Understanding Festoons and How to Treat Them

By Adam J. Scheiner, MD, Laser Eyelid and Facial Plastic Surgery

Posted on | By Adam J. Scheiner, MD

Some people call them puffy eyes. Others identify them as severe  bags under the eyelids. The medical term for skin folds and ballottable skin edema or swelling in the lower eyelids and upper cheek area is “festoon” or “malar mound.” While many of the people who suffer from this condition simply think it is an unpleasant sign of  aging, severe festoons can cause a dramatic aesthetic disturbance and can even lead to peripheral vision loss in extreme cases.

This isn’t just a case of vanity. Festoons broadcast a nonverbal message of being sick or tired. When you project a certain image, it is natural to begin to embody that image. Appearing sick and tired can make you feel sick and tired!

What Causes Festoons?

Factors contributing to the eye bags hanging in a hammock-like fashion and the puffy eyes that are characteristic of festoons include:

  • Sun exposure
  • Smoking
  • Genetics
  • Aging

When you have festoons, there is a structural problem beneath the surface of the eyelid. It is believed that underlying muscle-forces cause stress in the overlying skin in this specific part of the face. With time and exposure to the sun, this area undergoes subtle but progressive damage to the elastic fibers in the skin. This then creates a kind of gap in the skin layers, which leads to different amounts of swelling or puffiness during different times of the day or month.

Considering the cause of festoons, you can understand how eye creams, gels and other external treatments are completely ineffective. A topical product cannot cure the problem of herniated tissue and structural problems.

Until recently, the primary treatments for festoons were surgical removal, oral diuretics and steroid injections, but these procedures yielded minimal and often temporary results. Even blepharoplasty lower eyelid surgery, which is a common treatment for sagging eyelids, does not provide optimal results for the festoons condition and can even exacerbate the problem.

When Eyelid Surgery Isn’t Enough

Blepharoplasty rejuvenates the appearance of the eyelids for many patients, but individuals with festoons require additional treatment. With eyelid surgery alone, the fullness of the lower eyelid is removed above the festoon, which then highlights the puffy area making the issue even more obvious.

Because direct excision of the festoons results in unacceptable scars and other typical treatments are temporary or unsuccessful, patients suffering from festoons and malar mounds are left wondering what they can do to achieve a healthy, vibrant and more youthful look.

There is now a new specialized laser resurfacing process to treat the condition and manage the critical wound healing protocol following the procedure. Taking advantage of these latest advances in laser application and wound healing makes it possible to dramatically improve the festoons condition. When utilized along with lower eyelid surgical rejuvenation, the procedure leads to a more natural and complete revitalization of this expressive part of the face.

A bonus to the festoons laser resurfacing procedure is the fact it can remove precancerous areas that may be below the surface, as well as those already visible on the skin. While the festoons themselves are not cancerous, doctors have discovered they can be markers for pre-cancerous skin conditions.

Laser Skin Resurfacing for Festoons: How It Works

Laser skin resurfacing, utilizing sophisticated Erbium:Yag (Er:Yag) and Carbon Dioxide (CO2) lasers, has proven to be a preferred option for the treatment of festoons. This groundbreaking procedure takes advantage of creating a wound in the area of the festoon and coaxing the skin to heal this area with better quality skin.

By purposefully injuring the skin with just the right amount of injury, the skin can heal without any problems with scarring and, in fact, with better quality skin.

Treatment of festoons by modified resurfacing techniques can be accomplished in about 10 minutes per lid. In contrast, invasive surgical procedures are more time intensive and provide results which are often less than optimal.

Frequent follow-up appointments after the procedure are essential and allow for better management of the healing process as well as early recognition of complications. Having a doctor who is dedicated to postoperative laser skin healing care and detecting possible complications is critical to the clinical and aesthetic outcome.

When performed expertly, festoon reduction by modified laser skin resurfacing is an effective treatment, which can greatly improve the overall aesthetic outcome in rejuvenation of the lower eyelid and cheek region. This is a powerful area for nonverbal communication since people are constantly looking at each other’s eyes in conversation. Improving these festoons can make a huge impact on the way the world perceives a person suffering with them.

Facial Rejuvenation and Relief From Festoons

Modified laser skin resurfacing techniques offer a predictable, rapid, and safe treatment for lower eyelid festoons. Having a doctor knowledgeable and skilled in laser safety, laser use and the wound care required after the procedure are necessary to achieve the optimal clinical results that this procedure can provide.

Laser skin resurfacing, in general, and laser festoon reduction, when needed, can add greatly to the overall aesthetic outcome in rejuvenation of the lower eyelid and cheek region.

The images below speak for themselves in illustrating just how powerful and successful laser skin resurfacing can be for individuals seeking relief from festoons. [Left: Before surgery; Right: 11 days post-op]

Article written by Adam J. Scheiner, MD
Laser Eyelid and Facial Plastic Surgeon