regarding the puffy fluid-like pockets in both of your cheekbones, whether these are festoons, and if so, how can they be treated? Thank you for your history and your pictures. In accordance with your pictures, you definitely have festoons. Festoons are pockets of excess fat located over the infraorbital, malar, or cheekbone region. There are multiple treatment options available for these areas, including laser treatment, injections of doxycycline, and injections of fat-melting fluid, such as Kybella. However, the best treatment for your festoons would be direct excision. An incision is placed over the festoon, and the festoon is directly removed. It will leave a scar; however, it is a trade-off —a scar for a festoon. After surgery, the festoon is usually completely gone. Treatment really depends on your desire to eliminate the festoons. If you want them gone, go with the direct surgical approach. If you cannot cope with the potential facial scar, consider injections or lasers. Nonetheless, you do have festoons. Thank you for your question regarding puffy fluid that forms pockets on both cheekbones. Good luck.  Many plastic surgeons offer free virtual consultations. Therefore, explore what other plastic surgeons have to say.  If you cannot find an experienced plastic surgeon in your area, consider traveling to another state for specialized care.  Sincerely, Dr. Katzen. (Plastic Surgeon, President of  the American Society of Bariatric Surgeons, certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, and International College of Surgery and ​member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery, RealSelf Hall of Fame, and RealSelf Doctor Advisory Board for Medical Review and Consumer Panel.)

Great question and thanks for providing such great photos!
These certainly look like festoons which are essentially areas of fullness at the eyelid/cheek junction. There are a number of reasons that people develop festoons from excess fluid, allergies, excess skin, excess muscle, etc and treatment should be tailored based on your unique issues. Options to address festoons can include changes in the diet (decreased salt intake decreased fluid buildup in the body), laser resurfacing (tightens the overlying skin), and surgery (excision of skin, fat, or muscle contributing to causation of festoons). Your best bet would be to schedule with someone who can determine which of these causes is most likely in your situation and address things accordingly.
I hope this helps and best of luck! Kyle Kimura, MD

If you’re dealing with puffy, fluid-like pockets on your cheekbones, commonly referred to as festoons, there are several effective treatment options available. Non-surgical solutions include otions like radiofrequency skin tightening, which helps firm the skin and reduce puffiness. Additionally, lifestyle changes like reducing salt intake and staying hydrated can also minimally alleviate some swelling. For more significant or persistent cases, surgical options such as blepharoplasty (eyelid surgery) or excisional surgery to remove excess skin and fat may provide lasting results. It’s essential to consult with a qualified professional to discuss the best approach for your specific situation.

Hello and thank you for your question! In our practice, we have had some good success using a device called Plasmage (fractionated plasma) to resurface, shrink and tighten the skin over the festoons and thus shrink or eliminate them. Laser resurfacing may also be helpful. Neither of these options should leave any scarring, though they may need to be repeated from time to time. I hope this helps, best of luck! Genie Alexander, RN BSN for Anna Petropoulos, MD FRCS at Center for Classic Beauty, Danvers & Boston, MA

Dear Patient from Virginia,The swollen mounds you appear to have based on your photos are referred to as eyelid festoons and Malar Mounds. They are often related to sun damage over time to the skin in this part of the face. They can wax and wane and are more common in people with lighter skin types. I've had success using lasers to tighten and improve this condition. Other options include surgery to cut them out but this leaves a scar in this area. I hope this was helpful. 

Lasers or fillers can help, but often surgery is the best option. I suggest seeking an expert for an in person evaluation. Best, Dr. Emer

This is swelling in the malar fat pad, and can be referred to as festoons.  Often with festoons there is also a thinning of the skin which you don't seem to have.  These are not easy to remove.  An extended lower lid blepharoplasty can elevate the whole area, and this can improve the contour.  Some laser resurfacing on top of them can also sometimes flatten them.  The difficulty is that this fat pad often can remain full after any trearment.