Possible festoons? Will HA fillers make things worse? (photos)

Question

I sometimes swell up along my upper cheeks. I'm pretty sure they're festoons. Which sucks. I wanted to get tear trough and mid-cheek fillers but my festoons showed up. They don't look this bad all the time. I'll post photos with pics from a few days ago and today so you can see the difference.

Trevor M. Born, MD · Answer

Dear jbabjbabThank you for your question and photos!  Fillers may make the festoons worse and chronic. In fact any procedures may make it worse. Fat grafting can be considered, with caution.With Warm Regards Trevor M Born MD

Alexander Rivkin, MD · Answer

Hello and thank you for your question.   When treated carefully and precisely with fillers, your tear troughs and malar fat pads (festoons) can be camouflaged well.  Since it seems that the intensity of the festoons differ from day to day, it is important to have your injector under-treat to account for the water retention that happens when injecting a hyaluronic acid filler.  Be sure to seek an experienced injector who specializes in facial aesthetics for best results.  Good luck!

Nelson Lee Novick, MD · Answer

Close examination of the photos evidences volume loss-related flattening of the mid-face with resulting development of smile lines, marionette lines below and malar separation and bag formation under the eyes. Rather than direct treatment of the "festoon" under the eyes, it would seem most appropriate to revolumize the mid-face, which acts to support and buttress the undereye region and to lift and recontour the smile line and marionette line regions below. Properly performed, there should not only be shape and contour improvement of the cheeks, but secondary diminution in the bulgy "festoon" regions under the eyes. Following this, should it be deemed necessary, a small amount of filler may be layered into residual tear troughs to further elevate and smooth them and create a more gradual upper cheek to lower lid transition. Voluma XC would be my choice for the cheeks and Belotero Balance for the tear troughs in my NY practice. (In my Israel satellite facility, where a far greater number of regulatory agency approved fillers and volumizers are available, I would opt for Stylage XXL for the cheeks and Teosyal Redensity II for the tear troughs). This kind of nonsurgical facial reshaping and recontouring are advanced injections skills that should not be left to the hands of novice or medspa injectors accustomed only to treating simple smile lines with ordinary Restylane.So, make sure that you consult with a board certified aesthetic physician and ask to see his/her personal before and after photos before agreeing to proceed. Best of luck.

Michael A. Zadeh, MD, FACS · Answer

Festoons are a difficult thing to treat and there's really no great non-surgical treatment for them. You can camouflage them somewhat with fillers, but this is definitely an advanced injection technique and you need a physician with good knowledge of the anatomy and the process. You would need to use a filler that does not pull in much water to prevent them from looking worse. We have also found some temporary improvement with radiofrequency treatments. Make sure you see an experienced physician for an in-person consultation and evaluation. Best wishes.

Manuel M. Peña, MD · Answer

Festoons can be made worse by fillers and even if they are not hydrophilic (pull in water).. If they appeared worse shortly after an injection of hyaluronic acid fillers then you can consider having a dissolving agent applied to the medial aspect of the tear trough where was injected.  This seems to be the "drain" for the lymphatic of this area.  If this works then have your injector avoid this area and perhaps fill your malar area, medial to the festoon. Make sure that your injector has a lot of experience injecting around the eyes..

Daniel Lafond, MD · Answer

Hi!
Fillers are a good option to improve the cheeks and under the eyes area. You seem to be prone to swelling so choose a experienced aesthetic injector. He/she will choose a filler with less hydrophylic property ( tendency to retain water). Maybe consider to undertreat the area and maybe treat it in two separated sessions. People with festoons can be treated.

Evelyn Feng, MD · Answer

this is a difficult area to treat....we can inject below the malar fat pad to hide the it, and also inject the tear troughs. It will improve the appearance, but not necessarily eliminate completely..

Leonard Grossman, MD · Answer

The single best way to treat festoons is with autologous fat grafting. Fat will revolumize your face and create a natural look that will last you for many years to come. On very rare occasions do I find it necessary to remove any skin from a festoon in patient like yourself. Good luck from New York City

Leonard Tachmes, MD · Answer

Hi and welcome to our forum!
Fillers may camouflage the protruding fat pads. If they fail to give you your desired result, consider blepharoplasty to remove the herniated fat pads of the lower lids. As there is no significant skin laxity, the procedure can be performed on the internal aspect of the lid, leaving no visible skin scar.
If this option appeals to you, visit a board certified plastic surgeon.
Best wishes...

Possible festoons? Will HA fillers make things worse? (photos)

Answers (9)

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