Festoon Treatment


What are festoons?

Festoons refer to the triangular area of the cheek of excess tissue and where fluid develops. Other terms for festoons include malar mounds or malar bags. Festoons are not the same as “eye bags”, which are a semi-circular area directly under the eyes, that are related to herniated orbital fat. Eye bags are primarily fat, festoons are primarily fluid and non-fatty soft tissue.


Why do festoons look the way they do?

Festoons are always different variations of a triangular shape. They are always in the lateral cheek region. The consistent shape and location of the festoon has to do with anatomy. Simply, there are ligaments that support the facial structures. The triangular borders of the festoon are due to ligaments that support the facial structures near the festoon. As facial tissue descends and volume loss progresses with time, the ligaments become more visible and reveal the festoons.


How can I treat my festoons?

First, your doctor may ask about other causes for fluid retention, such as salt intake, high blood pressure, and kidney disease. After removing other factors that may be worsening the festoon, other treatments can be considered. Some treatment options include direct festoon excision, doxycycline or tetracycline injections, CO2 laser, and lower eyelid blepharoplasty.


Doxycycline or Tetracycline injections are one treatment option. These are given as an injection in the office setting. The injection allows a straightforward treatment that allows for a quick procedure without incisions. Dr. Chon has published on the results of this treatment during his time at Cleveland Clinic with his mentors and have studied the safety of the injections. For mild or moderate festoons, this may be an ideal treatment option.


CO2 laser is an alternative treatment that has an intermediate amount of downtime between injections and surgery. Treatment can both help reduce the appearance of festoons, as well as improve skin quality and texture.


Direct Festoon Excision is the most reliable way to successfully remove a festoon. The festoon is marked around the festoon, and excised. The skin is closed with sutures, which are removed at a later point. This runs the risk of a potentially visible scar, though often the scar heals well.


Lower eyelid blepharoplasty is an alternative approach to treating festoons. For the appropriate patient, lower eyelid blepharoplasty can both treat lower eyelid bags and festoons.