I'm only 19 and i think i may have malar festoons/tear troughs how do i get rid of them? (photos)

I seem to have developed these lines from my eyes to cheekbones, i started to notice them near the end of april (finals week for college). I figured they would go away over time so i waited about 2 months but there still here and seem to have gotten worse. I always moisturize with sunscreen moisturizer and i workout and have a pretty good diet, i do have a night job 4-10pm but i get 7-10hr of sleep, I really dont know why these have appeared and i just want to get rid of them, what should i do?

Doctor Answers 8

Dark Circles, Eyelid Wrinkles/Bags Treatment -- Restylane or Belotero with Cannulas, Clear+Brilliant, Eclipse Micropen, Viva

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Fillers, lasers, skin care can all help this issue in someone younger.  I suggest you see an expert.  Best, Dr. Emer.

Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 203 reviews

I'm only 19 and i think i may have malar festoons/tear troughs how do i get rid of them?

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Hello Ze97,
Thanks for your question.
Those lines are known as the tear trough deformity.  In your case they just indicate that your cheek bones don't project as far forward as they should.  It is normal and frankly very common.  If they bother you, the easiest way to correct them is to use injectable hyaluronic acid filler like Restylane or Juvederm to build that area up.  There are risks to the procedure that need to be understood before moving forward.
A consultation with an injectable filler specialist in your area would be the next step if you choose to correct them.
Good luck,
Dr. Shah

Technically this is not a festoon so don't let anyone operate on this.

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This is a mid cheek groove.  It is caused by a relative deficiency in the buccal fat that normally supports the cheek superior cheek volume.  First, this slight groove is normal and masculine.  You do not need to do anything about it if you choose.  Alternatively you can have a small amount of hyaluronic acid filler in the groove.  Treatment is comfortable and likely to last over a year.  Do not have permanent fillers for this and do not get a so-called smooth filler for this.  My preferred filler for this is Restylane.  Look for a highly experience injector.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

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Malar Festoons and Pronounced Tear Trough: What can be done?

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From your photos, I don't think your concerns are excessive or that I would recommend anything at this point.  The "tear trough" deformity or nasojugal deformity is quite pronounced in some as they get older and their midface has descended from age and the effects of gravity.  If there is prominent fat pushing forward above it is can make the trough look much worse.  Many patients get festoons or swelling over the malar (cheek bone)  areas from allergies, excessive salt intake and for various other unknown reasons.  One of the solutions I like to provide is a "filler blepharoplasty" for those not ready or not needing/wanting surgery.  Filler is injected to smooth out the transition between the trough and inferior cheek area.  For more pronounced troughs a fat repositioning blepharoplasty with/without a lower eyelid (orbicularis) muscle sling can provide significant improvement.  For patients who struggle with frequent swelling of their upper cheeks, surgery and fillers (depending upon which is used) can worsen the swelling by disrupting the lymphatics that drain our skin of fluid or if a filler is to hygroscopic (water attracting).  In my experience the best fillers for the tear trough are Belotero (esp for thin skin) and Restylane.  I know you are concerned about your appearance, but you have an attractive face and features. I would encourage you to try not to focus on your lower eyelids and cheek and find a focus or interest that you are passionate about.  Best regards.

John R. Burroughs, MD
Colorado Springs Oculoplastic Surgeon
5.0 out of 5 stars 16 reviews

What Do I Do About My Tear Trough Deformity?

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The tear trough deformity is an anatomic/genetic band separating the medial one-third and the lateral two-thirds of the lower eyelid.  If you were over 40 years old and my patient, I would recommend a lower eyelid bleph with an obicularis muscle sling which, in my experience, can get rid of the step off.

Since you don't have enough loose skin and lower obicularis muscle for a muscle sling, I would recommend Voluma injected into the medial one-third or nasal aspect of the lower eyelid.  Voluma can fill the apparent depressed area and therefore camouflage the step off.

In my opinion, the advantage of Voluma is that it lasts over 1-1/2 years and is much more malleable than most of the other HA's.  I am a big believer in "if something about your appearance bothers you and you are going to waste psychological energy on that, then JUST FIX IT." 

Start with fillers

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A possible solution is to have the depression(line) filled with Juvederm or Restylane to help mask the hollowness of your medial cheek.  It would not take much.


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Malar cheek bags or edema seem to be genetic, sometimes associated with allergies. You are a handsome young man and wasting time and money on this at your age should not be encouraged.  Being attractive is more about personality than looks. Find something you love and try to be expert at it. Read widely and be conversant in many subjects. This will make you more attractive than thousands of dollars in fillers.

Luis Villar, MD, FACS
West Palm Beach Plastic Surgeon
4.4 out of 5 stars 11 reviews

Concerns about lower eyelids

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Thank you for sharing your question. The quality of your photos is poor for evaluation purposes. You might have tear troughs, which could be treated with fillers. See an experienced Oculoplastic Surgeon for evaluation and to discuss possible solutions.
Good luck,

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.