What Are the Unusual Lines Starting from the Corners of my Eyes and Extending to my Cheekbone?

I am 25 years old and take VERY good care of my skin (clarisonic cleansing; peptides, moisturizer and spf 90 in the morning, retinol, moisturizer at night; face masks, peels; good diet and exercise; plenty of water, vitamins etc.) However, I've had unusual lines on my face since I was a teenager. They start in the corner of my eyes and curve down past my eye socket area to the point of my cheekbone. I just want to know what they're called and if there is a treatment. Thank you very much.

Doctor Answers 6

Malar festoons and tear troughs.

Great job on the skincare. Essentially you are developing both a prominence of the nasojugal groove (tear trough) and lengthening of the malar supporting cheek ligaments (festoons). The tear trough anatomically travels from the medial eye corner to the mid pupillary line (a line straight down from the pupil). The malar festoon travels from the mid pupillary line to the lateral cheek. Although they are anatomically distinct and caused by separate mechanisms, the best treatments are always volumetic (fillers, fat, implants, etc.) This is a genetic issue that is managed and not cured by skincare. Speak with a qualified plastic surgeon as this is a tricky issue. Best wishes, Dr. Todd Hobgood

Phoenix Facial Plastic Surgeon
5.0 out of 5 stars 38 reviews

Tear Trough Treatment with Restylane

Tear troughs on the cheeks can be treated with a dermal filler. For you, I would recommend Restylane.

1) Restylane is long-lasting, but not permanent. Lasts about 1 year.

2) Doesn't seem to swell excessively like Juvederm sometimes can.

3) Is reversible with Hylauronidase, in case you don't like it.

Michael T. Lin, MD
Los Angeles Dermatologist

Facial lines

In the young individual the transition between lower eyelid and cheek is imperceptible. The dividing line between these areas in older individuals is the nasojugal crease also called the nasojugal groove or tear trough. The aging process starts near the nose as the tear trough and progresses outwardly towards the same side ear becoming what is called the palpebromalar groove. The facial skin is different than other areas of the body in that there are ligaments directly connecting the inner surface of the skin to the bone. In the palpebromalar groove the ligament is called the orbicularis retaining ligament. Lower down on the cheek is another ligament called the zygomatico-cutaneous ligament. The reason for all this is that different parts of the face move separately and with variable ranges of motion. Without these separating ligaments facial expression could not be so diverse. I your case the zygomatico-cutaneous ligament is tighter or shorter relative to the others causing this line to appear. Disrupting the ligament can reduce or remove the line at the expense of loss of soft tissue support and the risk of premature sagging. Your best bet is a filler.

Aaron Stone, MD
Los Angeles Plastic Surgeon

Unusual Lines in the Cheek

The lines you are concerned about are caused by sagging of the cheek tissue downward.  The tissue above the line is being held up by ligaments to the cheekbone, the tissue below the line lack these strong ligaments and are more susceptible to falling.  The line then is the division between these two areas.  There are many names for these lines but the most common is 'tear trough'. 

Treatment is generally with filler.  Getting this line to go away completely is hard.  Again this has to do with the fact that it is the division line between two types of tissue.

Joseph Campanelli, MD
Portland Facial Plastic Surgeon
4.5 out of 5 stars 8 reviews

Very common problem with a relatively easy solution...

just need some filler in the area...commonly referred to simply as the tear trough...and it should tell you something that you're doing all the popular skin therapies but you still have the problem...think you can ease up on the regimen...can visualize your routine in a Woody Allen movie...

Ken Landow, MD
Las Vegas Dermatologist
4.5 out of 5 stars 9 reviews

The lines that extend from the corner of your eyes down onto your cheeks may be improved by a well-performed Injectable Filler.

It is fairly common to see lower eyelid grooves that extend down into midface depressions. A well-performed Injectable Filler procedure may be performed to significantly improve the appearance of these indentations. You should consult several reputable physicians experienced in the delicate art of filling these areas. My personal preference is to use Silikon-1000, an off-label filler, for permanent results.

I've attached a link to a photo from my RealSelf gallery of one of my gracious patients with a similar situation.

I hope this is helpful for you.

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
5.0 out of 5 stars 372 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.