Festoon Treatment

Under-eye bags sit directly beneath the lower lashes and are usually caused by fat that bulges forward from behind the eyelid. Festoons sit lower, on the upper cheek, and are made up of loose skin, weakened muscle, and fluid. Many patients have both. Because the causes are different, the treatments are different too, which is why an accurate diagnosis from an oculoplastic surgeon is imperative.

Festoons develop as the skin and muscle below the eye lose strength and elasticity, creating a pocket where fluid can collect. Aging, sun exposure, genetics, smoking, thyroid conditions, allergies, and a high-salt diet can all contribute. In some cases, under-eye filler can trigger or worsen festoons.

Festoons do not usually resolve without treatment. Reducing salt, sleeping with your head elevated, and managing allergies may temporarily lessen the swelling, but the loose skin and muscle that form the festoon remain. Professional treatment is typically needed for a lasting improvement.

Yes, dermal fillers injected under the eyes or into the cheeks can cause or worsen malar edema, malar bags, and festoons. Hyaluronic acid (HA) fillers are commonly associated with this complication because they attract and retain water. Fillers can also interfere with the delicate lymphatic drainage system around the lower eyelids and upper cheeks, causing fluid to accumulate. Swelling may develop immediately after injection or appear months or even years later. Excessive filler volume, improper placement, preexisting lymphatic dysfunction, and age-related skin laxity increase the risk.nnTreatment depends on the underlying cause and type of filler used. For HA fillers, hyaluronidase injections are often the first treatment considered because they dissolve retained filler and may improve lymphatic drainage and swelling. Patient may require a series of hyalurodinase injections. Additional measures may include lymphatic drainage, reducing fluid retention, and addressing inflammation when present. nnNon-HA fillers, such as Sculptra and Radiesse, cannot be dissolved with hyaluronidase and require different approaches. Early identification of filler-related malar edema is important, since prolonged swelling can be difficult to treat.

Malar edema and festoons are related but distinct conditions that affect the area beneath the eyes and along the upper cheeks. Malar edema primarily involves fluid accumulation in the upper cheek area, resulting in puffiness or swelling. It may be associated with impaired lymphatic drainage, inflammation, or other factors that contribute to fluid retention. Festoons, on the other hand, are more complex and typically involve a combination of skin laxity, changes in the underlying muscle, and sometimes chronic fluid accumulation. They often appear as folds or sagging pouches along the upper cheeks/ eyelid junction.rnAlthough these conditions can look similar and may coexist, their underlying causes are different, and treatment should be tailored accordingly. Malar edema may respond to treatments that address fluid retention and lymphatic drainage, whereas festoons may require approaches that target skin laxity, structural changes, and persistent swelling. Accurately identifying the factors contributing to each condition is essential for selecting the most appropriate treatment and achieving the best possible outcome.

A standard lower blepharoplasty is designed to address under-eye bags and is often not enough to correct festoons on its own. Festoons usually require a modified surgical approach, such as muscle suspension and festoon repair, sometimes combined with a cheek lift or laser resurfacing. Dr. Ghafouri tailors the technique to each patient.

Fillers are generally not recommended for festoons. Because festoons involve trapped fluid, adding filler to the area can draw in more fluid and make the puffiness worse. If filler has contributed to your festoons, Dr. Ghafouri can evaluate whether it should be dissolved as part of your treatment plan.

Most patients experience only mild discomfort after treatment. Surgical procedures are performed with local anesthesia or IV sedation, so you will be comfortable during the procedure.

Results from surgical festoon repair are long-lasting. You will continue to age naturally, but the treated area should look smoother and more rested for many years. Protecting your skin from the sun, avoiding smoking, not sleeping face down and maintaining a healthy lifestyle help preserve your results. As mentioned before in certain cases complete resolution of festoons could be very challenging and may need additional treatments to maintain results.

As with any procedure, general risks include infection, bleeding, poor healing, and scarring. Risks specific to festoon repair include prolonged swelling, recurrence of festoons, changes in the shape or position of the lower eyelid, dry eye, and asymmetry. In the hands of an experienced oculoplastic surgeon, these risks are minimized through careful planning and precise technique.

Festoons are one of the most complex concerns around the eyes, and successful treatment requires a detailed understanding of eyelid anatomy and function. As a board-certified ophthalmologist with specialized training in oculoplastic and orbital surgery, Dr. Ghafouri focuses exclusively on the eyelids and face. He has performed over 20,000 aesthetic and reconstructive surgeries and creates each treatment plan around the patient's unique anatomy and goals.