Festoons and lower bleph - are fillers or fat grafting better alternatives? (Photo)

Thank you for your question and sharing your photographs. There are several points to consider in relation to your questions.

First, if the festoons have developed recently, it would be wise to avoid doing any treatments until your ophthalmologist has confirmed that your blepharitis has settled. If the blepharitis is settled and the festoons have cleared, then you can re-evaluate your options and potentially a skin pinch blepharoplasty could be a reasonable solution.

Second, if the blepharitis is settled but the festoons are still present, there is a technique for direct excision of the skin in the area of the festoons. It leaves very discrete scars and generally represents an acceptable solution.

Finally, if when the blepharitis settles, the shape of the lower eyelid appears just marginally problematic, volume enhancement in the midface can create a good contour.

Hello and thank you for your question. A formal evaluation would be needed to determine the best treatment. There are both surgical and non-surgical options to correct this, however, I feel you would need surgery.

For less significant puffiness and sagging UNDER the eyes, or more mild improvement, there are nonsurgical treatment options: we often use Renuvion helium plasma radiofrequency (RF) energy to achieve incredible results and take years off of your appearance. Combining RF energy and cool helium plasma, the signs of aging (wrinkles, pigmentation, skin laxity) are improved in a ‘Nonsurgical Lower Eyelid Lift.' The focused heating tightens and peels the outer skin layer with extreme precision, leaving the surrounding area undamaged, smoothing and tightening the periorbital skin, and improving the overall skin quality around the eyes. It's an aggressive treatment, and the recovery time is longer than with other nonsurgical procedures, but the results can be life-changing.​

Surgery (a lower blepharoplasty with or without canthopexy/canthoplasty or orbicularis muscle suspension) is a great option for more significant improvement- for example if there are more severe lower eyelid bags / bulging present, as in your case. Sometimes the surgery can also be used to intentionally adjust the shape and/or size of your eyes, or correct any asymmetries!

Dr. Donald Groves is an expert facial plastic surgeon that I work with, who specializes in these types of procedures. It is important that if you are considering surgery that you go to someone who is well trained and very experienced with these delicate operations to get the best results. I suggest getting a consultation with an experienced cosmetic dermatologist and facial sculpting expert, or an aesthetic facial plastic surgeon like Dr. Groves; we are both located right here in Los Angeles.

Best,
Dr. Emer

Festoons are difficult to treat. Lower blepharoplasty will not have much impact on them and fillers can actually make them look worse in some cases. You can consider lasers or treatments such as Morpheus8 to provide some improvement. Direct excision will give the best resolution of the festoon.