How do I get rid of undereye bags and malar festoons so my cheeks won't have ugly indents anymore? (Photos)

Festoons, under eye hollows, and dark circles are very tricky. These services are very technical and fussy to deliver. It is not unusual for me to take more than an hour to place the kind of service you need. Most of the issue in your photographs is consistent with hyaluronic acid overfill. You did not supply us with a before picture, but the photos suggest that fillers have been inadvertently placed into the bags making them worse. All this product has to be removed. While there are surgical and chemical peel options, I see no reason why a correctly performed filler service would not profoundly improve your issues. Here is the rub. I see patients who fly in from all over the country and as far away as Europe and the Middle East. You would not fly to Beverly Hills from Dubai if you were not pretty frustrated with your local injectors and that is exactly the case. Fix the filler and get the right service. Whatever you do, do not get talked into fat graft in this location. Many of the surgeries offered for festoons do create unfixable issues.

Thank you for your question and photos. Festoons like yours can be challenging to treat, so make sure the doctor you are working with is board certified and has extensive experience working with this concern. When fillers are administered correctly, they can produce very good improvement under the eyes. Skin tightening treatments like Ultherapy might also give you some positive results. Find a doctor with expertise in nonsurgical skin rejuvenation for an in-person evaluation and treatment plan customized to your needs and expectations. 

Fillers like Belotero, Volbella, and Restylane Silk are good for improving under the eyes, but keep in mind that a combination approach will give the most improvement. My patients try to get non-surgical treatments to avoid surgery, so we use fillers, lasers, microneedling/PRP and stem cells. I suggest consulting with an expert to develop a treatment plan best suited for you. Best, Dr. Emer

There are two anatomic concerns here:1. Lower eyelid fat prolapse. This is sometimes addressed non-surgically with the use of fillers in the hollow (tear trough) below the fat in attempt to camouflage the fat, often with good success. However, I believe this is risk in your case because of the festoons. especially with hyaluronic acid (HA) fillers which draw in fluid, even with Restylane which is the best of the bunch. In fact, it may have already happened to you with the filler that you have had injected. In this case. I would recommend removing all your previous HA filler and perform a fat repositioning lower blepharoplasty to smooth out your eyelids/tear troughs.2. Festoons. This is the swelling at the top of the cheek with a slight depression below it (orbito-zygomatic groove). This is a much more challenging issue to correct and thus there are many different treatment modalities that try to address this problem. These include laser resurfacing, chemical peels, cautery, injections (doxycycline or tetracycline), RF microneedling, and in really severe cases, surgical resection. Seek an experienced eyelid surgeon that doesn't over promise results, especially on the festoon. 

You present with a very difficult problem which, in my opinion, can be treated only with surgery. This is in particular the case with festoons. Combination of lower eyelid surgery and nano fat grafts may be considered. Consultation with a very experienced board certified plastic or occuloplastic surgeon with good reputation in eyelid surgery is recommended. Good luck.

I couldn't disagree any more strongly with the last answer you received.  There are very few doctors willing to treat festoons and even fewer who do it well.  The treatment of this problem is absolutely outside of the realm of a general plastic surgeon, board certified or otherwise, most of whom spend their careers in doing breast augmentations and tummy tucks.  The treatment options of this delicate sensitive area should only be attempted by a specialist in oculofacial plastic surgery.  Choose one with extensive experience and background in treating this problem.  Personally, I do not believe that this can be treated successfully without surgery and I would avoid fillers to this area.  Good luck.

I strongly recommend that you schedule a consultation with a Board-eligible or board-certified plastic surgeon to address this issue. From your photos, it appears you would be an excellent candidate for a lower lid blepharoplasty. This procedure will address your concerns and give you a more rested, youthful, and rejuvenated appearance.  

Thank you for your photos and questions. As several of the other doctors on have said in their replies, your issue is complex especially given that you have had prior treatment with filler. While festoons are believed to be caused by accumulation of fluid ("malar edema"), having fillers injected into the tear trough and lower eyelid region can make them worse either through direct injection into the space where the fluid accumulates or by impairing lymphatic drainage from that space. A good first step would be to dissolve the filler with hyaluronidase injections and see how much of a difference that makes for you. I recommend seeing a facial plastic surgeon or oculoplastic surgeon for an in person evaluation and to devise a plan that can help you reach your aesthetic goals.

You have received some good information. Your original problem can be fixed with either surgery or fillers. Whoever does this needs to be a true expert in the area. It appears that that is not who you saw initially. Restylane was one of the initial non surgical treatments for the problem. However, it causes significant swelling in many people when placed here, especially above the orbital ligament, which is where almost everyone using it places it. Experts no longer use similar products or place anything there. The proper placement of fillers for the problem is below the ligament, pushing it up with a heavy filler like Juvederm Voluma or.Radiesse. However, very few “injectors“ do this, leading to problems like yours. You need to see an expert in both perioccular fillers and surgery. Take your pre filler pictures and the precise history of your treatment. You probably need the Restylane  dissolved and then decided what the best option is. Good luck.