How to treat malar festoons?

Question

What are the ways to treat malar festoons. Lower blepharoplasty performed without addressing malar festoons. Would midface lift help? Other suggestions. Are there surgeons that specialize in malar festoon correction, and if yes, would you have any suggestions for southern Wisconsin, Chicago area?

Nima Shemirani, MD · Answer

Hi @Julia W. Thank you for your question. Malar festoons can be difficult to treat. I recommend Morpheus 8. Morpheus 8 is a non-surgical treatment for full body skin resurfacing, skin tightening, and fat reduction of stubborn areas. It uses minimally invasive fractional radiofrequency energy (RF) to penetrate the skin deeper than other microneedling devices, triggering the skin’s natural healing response to promote skin tightening and lifting.

Best of luck,

Dr. Nima

Best of luck,

Dr. Nima

Jonathan Kulbersh, MD · Answer

Thank you for your question. Festoons can be difficult to address, which is why a dual-treatment approach is often the most effective. Surgical excision, followed by laser resurfacing and microneedling may provide you with the best results.

Laser resurfacing is used to remove the outermost layer of dermal tissue to reveal the smoother, softer layer of skin below. RF microneedling can also enhance the skin’s appearance by encouraging the body’s natural collagen production. I recommend scheduling an in-person consultation with an experienced, board-certified facial plastic surgeon who can assess your concerns and suggest the best approach for you.

Jonathan A. Schwitzer, MD · Answer

Unfortunately the best treatment for malar festoons is prevention. Festoons can actually be worsened by lower blepharoplasty as the lower blepharoplasty can worsen swelling/fluid accumulation in the area if you are prone to festoons. Patients undergoing lower blepharoplasty who have pre-existing festoons or are prone to fluid accumulation in the area should be treated with steroids both intra-op (IV steroids) and post-op (oral steroids) and /or diuretics. Persistent malar festoons that cause serious cosmetic issues can be excised with pretty nice results. The scar is typically well-hidden in the lid-cheek junction (where a crease is already present). Hope this helps!

David M. Kowalczyk, MD, MBA, FACS · Answer

Hi Julia! Festoons are a very difficult problem to correct. A midface lift tends to shift the problem more upward. One intervention which we utilize that has shown benefit is Morpheus8 microneedling RF via a festoon protocol. This utilizes energy-based technology to tighten the skin. Several treatments may be required in tandem with IPL. The results show improvement. Hope this helps!

Dean P. Kane, MD, FACS · Answer

Dear Julia W.:

I been in practice for over 34 years in the Mid-Atlantic region and
1.	I am seeing many more patients with more active fluid festooning associated with longer “allergy” pollen seasons (“climate change”?). This is compounded by lower lid surgery and cheek fillers with hyaluronic acid gels. Malar swelling or bags and festooning(a particular compartment of the cheek which is over the bone) is an evolving and difficult problem. 
2.	I have referred many a patient for Allergy, ENT, Oculoplastic consultations and there is no cross-specialty consensus for this concern.
3.	Steroid injection can cause more deformity than good.
4.	A Medrol dose pack or higher dose tapering prednisone prescription may be helpful.
5.	OTC sedating and non-sedating antihistamines, eg., Claritin, Benadryl, Xyzal are only somewhat helpful.
6.	Skin tightening with a TCA mid-dermal peel is helpful. Laser is not my first choice as it causes more inflammatory swelling.
7.	New options show promise but are not yet well experienced to help. These include:
a.	Microliposuction which may induce more collagen retraction as the modus operandi.
b.	Sculptra helps, possibly because of the same collagen synthesis and retraction
c.	RF works reasonably well as a minimally invasive skin tightening for the submalar face, jowl and neck and I am eagerly awaiting other peers experience with RF (radio-frequency) heating of the OcularMalar Ligament and 
d.	The use of tetracycline for fibrous contraction of the malar space. 
For the moment, oral anti-histamines, a short course of oral steroids and skin tightening are the best approaches. Always consult with a Board Certified Plastic Surgeon to evaluate and discuss your concerns. All the best.

How to treat malar festoons?

Answers (5)

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