Options for genetic festoons? (Photo)

Hello rgifox - Thanks for your question.  I think that use of injectable filler that is soft, like Belotero or Restylane Silk, would work wonders to fill in the hollow.  I would follow up with some PRP microneedling of the whole lower eyelid to thicken and tighten the overlying skin.  I've had success with laser resurfacing, festoon excision, laser lipo of the festoons, etc.  Any one of these options might also work for you, but you need to be evaluated in person by an expert in treating festoons. Good luck, Dr. Shah

I suggest seeing an expert as this needs a formal evaluation and a combination of treatments for improvement.  Best, Dr. Emer.

It is difficult to tell from the photos what is going on. Sometimes, under eye fat can simulate festoons in which case lower blepharoplasty can help. Another option may be filler injection around the festoon to camouflage them. 

We agree with your dermatologist that laser or thermal treatments may be problematic. We have seen limited improvement in the appearance of congenital festoons by carefully adding volume below the bulge. In our practice we may prefer using Silikon-1000, an off-label filler for permanent results. Hope this helps. Dr Joseph

Festoons are difficult to treat. You may want to consider Morpheus8 treatments. These will stimulate your body's natural collagen production and improve the overall appearance of the festoons.

Thank you for your photo. True festoons tend to be difficult to treat because they are a combination of swelling and sagging skin/fat tethered into place by your facial ligaments and worsen over time. Your photo is a bit small so it is difficult to see exactly what is causing your problem. Festoons are best treated with an extended lower blepharoplasty (eyelid surgery) to release the ligaments and lift and retighten the skin and fat in the area. This can remove or significantly reduce the apperance of festoons. At the same time, your lower eyelid bags are fixed. If not, fixing or reducing the appearance of festoons may make your lower eyelid bags stand out even more. If you absolutely wish to avoid surgery, you may try fillers to blend the areas, although the effect may be minimal/mild and temporary. It is best to have an in-office examination to determine what areas of your face are affected to create the most effective treatment plan. Hope this helps!Johnson C. Lee MDPlastic Surgery