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.

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