Malar mounds, festoons. What is the best treatment for my particular facial asymmetry? (Photo)

You seem to be a good candidate for lower, transconjuctival blepharoplasty with cheek augmentation by means of fat and nano grafts and/or cheek implants. In person consultation with a board certified plastic surgeon with reputation in facial and periorbital rejuvenation is recommended. Good luck.

There is a controversy as to what causes festoons vs. malar bags. I feel that malar bags represent a falling of the fat pads and orbicularis muscles over the ligaments of the face. A mid-face lift, performed through an endoscopic incision behind the hairline, lifting under the lining of the bone seems to improve or eliminate the bags. It is posssible that a blepharoplasty would also be essential, but a consultation without the eye shields is necessary. You can see on your smiling pictures that your cheek has dropped and elevates with smiling, so there is a general falling of your mid-face. Information about age and a consult, either remote or in person will give a better idea.

Malar mounds are difficult to treat. Some patients find improvement with Morpheus8. These treatments help stimulate collagen production to add underlying support of the structure and give a smoother contour. See a board certified plastic surgeon near you to learn more.

Hello! From these pictures, it looks like you would benefit greatly from a lower blepharoplasty. This procedure would tighten the skin below your eyes, remove ptotic fat pads, and if necessary would tighten the lid margin. A Skype or FaceTime consultation with a specialist will help you get an accurate recommendation and pricing.

Respectfully,
Arian Mowlavi MD, FACS
Realself 100 Hall of Fame Inductee

Tear troughs, malar festoons, whatever you want to call them are caused by an interaction of the anatomy of the area and volume. The reason there are differences in what you see is that the anatomy varies between individuals. The reason you do not find many examples that look like you is that your anatomy is relatively uncommon. However, correction using fillers is the same as the more common presentations as long as the injector understands the differences in the anatomy.