Eye festoons caused by filler, tear trough deformities and wrinkles. Best approach? (Photo)

Festoons are difficult to treat.  If they seem to have become worse following filler injection to the lower eyelid then it is quite possible that there were festoons prior to nasojugal injections and edema may now be present.  If it is filler a dissolving hyaluronidase should address the issue.  Unfortunately, festoons are not particularly responsive to surgical intervention even with an aggressive lower eyelid blepharoplasty nor fat transfer.   Treating the skin with less invasive modalities around the eye would be a better first approach.  Incidentally, how did the CO2 Laser work out for you?

If your festoons are from fillers, reverse with hayluronidase.  If you already had them, consider lasers, peels, microneedling to get improvement.  Best, Dr. Emer.

Thanks for your question. I agree with most of what the other commenters have stated. The first step is to identify WHAT filler was placed under your eyes. Most likely the next best step is to reverse the filler that is giving you problems (presuming it is reversible). After that relatively simple step, you can assess what you want done for the area around you eyes and the rest of your face.
Based on your photo, I agree that you would benefit from CO2 laser resurfacing of your whole face, not just around your eyes. It would make sense to do this all together instead of separately (twice the recovery!). 
In the long run you may benefit the MOST from lower eyelid surgery. This would allow removal of excess skin and saggy muscle, and smoothing out of the lower eye/cheek area. There are many ways to do this and to combine it with CO2 laser treatment. An in person consultation with a qualified surgical provider would be needed to come up with a plan unique to you. Warm regards.

There are various treatments available but none will give perfect results. Combination of procedures might be best. The main procedure you would benefit from is transconjunctival lower blepharoplasty with fat bags repositioning and skin pinch removal. Later may get additional benefit from touch up filler and laser resurfacing.

Festoons are caused by fluid retention in the delicate tissued between the eye and the cheek. Fluid drainage and dynamics can be upset by very subtle changes in some people. Filler injections completely change the fluid  flow dynamics in the cheek and this is causing the festoons. its actually a very common side effect. Do NOT have and CO2 laser. You need to have the filler dissolved and then see how it settles. there may ba a role for less cohesive fillers or surgery to reduce the festoons. I cant say more based on the limited information that you have provided. Best of luck for your future treatment.

Eye festoons are difficult to treat and if provider injects dermal filler as if it were a simple case of deep tear troughs the results are often just as you had experienced.  I recommend you either wait for HA to dissolve naturally or with treatment.  Personally I prefer to wait as the treatment to dissolve will create a lot of water under the skin and worsen the edema in festoons and can look worse for several days or longer.
I think oculaplastic surgeon is best but others may have needed experience. Since festoons are hard to treat, period, then ask if properly placed fillers by someone with lots experience can lessen their appearance. 
Good luck and let us know what you decide.

The filler that was injected could be dissolved using hyaluronidase injection. I would then followup with an oculoplastic surgeon to discuss your surgical options. 

Please consult an expert in under eye fillers and eye rejuvenation.  It appears that the product that was injected needs to be dissolved and then the appropriate steps can be taken to help you.  Best, Dr. Green

The first thing I would do is dissolve the filler if this has not been done already.  The filler can sometimes get trapped above the malar ligament and produce festoons and filler can also cause unwanted puffiness especially in the eye area.  If this has already been done, I think a fractionated CO2 laser is a good starting point. Lana Long MD