We often think of “festoon” as a positive word, redolent of garlands and celebration. But for many middle-aged adults, festoons are nothing to celebrate. In their case, festoons are swollen mounds that appear under the eyes, in the upper cheek area.
Festoons, also called malar mounds, make a person look sick or always tired. Malar festoons are different from “under-eye bags,” which are caused by protrusion of normal fat pads located in the orbit (eye socket). Festoons are mounds resulting from chronic accumulation of fluid (edema) below the eyelid in the upper cheek area. Festoons give the area under your eyes a look of puffiness and magnify the appearance of under-eye bags.
There is a long list of ineffective remedies that have been tried over the years, from facelift and blepharoplasty to injections of dermal fillers or steroids. Most plastic or cosmetic surgeons don’t have the experience or expertise to deal with this condition.
The immediate cause is a breakdown in collagen and fibers in the lower eyelid and upper cheek region, laxity of muscles and damage to the lymphatic drainage system. This creates a void that is filled with fluids that amplify volume and create deep troughs. Sometimes this breakdown is triggered by years of smoking or excessive exposure to the sun’s ultraviolet rays, sleeping in a face-down position, sleep apnea or chronic allergies. But often genetics and the natural process of aging are the main causes.
Options: From Imprudent to Ineffective
Treating festoons requires a comprehensive approach. Facelift or standard eyelid surgery (blepharoplasty) cannot improve the appearance of festoons. Similarly, if an individual with festoons undergoes blepharoplasty without addressing the swollen mounds under the eyes, the festoons will actually look more pronounced after the surgery.
Many noninvasive techniques are just as inadequate. Using dermal fillers to treat festoons will often accentuate their appearance, by plumping up their volume. It is not uncommon to see festoons in patients who have had hyaluronic acid (HA) fillers (such as Juvederm) under the eyes or cheek area. Fat transfer techniques may not be appropriate. Not surprisingly, over-the-counter skin care products are ineffective in improving the festoons.
There are several types of surgical procedures that have occasionally been embraced over the years, including lower eyelid blepharoplasty and direct excision. These surgical strategies do not always address root causes, and fluid may again accumulate in the region if the underlying structures are not fortified. Even less effective are some other traditional treatments, such as oral diuretics or topical steroids.
The Solution: Precise, Pure Energy
Dr. Ghafouri advises patients with festoons to consider an advanced technique using the precisely targeted energy of combined carbon dioxide laser and radio frequency (RF) energy. We offer the latest technologies in both of these energy devices. The laser applies heat to moderately “injure” the skin and agitate subdermal layers. This awakens the body’s natural healing response, flooding the zone with skin-strengthening collagen and elastin. It also vaporizes the top layer of cells that, in cases of festoons, have typically been damaged by excessive exposure to UV rays. The fractioned CO2 laser and RF stimulate different tissue layers of skin.
The laser treatment can be performed in the office with local anesthesia. In the hands of an expert and experienced oculoplastic surgeon, this procedure can be performed safely. The main potential risks and complications include eyelid retraction and scarring. More than one treatment may be needed to obtain optimal results. In some cases the above modalities may be combined with a customized surgical approach to address the lower eyelid bags and festoons at the same time.
To learn more about treatment for festoons, schedule a personal consultation with Dr. Ghafouri at his Scottsdale office. Contact us by calling (480) 905-1010 or emailing Arizona Oculoplastic Specialists today.