What is being treated

The mound or pouch located below the eyelid at the upper part of the cheek.

What is a festoons treatment?

The treatment for malar mounds or festoons depend on the type of festoon and its underlying cause.  As with all cosmetic eyelid surgery, there is not one singular treatment that treats all types of festoons.  Often a combination of treatments is used, as determined by your doctor.  Lower blepharoplasty or lower eyelid lift is primarily directed at improving the eyelids themselves, but can also target the festoon area below the eyelids.

Volume loss- If the festoon is caused by hollowing or loss of facial fat, it can be improved with the addition of volume.  This can be achieved with injectable fillers, fat injections, or facial implants.

Sagging skin- Skin folds may be related to volume loss and/or aging of the skin itself.  When the festoon is caused by folded skin, it may be removed directly on the cheek with a skin removal, but this places a scar on the cheek.

An extended lower eyelid lift may lift the skin upward and outward to flatten the fold.  Often this is performed with the addition of volume (fillers or fat).

Laser resurfacing can also improve the skin quality and may reduce folding.

Fluid pouches- The underlying cause of fluid retention should be investigated and addressed.  Laser resurfacing and lower eyelid lift surgery can reduce fluid pouches but there is a possibility they can recur.

Ligamentous stretching- Lower eyelid lift surgery can be directed at isolating and elevating the orbitomalar ligament and surrounding tissues to correct sagging of these structures.

A typical festoon reduction surgery

The surgery to correct festoons is a multi-targeted plan to fix one or several of the age-related problems listed above.  The cosmetic solution may include a surgical procedure to remove or redrape lower eyelid fat, tightening of the eyelid muscle (orbicularis lift), fat injections to deflated areas around the cheek mound, and removal of lower eyelid skin or laser resurfacing to the lower eyelid to shrink the skin.  Festoons have a reputation as being difficult to correct and there is not a universal technique that works for all festoons. Your oculofacial surgeon will evaluate you before suggesting an appropriate treatment plan.