What is your recommendation on festoons as per attached photos? (Photos)

Question

52 year old. Upper/lower lid surgery 6 years ago and very pleased with results. Sinus issues/genetics causing festoons. Tried diet/low salt/etc- they will not go away. Went in January and Dr added 2 syringes of filler in cheeks/tear area. In June severe swelling on one side where filler was. Steroids cured swelling. Dr says laser or fat would be the best course of action. The laser is VLB (or VLB) - Opinions?

Jason Emer, MD · Answer

there is no cure for this but microneedling RF and RF facials regularly with in office lasers like halo/erbium help.  you will need long term peels like aerify around the eyes weekly and MTS roller (see link) and I would suggest a blepharoplasty with fat pad repositioning you may need this on the lower now.  skin tightening will be important.  Best, Dr. Emer.

Mats Hagstrom, MD (license on probation) · Answer

I don’t think you have festoons.

Overall your body fat layer in your face is very thin and you can see some of the residual lower eyelid fat pads that are still present.

There also appears to be filler in the area.

I would let all the filler dissolve completely and then find the best Botox filler person in your area and stay with that person.

For example, in San Francisco I often refer patients to David Marbie, MD. You can check out some of his results on his website.

Look for someone with equivalent skills in your area.

I’m not sure what a laser treatment is going to do but I’m not a laser expert.

For some people less is more and they should consider leaving good enough alone and not trying to push the envelope over and over.

Best,

Mats Hagstrom MD

Val Lambros, MD, FACS (retired) · Answer

i dont see festoons. Festoons are draped and folded skin wrinkles occurring in the upper cheek and lower lids. You dont have that. What i see is a little medial hollowing in what looks like the left eye and what looks like filler laterally. The right eye seems to have what looks like some fat with maybe some filler.
It is often harder to fix small things than larger things on the face and you risk looking worse with far grafting. I dont think laser will help at all. 
You could try a small dose of hyaluronidase to see if some of the filler can be reduced.  Or you could leave it alone...perfect is the enemy of good.

What is your recommendation on festoons as per attached photos? (Photos)

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