Best treatment for malar bags/festoon? I am 21 so I am fairly young. (Photo)

Festoons are difficult to treat, but can be best improved using a combination approach. You would need an in-person evaluation to determine the best way to approach your problem. In general, I would avoid filling the tear troughs first and would target your cheeks to blend and camouflage the festoons. I would not use a filler that pulls in too much water as it can make the problem worse. We also use radiofrequency and lasers to further improve the area. The effects of the ligaments pulling on your skin can be improved, but likely will not completely go away. Make sure you see an experienced physician provider for an in-person consultation and examination. Best wishes.

A combination approach will give the most improvement. Fillers, lasers, and microneedling/PRP can improve under the eyes. My patients try to get non surgical treatments to avoid surgery. We use PRP and stem cells there often. I suggest consulting with an expert to develop a treatment plan best suited for your short and long term goals. Best, Dr. Emer

You would be an excellent candidate for Belotero or Restylane Silk in the under eye and outside cheek area.  This would fill and lift the area and make your eyes look more rested and youthful.

Hello and thank you for your question. I would recommend filler to the cheek bones. This would help tack the skin up, adding more structure to the bone, and the goal would be to soften out the bags. Additionally, filler can be placed under them, in the "break", to help pop out that area as well. I would do that second, after first adding structure to the cheeks. Best of luck!

These are very tricky to treat and even with surgery they can be stubborn.  What you are seeing is the zygomatic-cutaneous ligament and putting filler directly above it can add weight to the area it is supporting, causing the problem to look worse.  This sounds like what you experienced.  Through experience I have learned that it is best to but filler in the cheek, inferior to the ligament, to lift it and help loosen the "teathered" look that the ligament causes.  Once in a blue moon I will put a light filler, in tiny amount, right under the ligament as well--but only if the supportive cheek filler is already in place.
Sometime surgery is the only answer, and even with a surgical procedure a certain subset of patients will continue to have that pronounced demarkation.  I have not had luck with injectable steroids or other treatments to eliminate the line.
Hope this helpful information.  Best regards,
Dr. Amy