Under eyes bags? Festoons at 20? (photos)

Since I was a baby I've had under eye pockets that are rather unsightly. Ive just reached my 20s and am sick of them! Nothing topical has helped reduce them. I also have a hypothyroid condition but have been treating it for the last 6 or so years of my life. I get a lot of sleep and have a very healthy diet. Are there any options for me, surgical or otherwise?

Doctor Answers 2

Malar edema

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Hi eklat272,Thanks for your question and photos. In the first photo, I can appreciate some malar edema causing lower lid bags. This is especially difficult to treat with surgery or filler since they both tend to make swelling (aka edema) worse. We have had good results lately with injection of tetracycline (an antibiotic) into the area of edema. It causes about 2 weeks of redness and swelling but at the conclusion, the malar edema is improved. At just 20 years old, I would certainly only recommend non-surgical interventions. I would seek a consultation with a skilled oculoplastic surgeon in your area. Good luck!

What can be done about festoons

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It is difficult to tell from photographs but you have an interesting issue. It does look like you may have a festoon or what we call a malar bag.  This can often be improved with different modalities.  Often I will use Radiesse rather than hyaluronic acid fillers in the lateral cheek to support the cheek and reduce the appearance of the festoon.  Hyaluronic acid fillers tend to absorb water and can sometimes make festoons worse.  We've had very good responses in many patients with devices such as Ultherapy and ThermiRF.  Surgery is usually reserved for patients that won't improve with these other devices since it usually involves potentially creating prominent scars .  Thermi RF is now my preferred treatment for malar bags in most patients but you need a thorough consultation to determine which treatment would be most effective in your case.
Best of luck!

Joseph A. Eviatar, MD, FACS
New York Oculoplastic Surgeon
4.7 out of 5 stars 68 reviews

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