What is the difference between festoon and lower eyelid surgery?

I've seen two board certified plastic surgeons. Both recommend I have upper and lower eyelid surgery and also surgery to address festoons. What is the difference between festoon and lower eyelid surgery? It seems like the lower eyelid surgery would address the festoons? Thanks

Doctor Answers 9

Difference between festoons and lower eyelid puffiness

Festoons are a manifestation of edematous tissue below the orbital rim in a separate and different compartment of tissue. The lower lid fat pads are orbital and prolapse forward above the orbitomalar ligament. Often patients who have festoons also want lower eyelid blepharoplasty. If the blepharoplasty is planned through a skin incision, then both may be addressed through that incision. Festoons are difficult to manage because of the subcutaneous edema, stretching and thinning of the skin, the need to dissect multiple layers of tissue. Then, re-draping and support of these multiple layers (orbicularis, skin) must be accomplished to eliminate the festoon. Some festoons are massive and may be directly excised, but this has an associated risk of a visible scar - not a good idea when one is trying to improve their appearance with a cosmetic blepharoplasty! Best wishes with your decision.

Charlottesville Oculoplastic Surgeon
5.0 out of 5 stars 7 reviews

Lid festoons

Lid festoons or malar cheek bags are a combination of fluid accumulation, laxity and descent of the orbicularis muscle that surrounds the lid along with loss of soft tissue volume of the cheek, so that the cheek bone and orbital rim are exposed.  Although, these may be improved with a technique that elevates the droopy muscle, which is part of a blepharoplasty, you may require facial injectable fillers to the area surrounding the festoon or cheek bag to assist in contouring this region.

Jeffrey S. Rosenthal, MD
Fairfield Plastic Surgeon
5.0 out of 5 stars 6 reviews

Festoon of the Lower Eyelid

A festoon of the lower eyelid results when the lower eyelid skin is stretched, the fat form under the eye protrudes through the septum (a thin membrane that stretches also) and the malar (cheek) skin is deflated and descends. This is, in fact, an exaggerated tear trough. It can be repaired by lower eyelid surgery, but only with a component technique where the muscle is separated from the septum, the arcus (the attachment of the muscle to the orbital rim) is removed from the bone, the fat is draped over the rim and the skin and muscle is elevated and held suspended laterally to the lateral orbit, thus elevating the entire cheek. Care must be taken to support the eyelid so it does not pull down. Make sure whoever you see is an expert in this area. (See plasticsurgerytoday.com/face-rejuvenation-cosmetic-surgery-highlands-north-carolina/eyelid-surgery/)

Robert T. Buchanan, MD
Highlands Plastic Surgeon
5.0 out of 5 stars 6 reviews

Festoons and Lower Eyelid Surgery

"Festoons" can best be described as the area of tissue at the junction of the lower eyelid and cheek, which has a tendency toward fluid accumulation.  Sometimes, these festoons can be improved with lower eyelid blepharoplasty, but surgery will not address the proclivity for fluid retention after excessive salt intake, fatigue, allergy, etc.  Unless the festoons are really profound, I would not recommend direct excision.  I have included  a photo reference below of a patient who did gain significant improvement of festoons with lower eyelid surgery. 

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
4.8 out of 5 stars 95 reviews

What is the difference between festoon and lower eyelid surgery?

The anatomic difference is the lower lid is the ora below the eyeball vs the festoon is the cheek bone area or malaria zone. Best to ask next time you are in person with the surgeon to show you..

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 174 reviews

Festoons are tough

festoons are fluid accumulations at the lower border of the eyelid, where it meets the cheek. They result from lymphatic accumulation along the orbital retaining ligament. Lower eyelid surgery will not eliminate them but, sometimes, muscle suspension helps to improve them. The only surgery for festoons is direct excision, which most surgeons are reluctant to do, given the chance of scar visibility. 

Richard W. Westreich, MD
Manhattan Facial Plastic Surgeon
4.9 out of 5 stars 52 reviews

Festoon and Lower Eyelid Surgery

Festoons are swellings in the cheek and are below the lower eyelid.  While I agree with the other doctor who replied, I am not an advocate for direct excision of festoons, even if large, as this can leave unsightly scars on the cheeks.  I do believe that you would be much, much better off seeing an oculoplastic surgeon for treatment of this condition than general plastic surgeons who will have less knowledge of the anatomy and less experience in treating these conditions.  Good luck!

Lawrence Kass, MD
Saint Petersburg Oculoplastic Surgeon
4.9 out of 5 stars 134 reviews


Dear funinthesun,     To answer your question, it depends on how large your festoons are.  A festoon occurs when there is swelling beneath the lower eyelid and fluid retention.  This causes the skin to stretch and there is generally excess skin because of that.  Lower eyelid surgery addresses the excess fat in the lower eyelid to recontour and thin it. Laser resurfacing can help tighten the skin and collagen layer to tighten the festoon area to improve the appearance.  However, this does not work as well for very large festoons and they may need to be directly excised.  A full consultation would be necessary to give you the best opinion.  Furthermore, sometimes swelling is caused by other medical problems that could and should be addressed to also help the area.  Good luck.

Jasmine Mohadjer, MD
Tampa Oculoplastic Surgeon
5.0 out of 5 stars 2 reviews

Lower eyelid festoons versus lower eyelid blepharoplasty

Great question,Festoons can develop on the lower eyelids on patients that have from chronic swelling (edema) with skin laxity, or as part of their normal anatomy and aging changes.  Festoons are usually found at a lower position than the usual herniated fat pads seen when someone needs a fat-excission blepharoplasty.  Festoons are harder to remove since they sit so much lower on the face, and sometimes they do not go away 100% even after surgical excision.

Ana Carolina Victoria, MD
Miami Oculoplastic Surgeon
4.5 out of 5 stars 5 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.