How to treat malar festoons?

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!

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.