Is there a way to fix festoons? (Photo)

Question

I had facelift including under eye lift approximately 10 years ago. The surgeon originally suggested I have “a pinch” but I unfortunately thought a full under eye lift would be better. Unfortunately fat was removed that I didn’t have leaving me hallow. After years of filler, I now have festoons. Is there a way to fix festoons? I wear fake glasses to try to hide them. I want to be myself again. I’ve tried filler and very recent Morpheus 8 (series of 3) to no avail. Any help would be appreciated.

Jonathan Kulbersh, MD · Answer

Hello, thank you for your question. Festoons, also known as malar bags, are a common concern that can be addressed with cosmetic treatments. Festoons are pockets of swelling and fluid accumulation under the eyes, which can create a puffy or baggy appearance. Injecting filler strategically around the area can help smooth out the skin and reduce the appearance of festoons, resulting in a more refreshed and rejuvenated look. However, filler injections can also increase the problem, so meeting with a board-certified facial plastic surgeon is critical. Fillers can also be combined with other cosmetic procedures, such as laser resurfacing or microneedling, to help improve skin laxity and achieve maximum results.

I recommend scheduling an in-person consultation with a reputable board-certified facial plastic surgeon and expert injector. They will be able to evaluate your concerns and treatment history, then determine the best course of action to achieve your desired results.

I recommend scheduling an in-person consultation with a reputable board-certified facial plastic surgeon and expert injector. They will be able to evaluate your concerns and treatment history, then determine the best course of action to achieve your desired results.

Jason Emer, MD · Answer

For unique cases where a variety of modalities could be used to treat the condition, I would suggest an in-person or virtual consultation to develop a custom and effective treatment plan.  It is difficult to precisely define the best option without collecting the same information. I suggest reaching out to an expert for a consultation with surgical and non-surgical methods to get a comprehensive option. Best, Dr. Emer.

Anna Chacon, MD, FAAD · Answer

Festoon excision treatment is available for patients with more severe festoons, where there are significant amounts of overhanging skin and muscle present. The tissues can be directly excised, removing the dead space area where fluid collects.Laser Resurfacing: Laser skin resurfacing, utilizing sophisticated Erbium: Yag and Carbon Dioxide (CO2) lasers, has proven to be a preferred option for the treatment of festoons. Hope this helps

Eric M. Joseph, MD · Answer

Generally speaking, there is no great remedy for festoons. We have seen promising results using Morpheus 8, however, the information is relatively new. I believe in order to get significant remodeling of festoon fat, you would need a setting of at least 30 Joules and a depth of at least 3 mm to melt the fat in that area. Other than Morpheus 8 ,Other treatments tend to be more aggressive and possibly not worth the risk. I hope this is helpful! Sincerely, Dr Joseph

Nelson Lee Novick, MD · Answer

At least from the one photo provided, the upper cheek swelling see are not festoons and are more likely what has come to be called under "puffy pillows."  These swelling represent lymphatic obstruction (lymphedema) and are believed to arise from the use of an improper choice. HA filler injected in the tear troughs and/or too superficial placement of the HA filler. I have had success treating these in patients who have been filler treated elsewhere using an algorithm of varying intralesional injections of anti-inflammatory medications in differing concentrations and amounts. No surprise that the relatively expensive "bells and whistles" device treatments didn't work, since, unfortunately, the hard science to promote the use of these gizmos lags well behind the heavy social media and marketing hype to hawk them. Sorry. You would be wise to consult a board an experienced board certified cosmetic dermatologist and best of luck.

Camille Cash, MD · Answer

Festoons are difficult to treat.  Fillers can actually make them look worse.  If Morpheus8 had no impact you may need to consider laser treatments.  It's best to meet with a board certified plastic surgeon for an evaluation.  Together you can select the best treatment option for you.