What is the best way to get rid of festoons? My doctor made them worse after a blepharoplasty.

Question

I am 4 months post op and I am worse then when I started!! This doctor ruined my face. He wants me to now try doxycycline injections Any advise?

Lawrence Kass, MD · Answer

Thank you for your question.  I am truly sorry that this has happened to you.  While I cannot disagree with the idea of waiting a little longer and I am aware that there have been some reports of success with doxycycline injections, it would not surprise me if you will require revisional surgery.  Festoons are a serious problem that are often overlooked by surgeons eager to do blepharoplasty.  And sometimes, the eyelid surgery can make the festoons worse.  I think that, in my hands, it is likely that you will require a SOOF (suborbicularis oculi fat) lift with Hetter Resurfacing.  This is a perfect example of why eyelid surgery is best performed by oculoplastic surgeons, and not by general plastic surgeons who generally have little understanding or training in periorbital anatomy.  Please see an expert for your repair if necessary.  Good luck!

Thomas A. Mustoe, MD, FACS · Answer

Your festoons look like postoperative swelling that has failed to resolve.  I have seen festoons persist for as long as a year with gradual resolution.  That area of the cheek has impaired lymphatic drainage, and rarely can take a long time to resolve.  In my own experience, dilute steroid injections have sometimes been helpful.  At this time the best thing to do is conservative measures only. I would not consider additional surgery for at least a year.

Zoran Potparic, MD · Answer

Unfortunately, healing after this type of surgery can last months, in rare cases over a year. Condition will improve in time but waiting is difficult. Massage of the eyelids would help to eliminate fluid retention (lymphatic drainage compromise is one of possible reasons for festoons??) and avoid eyelid contracture and pseudo-ectropion. I am not aware of benefits of doxycycline for treatment of this condition? Stay in contact with your surgeon and try to be patient. Good luck.

Lucas Bryant, MD · Answer

Thanks for your question and sharing photos. It would be good if we could see before and after photos. There are many, many different ways to do eyelid surgery, but any lower eyelid surgery can, on occasion cause  prolonged swelling in the area. This is for two reasons, first, the blood flow to the operated area is increased. Second, the lymphatic and venous drainage pathways of the area have been disrupted from surgery and need time to restore themselves. At 4 months out, you have a few possible treatment options, but a physical examination would really be necessary to make a complete recommendation. There are some anti-inflammatory injections, you can try lymphatic massage and eye exercises, amongst other things.
Tetracycline (a relative to doxycycline) has been reported rarely as a treatment for festoons. It is an antibiotics that is a sclerosing agent, which means it causes a chemical scar reaction to prevent fluid build up in tissue where it is injected.
You are still in the healing stages of your surgery, but I think there are probably still some things that can be done to help speed along the process. As always, even if you get a second opinion, make sure you keep in touch with your treating surgeon. Warm regards.

John Alexander II, MD · Answer

I'm sorry your having such a challenging post operative experience.  It is not uncommon to experience post inflammatory changes under the eye area at 4 months post.  Swelling  can occur up to 6 months post surgery.  It is best to wait until 6-12 months post surgery before operating on the same area.

Jeffrey M. Joseph, MD · Answer

while they may improve with more time, your festoons will likely need additional treatment. Consider discussing both surgical and non surgical options with an eyelid specialist.

Patrick Flaharty, MD FAACS · Answer

Your photos show subcutaneous fluid at the lid-cheek junction of both lower eyelids, the right worse than the left. Given that you notice this is worse than before blepharoplasty suggests that this is retained fluid which has not resolved after surgery. I recommend a conservative treatment of a low salt diet and frequent lymphatic massage (4X per day). Lymphatic massage is performed by using the pads of your finger tips to roll over the fluid pockets from the inner eyelid to the outer eyelid. In essence you are rolling the fluid out, pushing it into the deeper tissue and activating the lymphatic channels to absorb this fluid. Once the fluid is gone you can then decide if further treatment is necessary for the loose skin but until the fluid is gone it is hard to know if anything additional will be needed. This may take a few more months to resolve. Treatment considerations going forward include direct skin removal (cut out the festoon), indirect ski removal (remove additional skin under the lash line), and CO2 laser resurfacing to shrink and tighten the skin.

Elbert T. Cheng, MD · Answer

Thank you for your question and I'm sorry you're not happy with your result.  I reviewed your pictures and it would be helpful to see before pictures, but having mentioned that my advice would be to go back to your surgeon and follow-up.  Stay in close contact with your doctor because your face and eyelids will change over 12 months.  He/she can help you in this process, especially because they performed the surgery.  Best of luck to you!

What is the best way to get rid of festoons? My doctor made them worse after a blepharoplasty.

Answers (8)

More Eyelid Surgery Questions

Best treatment for fine lines under the eye for a younger patient?

Blepharoplasty caused incomplete blink which caused MGD and many issues, could surgery help?

I had transconjunctival blepharoplasty 5 weeks ago. My eyes look round. Will the wrinkles go away? (Photo)

Is it safe to inject under eye filler after sclerotherapy treatment under the eye?

Please help me understand why my saggy skin is far worse after bleph than before? (Photos)

Follow-up question: Could orbital rim implants or a mid facelift along with a canthoplasty help this issue? (Photos)

WE SEND PRETTY
EMAILS