What can be done for upper cheek and lower eyelid bags? Dr. John Burroughs answers

Fluid bags under the eyes can be a very frustrating issue.  These are usually cosmetic and not harmful, but when severe they can cause mechanical ectropion.  Ectropion is when the eyelid is pulled away from the globe surface creating a gap between the eye and the eyelid.  This can cause considerable irritation.  Many methods have been tried, with varying success, to improve these fluid bags.  Modalities tried have included chemical peels, laser peels, radio-frequency or electrocautery ablation, enzyme injection, and direct excision.  The below patient had a bothersome fluid bag (malar festoon) of his lower eyelid.  He also had recurrent bouts of swelling of his upper eyelids that had stretched his tissues causing excess tissue that was bothering his vision.  He underwent an upper blepharoplasty and had a direct excision of his lower eyelid festoon.  He healed very well with minimal scarring and has been very pleased.  Unfortunately in younger patients it is more difficult to hide the incision scarring.  Recently a new study published in the Ophthalmic Plastic Reconstructive Surgery journal showed benefit to injection of tetracycline antibiotic into the area of swelling with moderate success without any complications.  Dr. Burroughs has used tetracycline injections for ocular surface swelling with good success when the problem couldn’t be improved under the care of other physicians.  Dr. Burroughs thinks this will be a potentially useful, safe, and repeatable tool for future use.