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Surgical Treatment of Festoons

Surgical Treatment of Festoons: 

Introduction

Festoons, also known as malar mounds or cheek bags, are persistent puffiness or swelling in the lower eyelid and cheek area. Unlike standard under-eye bags, festoons are caused by fluid accumulation, muscle laxity, and weakened connective tissue. While non-surgical treatments like fillers and lasers can provide mild improvement, surgery remains the most effective solution for severe cases.

In this article, we’ll explore the surgical options for treating festoons, including preoperative considerations, procedural techniques, and recovery expectations.

Understanding Festoons: Causes and Anatomy

Festoons develop due to:

  • Laxity of the orbicularis oculi muscle (the muscle around the eye)

  • Weakening of the orbital septum (the membrane that holds fat in place)

  • Lymphatic fluid buildup due to poor drainage

  • Sun damage and aging, leading to loss of skin elasticity

Unlike standard under-eye bags (which are caused by fat herniation), festoons involve sagging skin, muscle, and fluid retention, making them more challenging to treat.

Surgical Treatment Options

1. Lower Blepharoplasty with Orbicularis Oculi Muscle Suspension

The most common surgical approach involves:

  • Tightening the orbicularis oculi muscle to lift and support the festoon.

  • Repositioning or removing excess fat (if needed).

  • Resecting (trimming) loose skin for a smoother contour.

Procedure Steps:

  1. Incision: Made just below the lash line or inside the lower eyelid (transconjunctival approach).

  2. Muscle Suspension: The surgeon tightens the orbicularis oculi muscle using sutures to lift the festoon.

  3. Fat Repositioning/Removal: Excess fat is either redistributed or removed to improve contour.

  4. Skin Trimming: If needed, excess skin is excised for a smoother appearance.

2. Direct Excision Technique (for Severe Cases)

In extreme cases where festoons are very prominent:

  • A small incision is made directly over the festoon.

  • Excess skin, muscle, and fluid are removed.

  • The area is carefully sutured to minimize scarring.

This method is more invasive but provides dramatic improvement in stubborn cases.

3. Laser-Assisted or Radiofrequency Tightening (Adjuvant Therapy)

Some surgeons combine surgery with:

  • CO₂ laser resurfacing to tighten skin.

  • Radiofrequency (RF) treatments to stimulate collagen and improve skin texture.

These adjunct therapies enhance results by promoting skin tightening and reducing recurrence.

Recovery and Postoperative Care

  • Swelling & Bruising: Expected for 1-2 weeks; cold compresses help.

  • Activity Restrictions: Avoid strenuous exercise for 2-3 weeks.

  • Scarring: Incisions are well-hidden; scars fade over months.

  • Final Results: Visible after 3-6 months as swelling subsides.

Conclusion

Surgical correction remains the gold standard for treating festoons when non-invasive methods fail. Lower blepharoplasty with muscle suspension provides long-lasting improvement, while direct excision is reserved for severe cases. Consulting with an oculoplastic or facial plastic surgeon is crucial for personalized treatment planning.