Are these festoons? How to treat them? (Photo)

Question

I have this puffy bags under my eyes, one side is more prominent than the other. I believe they are festoons from what I see online. I had filler one time around 7 years ago so I don't believe it's from that. I've had somewhat mild laser treatments performed 3 times and see no improvement. What can I do to fix the issue

Harold J. Kaplan, MD · Answer

Hello Stel.  This does not look like your natural anatomy and does appear to be filler.  While it may seem strange for filler to hang around that long, we have seen it in the under-eye area.  Your best bet, if you have not done it thus far, is to have it injected with a hyaluronidase solution like Vitrase or Hylenex (see link below).  If it is hyaluronic acid based product it should dissolve.  From there you can determine how to move forward.

Zoran Potparic, MD · Answer

It appears that you have some residual filler which creates this lump. That happens occasionally after filler injection even if HA filler is used. If that is the case (this can be confirmed only with in-person consultation) removal of the filler is mandatory. The lower, transconjunctival blepharoplasty, to correct tear trough deformity, may be considered. Good luck.

Nelson Lee Novick, MD · Answer

At least from the photo and the history provided, the swelling seen is quite likely what has become known as under-eye "puffy pillows," a condition that results from the use of an improper choice of under-eye filler and/or too superficial placement of the filler. It is a form of lymphedema (lymphatic obstruction) and can start soon or long after filler the filler treatment and can be difficult to treat. I have been able to attain gratifying results using an algorithm of varying combinations, concentrations and amounts of intralesional anti-inflammatory agents. You would be wise to consult with an experienced, board certified cosmetic dermatologist. Hope this helps and best of luck.

Kenneth D. Steinsapir, MD · Answer

These fillers likely last forever in some form. As they age, they hold water in a way they did not when they were first placed. I recommend having a significant hyaluronidase treatment. One week later you can have a restorative filler service. For my traveling patients we often do the enzyme service at the beginning of the week with the initial consultation and the filler service at the end of the week before they leave the area.

Ralph M. Rosato, MD · Answer

You do not have festoons. AN examination is required to diagnose your condition however from the single photo it appears that you have aging in the mid face. This is a combination of laxity of the structures and loss of volume.  Treatments consist of fillers, fat graftng or surgery.

Mats Hagstrom, MD (license on probation) · Answer

It’s hard to tell if you have festoons based on the single picture. Have you had previous cosmetic surgery in this area? Festoons tend to be more lateral and have a slightly different appearance.
Sometimes we can differentiate true ideology in this area by very carefully observing the contour, and if it changes when the patient slowly begins to contract their orbicularis muscle.
I suggest consulting it with some senior, experienced plastic surgeons, facial plastic surgeons, or ocular plastic surgeons in your community.
Best,
Mats Hagstrom, MD

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