44 years old. Wound deep aggressive erbium laser help with my festoons?

Question

I’m 44. Been struggling with festoons for almost ten years now and nothing helps. Tried CO2, microneedling, even doxycycline injections. I don’t have any eye bags, just malar mounts on the upper cheeks. I don’t wanna have any surgery on my face. I’ve done some research and many doctors claim that a deep aggressive erbium resurfacing would help. But I’m starting to think that maybe these aren’t festoons? I don’t have any HA filler other than the lips. And Bellafill in marionettes lines.

Anna Chacon, MD, FAAD · Answer

At 44, and with a history of these areas being present for nearly 10 years, what you’re describing could certainly be in the festoon/malar mound spectrum, but the terminology can be confusing. Festoons, malar mounds, and chronic malar edema can overlap, and they are not necessarily the same thing. The absence of traditional lower-eyelid bags does not rule out a festoon.

A deep, aggressive Er (erbium) resurfacing treatment can improve the skin component of a festoon, particularly when there is mild-to-moderate laxity or excess skin. There is literature describing aggressive ablative resurfacing of the prezygomatic/malar area, including Er and CO₂ approaches. However, laser resurfacing does not reposition lax muscle or fat and does not reliably eliminate the underlying edema or fluid component.

That distinction is important in your case. If what you have is primarily malar edema or a deeper festoon with a significant fluid/soft-tissue component, simply going deeper with a laser does not necessarily make the problem disappear. In fact, more aggressive treatment in a delicate area has to be approached carefully because complications such as prolonged swelling, scarring, pigmentary changes, and ectropion are possible.

The fact that you have already tried CO₂, microneedling, and doxycycline injections without satisfactory improvement also makes me cautious about assuming that another resurfacing treatment will automatically solve it. Current reviews emphasize that treatment needs to be individualized according to whether the main component is skin laxity, edema, fat, muscle laxity, or a combination.

Your lack of filler in the cheek area is useful information, because filler-related malar swelling would be less likely based on what you've described. The Bellafill in the marionette lines is anatomically separate from the upper-cheek/malar region, so it would not be my first explanation for this appearance.

So, yes, deep Er resurfacing can help selected patients with mild festoons or malar mounds, particularly when lax skin is a major component, but I would not consider it a guaranteed treatment for a longstanding, pronounced festoon. The key question is what is actually creating the fullness in your particular anatomy rather than simply treating the area more aggressively.

And I completely understand wanting to avoid surgery. There unfortunately isn't a nonsurgical treatment that reliably eliminates every type of festoon, which is why getting the underlying anatomy right is more important than simply choosing the most aggressive laser setting.

44 years old. Wound deep aggressive erbium laser help with my festoons?

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