Malar Festoons: Two Questions?

Malar festoons are often asymmetric.  Their treatment is difficult.  In fact, this is an area of facial surgery in need of much better solutions.

 

Unfortunately,  the fluid can not be simply aspirated from festoons.

 

 

      I have used fillers and laser resurfacing to help with this condition.  Usually multiple modalities are needed.  Due to the fact that the swelling is not going away, fat grafting for camouflage provides a more durable solution that temporary filler.  Also, people with these festoons do benefit from diuretics, but these should never be prescribed for cosmetic purposes.  I notice this most commonly with patients starting thiazide diuretics to control high blood pressure.

Asymmetry is quite common among festoons, and can be unilateral.

And as you guessed yourself, the problem is "interstitial" in that it is within the intercellular spaces and CANNOT be aspirated. This is one of the toughest problems to deal with and more often than not, a perfect solution does not exist. Depending on the extent of the festoon, laser resurfacing or direct excision of the tissue may be helpful.

Malar bags and festoons can sometimes be quite asymmertical and  they can be  be unilateral or bilateral.  They are composed of interstitial fluid and cannot be aspirated.  There is no one technique that works well, but a combination of lasers, injections and direct excision is sometimes necessary

Everyone has an assymetric face.  One sided eyelid bag or festoon is not uncommon.

The swelling can not be aspirated. If it is determined to be fat the Cellulaze Sidelaze may be appropriate to melt the fat.

Injections of Kenalog or Fluorouracil may help to decrease the swelling.

Please consult with a Board Certified Plastic Surgeon in person prior to making any treatment decisions

As Dr. Amadi alluded to this is a difficult problem to treat. It's critical that people with festoons don't undergo a lower blepharoplasty alone to improve this area as it will lead to disappointment. Resurfacing, skin excision and fillers can be helpful in some cases. Often, multiple approaches or multiple treatments are required to provide the desired level of improvement. Lastly, asymmetry is the rule rather than the exception and it totally normal. I hope this information is helpful.Stephen Weber MD, FACS