Under eyes bags? Festoons at 20? (photos)

Question

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?

Cameron Chesnut, MD, FAAD, FACMS · Answer

Festoons are commonly confused with eyebags, as they sit right below the eyelid, but actually encompass the upper part of the cheek. There are different kinds of festoons, wet and dry, and the management of them differs based on the underlying cause. Treatments vary from over the counter medications to in office injection and even surgery. 
This is definitely a situation where you want to make sure you are seeing somebody who is an expert in dealing with eyelid aesthetics, as this can commonly be confused in it’s diagnosis and management.
To ensure you are receiving the highest level of care, seek out a modernly trained, new-school dermatologic surgeon, oculoplastic surgeon, facial plastic surgeon or plastic surgeon who is board certified and fellowship trained in one of these “core four” cosmetic specialties. Membership in organizations like the American Academy of Facial Plastic and Reconstructive Surgery help to identify a highly trained surgeon.
Cameron Chesnut
#realself500 Physician

John McCann, MD, PhD · Answer

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!

Joseph A. Eviatar, MD, FACS · Answer

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!

Under eyes bags? Festoons at 20? (photos)

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Under eyes bags? Festoons at 20? (photos)

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