Revision surgery for festoons - does this sound a reasonable solution for lump under eye? (Photos)

Festoons are one of the more difficult entities to treat. It sounds like your surgeon is recommending an “extended” blepharoplasty. This involves making an incision in the lateral canthus (corner of the eyelid) and tightening the muscle (orbicularis) and skin. This is a reasonable option although the festoon can reoccur. I tend to combine aggressive CO2 laser with this procedure. The other option would be excision which does leave a scar but typically heals well.

Your surgeon may be planning a direct excision of the festoon. This can be successful or it can leave unacceptable scaring. The festoon develops due to scaring in the superficial plans of the cheek that should otherwise glide or slide. One of the challenges of fixing these is that these scars cannot simply be removed. I do think you have reason to be concerned about what is planned.

Festoons are not all that well understood and inherently difficult to treat. There also appears to be some individuals who have edema in this area which we don’t have an explanation for. The best surgical solutions start with having a clear understanding of what the problem is.
The chance of quality outcomes goes down when the diagnosis or underlying ideology is uncertain, and treatment is not directed at the exact cause of the problem.
I suggest you get a clear understanding of what your surgeon is planning to do including potential scars, and potential complications.
Expecting skin tightening from the lateral canthus to put tension on the skin to flatten the festoon sounds like a tall order to achieve.
Personally, I’m of the belief that second opinions are in order when patients are in doubt.
Second opinion, consultations should be done as in person consultations. Patients should come prepared bringing with them a complete set of before and after pictures and a copy of their operative report.
Your situation may be more complex and difficult to treat, then first imagined.
Recognize that some conditions simply don’t have easy remedies.
Best,
Mats Hagstrom, MD