Malar Bags or Festoons- Alternative treatments?

As you can tell by responses on this site, there are many varying opinions on any medical topic. Having said that, if you hear any "expert" talk in absolutes about anything, you should take that with a grain of salt. Though it is true that treatment of festoons with tetracycline injection is a relatively new technique and we need to see a larger series of patients and longer followup to adequately assess its efficacy, to thoroughly dismiss it as a treatment option by calling it "foolish" or a "fallacy" without ANY data to support THAT position is irresponsible. Have any of these Drs seen or reported any complications from this treatment modality as described in the Dr. JD Perry's article? I doubt it, otherwise they would have cited it in their response. Any new treatment option that is developed in medical field at one time was "experimental" until it proved itself to be efficacious and safe so that it became mainstream. For example, botulinum toxin at one point was highly controversial as many expert physicians were outraged that anybody would willfully inject a "toxin" into the body. We now see how that controversy has shaken out.Though Dr. Perry's series of patients was relatively small, he reported no complications. There were side effects of temporary redness and mild swelling, which resolved within a couple of days. There were no long term deleterious effects. Furthermore, Dr. Perry acknowledged in the paper that this treatment seemed to produce improvement in mild to moderate festoons, thus tempering his claims. He did not claim this to be  a silver bullet, but rather another possible treatment option in our "toolbox" to treat a very difficult condition.As anyone with experience in this area will tell you, festoons are one of the most difficult cosmetic problems that we encounter and there is no "perfect treatment". There are almost as many treatments, (lasers, peels, surgery, radiofrequency, etc) as there are "experts" denouncing one and touting another, and each of these treatments have their own possible side effect profile. Also to clarify on a statement made by another surgeon: Tetracycline as described by Dr. Perry, was not meant to "dissolve the fat under the eyes". It was described to be injected into festoons, subdermal swelling in the upper cheek just below the eyelids. Dr. Perry's article did not recommend or even discuss injecting it into  prolapsed eyelid fat.Any newer treatment option should be carefully considered and conservatively applied, and that applies to this treatment modality. I hope this clarifies things for you a bit.

Festoons and Malar Mounds have been a traditionally very challenging condition to treat.Options have included surgical skin flaps, cautery, and direct excision. Recently a variant of cautery using Thermi has been attempted.Although I haven't used the Tetracycline technique myself, it does seem similar to the cautery and new Thermi treatment in that it used to create an injury below the skin in the area of the festoon / malar mound.I have had success using Lasers to treat festoons and malar mounds. It also creates an injury which the body heals with new tissue that improves the festoons and malar mounds. Take a look at the links I've attached to this answer.I hope this was helpful.

JD Perry has a report of 11 cases on this in a journal called Ophthalmic Plastic and Reconstructive Surgery.  The series was small and the results are not impressive.  Tetracycline in tissue is highly irritating and cases scaring in the tissue.  Asking a doctor to inject your festoon with tetracycline is asking to be experimented on.  I think it is a foolish choice.  There are much more reliable methods of addressing the festoon.