Steroid injections for malar bags Injections with kenalog (steroid) or 5-FU may help some festoons but I have not seen Festoons, also known as malar mounds, are swollen, bag-like formations on the lower eyelids and upper cheeks. Sam Jejurikar. This article reviews the anatomic basis for malar edema, relates it to filler injection technique, and presents the author’s preferred method of injection to help ensure avoidance of this adverse event. Corticosteroids have potent anti-inflammatory properties and can reduce swelling by suppressing the body’s inflammatory response. Treatment must be individualized based on The best treatment for malar bags is the injection of fillers such as Restylane, Juvederm, or Voluma into the cheek below the malar bag to hide the shadows of the cheeks and to restore the gentle convexities of youthful cheeks. Malar swelling or bags and festooning(a particular compartment of the cheek which is over the bone) is an evolving and difficult problem. He said the only thing to do to treat it was a steroid injection but has a low success rate and would look worse for a few weeks since it would initially The edema was long lived—6 to 8 months—and only minimally responsive to massage, head elevation, taping, salt avoidance, methylprednisolone, and conservative intralesional steroid injections. 3 cc of 2% tetracycline injection for treating lower eyelid festoons over a 10-year period. Festoons, also known as cheek bags or malar mounds can be exacerbated by HA fillers. 17 Festoons can worsen in a variety of clinical set-tings. Skin infections Malar edema is often used to describe a fluid collection over the lid and cheek junction. 18-20 In 2 of them, the intralesional injection of tetracycline 2% showed improvement in the contour to correct the festoons. Those who Find out more about treatment for under eye bags and wrinkles with Dr. ; Injections can lead to infection if It appears that you may have malar bags rather than lower eyelid fat. Traditional lower eyelid lifts (blepharoplasty) do not fully correct festoons. One surgeon has offered a preperiosteal mid-facelift along with tightening the obicularis oculi muscle and closing the anterior wall of the malar edema. Results appear around 3 months, with repeat injections possible. Talk with your surgeon and ask about lymphatic massage and possible steroid injections. Based on the photos, you appear to have malar bags of your upper cheeks rather than true eye bags. Sometime steroid injections help speed up the resolution Watchful waiting,14 reassurance, and appropriate follow-up are usually all that is required, and the majority of cases of post-injection, trauma-related edema dissipate within one week1. One lesser-known treatment for malar bags is injections of doxycycline directly into the bags. Although these two cases involved CaHA, malar edema arising from injections with hyaluronic acid (HA) has also been seen in clinical practice. There are such things as “bags” which often appear as puffy circles directly beneath the eye. Here are the key advantages: Pain Relief. Now, however, I've developed two "bags" under my eyes. 4. While Botox itself does not directly cause malar bags, the aging process, facial volume loss, skin laxity, and underlying medical conditions can contribute to their presence. This may occur sooner if you avoid salty foods and try a water pill (diuretic). From 61 responses, 59% of patients noted improvement in the appearance of festoons, with 26. Fig. Granulomas or small nodules, while rare, can occur and are typically manageable with massages, filler dissolution, or steroid injections. Botox and steroid injections can also be used to treat festoons if the cause behind them is due to muscle laxity Malar bags and festoons were less prom-inent with supine positioning in 84% of cases. The best treatment for malar bags is the injection of fillers such as Restylane, Juvederm, or Voluma into the cheek below the malar bag to hide the shadows of the cheeks and to restore the gentle convexities of youthful cheeks. Dr. If this is confirmed by a one-in-one consultation, there are various And if you happen to have a history of filler in your cheek and under-eye area, hyaluronidase injections are also a potential treatment because filler may cause worsening of malar edema, she added. Malar mounds or festoons may be promi- The best treatment for malar bags is the injection of fillers such as Restylane, Juvederm, or Voluma into the cheek below the malar bag to hide the shadows of the cheeks and to restore the gentle convexities of youthful cheeks. I look like Ive aged 20 years! Ive gone in for both hyaluronidase and hylenex 6 times now. 19 Other causes of malar bags include patients with systemic disease such as chronic renal disease, allergy, or hepatic cirrhosis. Because the laser will primarily treat the surface, it may not penetrate deeply enough to improve the malar problem significantly. 2–1 ml of 2% tetracycline are performed between the subcutaneous and suborbicularis planes, to act on the subcutaneous and suborbicularis fat/edema, in addition to I am 4 weeks post-facelift with fat transfer under the eyes in the area between where under-eye skin meets upper-cheek skin (malar area?) The swelling, for the most part, has gone away. Malar bags or ‘festoons’ are swollen bags that appear under the eyes affecting the lower eyelid and cheek junction. Malar bags are a common feature of ageing of the malar bag subtype and the author’s algorithm for treating congenital and acquired festoons via a series of 89 patients from the past decade. This is pretty common but should be resolving by now. festoons are a difficult problem. Medications and steroid injections can provide temporary improvement, and some older surgical procedures offer Steroid injections offer several notable benefits, particularly for those suffering from chronic pain and inflammation. Treatment for acne scarring can depend on how much the scar is raised. We do not believe that Botox and steroid injections, fillers, or fat transfer procedures are useful treatments for festoons and, in fact, may noticeably worsen their This can be easily corrected with an injection of Hylenex. Doxycycline injections into the malar bags cause localised inflammation which can helps the ‘bag’ to ‘stick’ down reducing the space for fluid to gather inane thereby reducing the appearance of the malar bag. This is the after result of that. One more reason For Mild to Moderate Malar Bags: Tetracycline Injection: Injection with 2% tetracycline may modestly reduce malar bags by triggering collagen and fibrin production. H Festoons, also known as malar pads, festoon eye bags, and malar fat pads, can detract from an otherwise attractive appearance. This is a new treatment, and it seems to work far It is also called festoons or malar bags,” says Robert Schwarcz, MD, a board-certified oculoplastic surgeon in New York City. Occasionally steroid injections can help. If you have diabetes, check your The authors’ analysis included 61 patients undergoing 0. Scheiner uses a combination of laser eyelid surgery and laser skin resurfacing to treat Hyaluronic acid-based fillers are hydrophilic (they love water) and often will draw more fluid into the malar bags, making them more prominent. If they are malar bags, the treatment I would suggest would be an injectable filler below the fullness to try and soften the depression beneath it. Michele Green, cosmetic dermatologist based in NYC. Malar bags are not easy to treat, so make sure to get in touch with a board-certified specialist plastic surgeon. I can't find any scientific studies that suggest a preperiosteal MFL for malar Hello there FLMom18,It definitely looks like you are having persistent swelling of the lower eyelid area. Juvederm treatment results can be visible for approximately one year following treatment. ” This means any manufactured medication that reduces swelling in your body. Most people can have steroid injections. They seem to be getting worse over the past 4 years, especially on the right side. They may already be affected by dark circles under the eyes and the addition of festoon eye bags can make this problem appear worse. With platelet-rich plasma injections for under-eye treatment, patients will notice results after just the first treatment. (J Clin Aesthet Dermatol. They remain a difficult entity to treat. Sometimes it involves surgery to remove unwanted permanent filler. 5-FU Injections, and CO2 Laser Resurfacing. Several types of injections are used to relieve knee pain symptoms, such as steroid injections, hyaluronic acid (HA), platelet-rich plasma (PRP), and regenerative therapies. The pockets of soft tissue are sometimes called hammocks because they droop and See more Patients undergoing lower blepharoplasty who have pre-existing festoons or are prone to fluid accumulation in the area should be treated with steroids both intra-op (IV In this detailed guide to malar bags and festoons, renowned consultant ophthalmic and oculoplastic surgeon Mr Daniel Ezra sheds light on Injection with triamcinolone appears to be a safe and effective option for the management of malar edema following hyaluronic acid filler injection. In New Zealand, triamcinolone injection is marketed as Kenacort-A and is available in 2 strengths: 10 mg per ml (Kenacort-A 10) and 40 mg per ml (Kenacort-A 40). No nonsurgical treatment cu Malar edema is a particularly significant and long-lasting untoward event that is frequently reported. This is common and will resolve over time. Tetracycline Injections: Festoons have been reduced by Tetracycline injections. Tell the doctor before having treatment if you: have had a steroid injection in the last few weeks – you usually need to wait at least 3 months between injections; have had 4 steroid injections in the last year – doctors usually recommend no more than 4 injections in Festoons are unattractive bags on the cheeks which occur in some people creating a fatigued look to the face. Sabrina is also an effective sclerosant agent. How Steroids Can Improve Your Life October 3, 2024; All The Things People Get Wrong It has created the results you see here in the photo. The bags just keep coming back, and now the skin looks dry and wrinkled as well. Mid-Facelift Since malar bags affect the cheek area, you can consider getting a mid-facelift. Microdermabrasion, dermabrasion, fractional laser therapy, laser resurfacing, surgical excision, and steroid injections to flatten raised scars are often the best acne scar treatments. Non-surgical treatments often yield unsatisfactory results. Correct filler choice, placement, and injection technique . Sclerosing essentially means stick together, so the doxycycline makes the bag stick together, and expel the fluid inside of it, therefore getting rid of the edema. Botox and steroid injections can also be used to treat festoons if the cause behind them is due to muscle laxity Malar bags/festoons are consistently found approximately 2. Festoons are sagging skin or folds of skin at the top of the cheek. Malar bags are a common symptom of midface ageing and can lead to a tired, older appearance. Bernardini, et al have demonstrated that management with hyaluronidase followed by repeat Common side effects of steroid injections include: Pain at the site of the injection; A temporary increase in swelling; Bruising; A temporary rise in blood sugar. Whilst festoons and malar oedema are fairly common. The sclerosing effects of Tetracycline have been applied to different body parts. This, in turn, minimizes the appearance of the malar bags. Chronic Under Eye "Swell Bags" Due to Lymphatic Drainage Problem , Triggered by Restylane Injection They looked good but had these unusual bumps or ridges in the malar area underneath. Malar Bags occur when fluid or fat in the lower eyelid area protrudes through the skin. For the best results, fix both lower eyelid bags and festoons and malar mounds at the same time. Ellanse or Hyaluronic Acid Gel Filler: Injected strategically into the cheek, fillers can camouflage mild swelling and support the malar area. These are soft to touch Medications and steroid injections can provide temporary improvement, and some older surgical procedures offer mixed results. Orbitocutaneous ligaments of the prezygomatic space. Pre-surgical steroid injections may prevent the formation of a hypertrophic or keloid scar. 18, 20 Another antibiotic in the tetracycline family, doxycycline, was used at a concentration of 10 mg/mL to Background Malar mounds (congenital) and festoons (acquired) are persistent puffiness in the prezygomatic space between the orbicularis retaining ligament (ORL) and zygomatico-cutaneous ligament (ZCL). It is our hope that a proper under-standing of the pathophysiology of this spectrum of dis- Lasers: For the treatment of malar bags, laser therapy using CO2 (carbon dioxide) and Er: YAG (erbium-doped yttrium-aluminum-garnet) ablative lasers have been described. CO2 laser treatment after kenalog steroid injections for scar? Raffy Karamanoukian, MD, FACS Malar bags are very difficult to to treat. Cortisone injections are commonly used to treat various medical conditions, including joint pain, inflammation, and certain skin conditions. Cortisone injections are administered directly into the affected area to reduce An intralesional steroid injection involves a corticosteroid such as triamcinolone acetonide injected directly into a lesion on or immediately below the skin. The epidural space is located where the bones and discs of The injections themselves may be a bit uncomfortable. Steroid injection can cause more deformity than good. Injection of hyaluronidase (following an allergy test), this is the same product that is used to dissolve the hyaluronic acid that has been over-injected into the under-eye circle; this For many patients, PRP / PRF injections will improve one’s under-eye appearance for anywhere between one to two years, depending on the patient’s current skin condition (and severity of concerns) and one’s age. Recently, a patient came to me with severe festoons that had been affecting Three recent studies focused on the use of antimicrobials in the treatment of malar mounds and festoons. A consultation with an experienced doctor would be recommended. Two-thirds of patients would consider repeating the A festoon and a malar bag (or mound) appear under the eyes, below the lower eyelid, and on the cheek. Our practice This scoping review updates the audience on the anatomy, pathophysiology, and evaluation of malar bags in addition to the latest literature regarding minimally invasive Doxycycline for Malar Bags Treatment for undereye bags. And if you happen to have a history of filler in your cheek and under-eye area, hyaluronidase injections are also a potential treatment because filler may cause worsening of malar edema, she added. Eyelid bags or palpebral festoons, which occur above the boundary of the inferior orbital rim, should be considered separately from malar festoons, mounds, and bags. People are keen to find the treatments that are available for festoons. 3. Elimination of topical allergy, and occasionally short-term topical steroid use are helpful. These can include a Continue reading Patients may complain of “eyelid bags,” a descrip-tor laypeople use to describe a number of issues. 20 Postoperative edema is thought to be a combination However, the management of malar bags is complex secondary to the diverse pathophysiology and varying severity of malar edema, mounds, and festoons. And do you do anything postoperatively in terms of steroid injections or oral steroids to try to help it go away faster or you just sort of let time do its thing? Dr. They are due to fluid retention. 16 Festoons can occur without tissue laxity as well. The last time a combo of hyaluronidase and steroid injection. patients showing malar bags before injections are supposedly more prone to develop lymphostasis in the area One lesser-known treatment for malar bags is injections of doxycycline directly into the bags. A person may also notice a flare-up of symptoms within the first 24–48 hours after a steroid injection. Injections of 0. This combination of procedures provides the most However, the management of malar bags is complex secondary to the diverse pathophysiology and varying severity of malar edema, mounds, and festoons. When they are pronounced, they are difficult to cover with makeup and may cause seriously deleterious effects on one’s appearance. You may ask yourself, are festoons fat or fluid? Festoons, commonly referred to as malar bags, are a frequent cosmetic issue that shows as bloated, puffy pockets of excess fatty tissue and skin under the eyes and on the cheeks. Who can have steroid injections. Malar bags are often hereditary contour irregularities that can be further associated with dietary and environmental issues. Steroid injections are now commonplace in aesthetic medicine to help prevent and manage scarring. The dura- tion of steroid therapies will vary according to the clinical situation. 2 to 0. I have referred many a patient for Allergy, ENT, Oculoplastic consultations and there is no cross-specialty consensus for this concern. These anti-inflammatory steroids are different from the anabolic steroids some athletes use to gain an unfair competitive advantage. While a facelift does not eradicate malar bags per se, it can tighten the skin and reduce sagging. Is this normal? Can a kenalog or steroid injection help remove this chalazion tissue from my eye? Have had it since Feb 2023 (Photo) I had a really large stye on the infected eye back in February of 2023 that really just never went away. Jon A Perlman M. There is little evidence to support the use of oral steroids in the management of swelling in the acute phase unless the edema is severe or if angiedema develops. D. They are also called cheek or malar bags, or even malar mounds. Facelift . I have malar edema/malar bags and mild midface aging. This paper aims to demonstrate a surgical approach for the treatment of malar bags by In this detailed guide to malar bags and festoons, renowned consultant ophthalmic and oculoplastic surgeon Mr Daniel Ezra sheds light on how these issues differ from common signs of ageing and how they can be Some people call them puffy eyes or severe bags, but Festoons, or Malar Mounds, are skin and muscle folds that swell and sag below the lower eyelids and upper cheek area. Post-surgical steroid injections can help to The malar pad area will sometimes have persistent swelling after a facelift or after fat injections. However, the most common and effective treatment option we recommend is SOOF Lift treatment combined with a form Malar mounds or festoons may be prominent in patients with thyroid disorders and those with allergies, 18 as well as postoperatively with infraorbital incisions. However, it can occur temporarily because of post-op swelling. Outcomes. One more reason to Malar bags are swollen mounds or lumps of skin that appear in the area between the lower eyelids and upper cheeks. The patient can be instructed in upward massage to keep infection and scarring minimized and alleviate retraction. 2011;4(12):32 The likelihood of malar edema can be reduced by limiting filler volume, proper filler selection, and placing filler material deep to the malar septum. 5–3 cm below the lateral canthus . What are epidural steroid injections? Epidural steroid injections place corticosteroid medication directly around a pinched nerve as it exits the spine within the epidural space. Injections with kenalog (steroid) or 5-FU and taping may Doxycycline for Malar Bags Malar bags, also referred to as malar oedema, are areas of swelling and puffiness between the eyelids/eyebags and the upper cheeks, usually sitting just to the outside of this area. They are very soft and tender, and look exactly like festoons. Good luck. I’ve been asking the plastic surgeon who did my upper blepheroplasty and botox/filler every so often for a solution for my malar bag for ages. Doxycycline is a sclerosing agent. How does Doxycycline for malar bags work? Doxycycline for malar bags is a type of Festoons represent a combination of fluid accumulation and soft tissue laxity in the superolateral cheek. If early cicatrix formation is detected, local nondepot steroid injection can occasionally eliminate the need for more involved surgery. Although c02 laser resurfacing can be performed on darker skin types, it might not be the only choice for malar bags. His wife happens to have the same problem and after some research, he offered to try doxycyclin injection. One of the most immediate benefits of steroid injections is pain relief. “Hip injections involve the use of ultrasound or fluoroscopy, a type of X-ray, to help locate the hip joint for an accurate We expect heavy lower lids to accompany eyelid festoons and malar mounds, and when only one of these conditions is corrected, festoons and malar mounds are accentuated and become more pronounced. Festoons are composed of lax skin and orbicularis muscle that hang between the medial and lateral canthi, and the pathophysiology is likely multifactorial; some of the proposed mechanisms suggest stretching of the orbitomalar ligament and lymphatic Steroid injections and topical creams should improve the rash. Knee injections for pain can be a practical Injections for Treating Hip Pain. The malar area is located below the eye socket bone, and malar edema Plastic surgeons discuss Malar Bag & festoon treatments, sharing insights on techniques, challenges, and postoperative care. I am 40 years old have been dealing with malar bags for over a I am only 27 years old but have had malar bags forever. These injections contain a synthetic form of cortisol, a hormone naturally produced by the body's adrenal glands. Most surgeons I've seen offer a subperiosteal mid-facelift. Patients undergoing lower blepharoplasty who have pre-existing festoons or are prone to fluid accumulation in the area should be treated with steroids both intra-op (IV steroids) and post-op (oral steroids) and /or diuretics. Festoons are caused by lax skin and a weakened lower eyelid muscle and often begin as Malar mounds. Angerame explains what occurs during a hip injection. The best treatment for malar bags is the injection of fillers such as Restylane, Juvederm, Botox and steroid injections can also be used to treat festoons if the cause behind them is due to muscle laxity or excess fatty tissue. A mild case (malar edema) might be exacerbated by allergies or a sinus condition or an overly salty diet, causing the puffiness. These injections If you are thinking about having this procedure done to treat your malar bags, be sure to have an in-depth conversation with a board-certified surgeon who specializes in eyes. Malar mounds and festoons are found inferiorly to the bony rim of the orbit. Injection of cortisone retard, at bone-contact level, at a very low dosage, (a few drops are enough) to treat the inflammatory participation of the malar pouch. The ideal treatment for festoons would possess minimal invasiveness and recovery time, and predictably improve the condition. This can help if the malar bags are a result of excess skin tissue. oral diuretics and steroid injections were the primary treatments for festoons, but these procedures would yield Soft bags after fat grafting are likely festoons (malar edema). We hypothesize that the patho-physiology of malar bags must be identified in order to properly treat them. This scoping review updates the audience on the anatomy, pathophysiology, and evaluation of malar bags in addition to the latest Sir: Among many changes that occur with aging, festoons present a unique challenge to the treating physician. You never want repeated injections in to a joint. This issue is easily addressed with hyaluronidase to dissolve the excess filler. Your doctor may prescribe hydroxychloroquine , an oral medication that can reduce your immune response. We understand the anguish caused by the signs of ageing. Or sometimes a creative approach is required. They are often confused with eye bags, but festoons are typically more pronounced and located lower on the face. Overfilling is another risk, which can lead to puffiness. Nevertheless, further research with larger patient groups is compulsory. Sal Differences Between Bags and Festoons. Steroid Injections and Their Efficacy: Steroid injections can be employed to manage persistent malar edema that does not respond to conservative measures. The fix is sometimes an injection to dissolve filler (if the filler is dissolvable). This helps some of them. If a malar groove contributes to a sunken appearance below the undereye area, a cheek filler may help replenish volume loss and These steroid injections are known to be toxic to cartilage, the connective tissue that keeps your bones from rubbing against one another. , FACSDiplomate, American Board of Plastic SurgeryMember, American Society for Aesthetic Plastic Surgery (ASAPS)ABC-TV Extreme Makeover Providers might refer to cortisone shots or steroid injections with the shortened term “steroids. It should gradually return to normal. Malar mound is a term used to describe a chronic soft tissue swelling over the cheek. 2. This is a new treatment, and it seems to work far Why PRP or Lasers Don’t Work for Puffy Under Eye Bags In summary, malar bags after Botox injections can be influenced by various factors. While I had initially refused a shot, the Orthopedic recommended it as an option to see if reducing the inflammation would allow the knee to regain full A raised scar can create an unfavorable skin texture. I stopped to mind it and tried to ignore it on my eyelid. 2% reporting complete resolution. Best Plastic Surgeon - Dr. The first thing I ask patients to do is to decrease their salt intake. change with botulinum toxin injections. Treatment must be individualized based on extent and content. jhn kymjtm emy dnfzu tqzf bmqvb lvnkse itlz zlr dduwbw brmfxb qjk sdiqlwi bsfff fqwma