What is the best way to make my malar bags and festoons look smaller or disappear? (Photo)

Question

I am a 51 year old woman, I am satisfied with my look, I had a facelift in 2018 and am still happy that I did that. My problem area is the area under my eyes, especially left side. This is festoons/ malar bags. I feel that I look tired and old. I am aware that this is a difficult problem, but What is the best way to make them look smaller (or preferably disappear)? MH"

Lawrence Kass, MD · Answer

These are festoons.  Or malar mounds or malar bags.  I see lots of patients with them and while many have a history of having had fillers to the area or fat, many patients, I believe, are genetically predisposed to getting them.  They can be very distressing to affected individuals.  Traditional facelifts don’t make these better and standard lower eyelid procedures can even worsen them.  In my opinion, these should not be treated with fillers or fat or sclerosing agents such as injectable doxycycline.  Non-surgical treatment options include radiofrequency microneedling.  Surgical options should only be performed by very experienced oculo-facial plastic surgeons, never by general plastic or facial plastic surgeons and include ablative laser therapy or delicate and controlled midface lifting with festoon repair.  The goal of treatment is improvement, not perfection or eradication.  Good luck!

Jason Emer, MD · Answer

For unique cases where a variety of modalities could be used to treat the condition, I would suggest an in person or virtual consultation to develop a custom and effective treatment plan.  It is difficult to precisely define the best option without collecting the same information. I suggest reaching out to an expert for a consultation with surgical and non-surgical methods to get a comprehensive option. Best, Dr. Emer.

Selcuk Inanli, MD · Answer

Hello! Thank you for your question.As far as I can see from your photos you have extra saggy skin and wrinkles under your eye area. For the bags you complain I recommend you lower eyelid blepharoplasty. If you can provide photos with better lighting, from the side of your face and 1 meter away I would be able to make a proper evaluation.Best Regards!

Nelson Lee Novick, MD · Answer

The photos show evidence of volume loss and descent in the mid cheek region giving rise to accentuation of the issues under the eyes (the upper portion of the cheek is a particularly important support area for the under-eyes) as well as accentuation of the smile lines below. The skilled use of a robust HA filler can help to not only lift the cheeks and diminish the smile lines below, but would likewise create a smoother transition between the cheeks and the under-eyes. The results are typically immediate and likely to engender a "Wow!" response. You would be wise to consult an experienced, board certified cosmetic dermatologist injector. Best of luck.

Camille Cash, MD · Answer

You are correct that festoons are difficult to treat.  Some patients have improvement from Morpheus8.  Three treatment sessions are recommended for optimal results.  We also recommend using medical grade skin care products and wearing sunscreen every day.

What is the best way to make my malar bags and festoons look smaller or disappear? (Photo)

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