What are Festoons?
Festoons are unattractive bags on the cheeks which occur in some people creating a fatigued look to the face. They are also called cheek or malar bags, or even malar mounds. When they are pronounced, they are difficult to cover with makeup and may cause seriously deleterious effects on one’s appearance. What is worse is that some folks, who may not know better, assume that the person with them suffers from a lack of sleep or excessive drinking.
Unlike bags in the lower eyelids, festoons are not due to herniated or anteriorly protruding orbital fat, and they are not improved with eyelid surgery. In fact, cosmetic surgery on the lower eyelids, which does not specifically address the festoons, may even make them appear worse by removing the eyelid fullness above the festoon.
See Clinical Descriptions of Selected Patients in Photo Galleries: Festoon Elimination Before and After Photos
Patients may go from doctor to doctor seeking help and may actually be told (falsely) that that this is a non-treatable condition. This is because traditionally, festoons have been difficult to treat. Non invasive procedures such as Botox and fillers, thread lifts simply do not help. Other procedures like microneedling and radiofrequency treatments such as Thermage are often of limited benefit and give disappointing results. As mentioned above, festoons are not improved with traditional lower eyelid lifts (blepharoplasty). Unfortunately they are not improved with a facelift surgery either.
If the festoons are related to injections of fillers (possibly many years earlier) into the cheeks or under the eyes or in the tear troughs, then injections of hyaluronidase may be indicated as an initial treatment option. After this, the only nonsurgical option which might result in significant visible improvement is doxycycline injections to the festoons. Dr. Kass has personally seen positive results in a handful of patients he has treated with doxycycline. Doxycycline should not be injected more than one or two times to each festoon. Please know that not all festoons are the same. While it would be wonderful if all festoons would respond to doxycycline, in Dr. Kass’ experience many, if not most, do not.
And if your non-oculofacial plastic surgeon suggests that he or she can treat your festoons either with commercial fillers or by Fat Transfer (normally a wonderful procedure for other conditions), we suggest that you run, don’t walk, away from that doctor before he or she worsens the festoons or causes irreversible harm to your appearance.
Vigorous laser resurfacing and direct festoon excisions may be fraught with prolonged healing times, pigmentary changes with obvious demarcation lines, undercorrections, or unsightly scars.
We believe that Dr. Kass has developed treatment options for this difficult problem which have proved greatly successful in the vast majority of the patients he has treated. Treating the festoons with a combination of ligation or cauterization of festoon feeder vessels, excision of hypertrophied orbicularis muscle with orbicularis muscle plication, a midface lift, and, if necessary, a unique resurfacing technique, Dr. Kass avoids the unacceptable scars associated with direct surgical excision, and also avoids the use of costly, less predictable, and more dangerous laser procedures.
There are very few surgeons, even amongst the super selective field of oculofacial plastic surgery, who have the requisite knowledge and experience to perform such delicate procedures near the eye. And even among these few who do, most of the others rely on severely burning the skin with invasive laser treatment which could result in prolonged healing time and permanent pigment abnormalities. We truly believe that our treatment options are superior and our many, many happy patients can attest to this fact. Of course, there are never any guarantees with surgery and healing times and individual results may vary. But Dr. Kass’ results really surpass the expectations of the vast majority of our patients who are thrilled with the outcomes we have achieved. Furthermore, the chances of festoon recurrences are extremely low.
Dr. Kass has treated so many patients who are desperate and despairing because of their unsightly festoons. He routinely treats patients who come to him from far away for his expertise and the excellent results that he achieves.
Please see our photo gallery of before and after Dr. Kass’ unique surgery to treat festoons. He personally developed and perfected this technique over many years. See for yourself the results which he has achieved and then decide if this treatment is right for you!
Still not sure? Here’s what some of our patients have said:
Festoons and Upper Eyes *****
5 months post-op
I had upper and lower eye lid surgery as well as had my festoons treated. Dr. Kass and his staff were wonderful and made me feel taken care of throughout the surgical process. I healed beautifully and would highly recommend Dr. Kass for anyone considering eyelid surgery.
Eyelid Surgery and Festoon Treatment *****
2 months post-op
Wonderful experience and staff. I had my upper and lower eye lids and festoon treatment done by Dr. Kass. I was so tired of people asking if I was tired or “ok” before surgery because I had loose skin around my eyes. Now I look refreshed and younger and feel better too. My results were so great that my mother scheduled her surgery shortly after mine. We both are very happy and would highly recommend Dr. Kass.
Festoons Malar Mounds – A FIX !! *****
6 months post-op
It has been a full six months since my surgery with Dr Kass so now I’ve pretty much reached the final result it’s time to write a review. Just one look at the pictures show that the results are outstanding. Rather than wax lyrical about how wonderful Dr. Kass and his staff are (I enjoyed dealing with them – but that’s subjective) I’m going to simply list out practical information relevant to the questions I had when I embarked on this surgery adventure.
Cost and method
I had the festoons treated and my brow lifted. The cost for both procedures was about 25% less than the other cosmetic the other widely publicized cosmetic surgeon in Florida that treats festoons through aggressive ablative laser treatment. Dr Kass did not discuss his exact method, but judging by the short incision hidden in a natural smile line, and the way the swelling resolved over the days and weeks, I suspect he used a thin cauterizing probe to fuse the malar pockets shut from the inside without damaging the surface of the cheek.
I was given twilight happy meds and I found the surgery to be a curious non-experience. I was vaguely aware somebody was prodding the top of my head. The entire surgery seemed to last for about 5 minutes – although in reality several hours passed. And then I remember finding myself dozing peacefully in my hotel room with my face all bandaged up.
Healing and scars
80% of the busing and swelling was gone within 8 days. The red line of the scars to about 8 weeks to fade. I was able to hide the scar with makeup. I’m a guy, so this was new to me – so for the sake of other guys reading this I’ll explain: I purchased a tube of Mabelline Master Conceal off Amazon for about $6. I picked the color I guessed was closest to my skin tone. I dabbed a tiny dot of it onto the end of each scar using a Q-Tip swab, and drew it along the scar. It looked terrible – wrong color, far too light. I then smudged it with the tip of my finger and like magic, the color blended with my skin and the scar disappeared. I was surprised how easy it was.
Other Practicalities
Tamp Airport is well signposted, and very simple to navigate compared to monster airports like Dallas DFW or London Heathrow. Just step outside of the airport terminal and call an Uber – it will stop right by the curb where you are standing. The fare to the hotel was $29.
The most convenient hotel is La Quinta – 66387 4th St. It is literally a 7 minute walk along the same street to Dr Kass’ office. The hotel was clean and ‘OK’ – the service was non existent because it was during the Covid pandemic – but there were several great cafés and restaurants within 10 to 15 minutes’ walk south of the hotel. The sidewalks were clean and pleasant to stroll along, but the roads are very wide – you need to use the crosswalks to cross them. – and grub hub will deliver if it is raining.
I arrived the afternoon before the surgery, checked in to the hotel and then met with Dr Kass. The surgery was the following morning. I went home two days after that. Your mileage may vary.
If You Have Festoons, Call Dr. Kass!
TL;DR: I had upper and lower blepharoplasty plus festoon treatment with Dr. Kass, and I’m very happy with my results. My festoons are completely gone. If you have festoons, I highly recommend that you contact Dr. Kass. For those of you considering this procedure, I know you’ll want all the details so read on.
My festoons started really bothering me when I was in my late 30’s / early 40’s. In 2018, I contacted a local board-certified plastic surgeon to see what could be done about them. He recommended a lower blepharoplasty, fat transfer, and laser treatments. Though he warned me that festoons were hard to treat, he was confident that we could significantly improve mine. Following this plan, I had a lower blepharoplasty with fat transfer in August 2018, Halo laser treatments in early 2019, and Contour TRL laser resurfacing in late 2019. Unfortunately, the lower blepharoplasty only made my festoons more noticeable and the laser treatments did not significantly improve the festoons. By 2021, I was feeling so self-conscious about the festoons that I rarely took pictures without sunglasses and I often continued to wear a face mask in public even after they were no longer required.
In summer of 2022 I started doing more research on festoons and possible treatments. I found two doctors that specialize in festoon treatment, both located in Florida. After reading every review on these two doctors that I could find, I decided to contact Dr. Kass’s office. I sent in pictures and we did my consultation over the phone. Dr. Kass determined I was a good candidate for treatment and I set my surgery date.
At my in-person pre-op two days before my surgery, Dr. Kass was very patient and willing to discuss any questions and concerns that I had. Since I was travelling alone to Florida, Dr. Kass’s staff had put me in contact with a local nurse that could drive me to my surgery and take care of me afterwards. I slept most of the day of the surgery and was never in any significant pain.
I looked horrible the next morning, but I followed all my post-op instructions and I saw improvement every day. I took pictures every morning so I could track my progress (highly recommend doing this). By my suture removal appointment on Day 8 after surgery, most of my swelling and bruising had resolved. I flew home on Day 9 after surgery.
For the next several weeks, I didn’t feel very comfortable around friends who didn’t know about my surgery. My eye shape looked more round than normal and my scars weren’t completely hidden by concealer. My eyes went back to a more normal almond shape around 2 months post-surgery. Now at 4 months post-surgery, my festoons are gone, my eye shape is great, my scars are continuing to fade and flatten, and I’ve scheduled family pictures in a few weeks!
I was very nervous to spend more money and time on additional festoon treatment when nothing that I had tried before had worked; but I’m so happy with my results. I wish I had found Dr. Kass sooner!
What are Festoons?
Festoons are noticeable puffiness or bags that appear on the cheeks, giving the face a tired or aged appearance. Often called malar bags or malar mounds, these bulges can be hard to conceal with makeup and may lead others to mistakenly think someone is fatigued or unwell.
Unlike traditional lower eyelid bags caused by protruding orbital fat, festoons are a distinct condition that eyelid surgery alone cannot fix. In some cases, eyelid surgery that doesn’t address festoons can even make them more apparent by removing fullness above the area.
View Clinical Examples in Our Photo Galleries: Festoon Elimination Before and After Photos
Many patients visit multiple doctors only to be told festoons can’t be treated. This is because traditional treatments often fall short. Non-invasive options like Botox, fillers, and thread lifts generally don’t improve festoons. Microneedling and radiofrequency treatments such as Thermage may offer limited or disappointing results. Also, standard lower eyelid blepharoplasty and facelift procedures usually don’t address festoons effectively.
If festoons are caused by prior filler injections, an initial treatment with hyaluronidase might help. Beyond that, doxycycline injections directly into festoons have shown promise in select cases. Dr. Kass has seen positive outcomes in some patients with this method, though not all festoons respond to doxycycline, and injections should be limited to one or two treatments per area.
Beware of providers who suggest treating festoons with commercial fillers or fat transfer without proper expertise—these approaches can worsen the condition or cause lasting damage.
Laser resurfacing and direct excision can lead to prolonged healing, pigment changes, visible scars, or undercorrections.
Dr. Kass has pioneered a specialized approach combining ligation or cauterization of festoon feeder vessels, excision and plication of hypertrophied orbicularis muscle, a midface lift, and a unique resurfacing method. This technique minimizes scarring and avoids the risks of aggressive laser treatments.
Only a few surgeons have the detailed knowledge and hands-on experience to safely perform these intricate procedures around the eyes. Dr. Kass’s patients often travel from afar, grateful for his skilled and compassionate care. While individual results and healing times vary, most patients are thrilled with their refreshed appearance and the low chance of festoon recurrence.
Explore Our Before and After Gallery to See Dr. Kass’ Unique Festoon Treatment Results, Developed Over Many Years. Decide If This Approach Is Right for You!
Hear From Some of Our Patients:
Festoons and Upper Eyes *****
5 months post-op
I had upper and lower eyelid surgery along with festoon treatment. Dr. Kass and his team made me feel cared for throughout. I healed well and highly recommend Tampa Bay Cosmetic Surgery Center.
Eyelid Surgery and Festoon Treatment *****
2 months post-op
The staff was wonderful. My upper and lower eyelids plus festoons were treated. People no longer ask if I’m tired because the loose skin is gone. I look younger and feel better. My mother was so impressed she scheduled her own surgery!
Festoons Malar Mounds – A FIX !! *****
6 months post-op
The results are outstanding—better than expected. The surgery involved a small incision hidden in a natural smile line and felt surprisingly smooth. Recovery involved manageable swelling and fading scars, easily hidden with makeup. Travel and accommodations near the office were convenient.
If You Have Festoons, Call Dr. Kass!
TL;DR: After multiple unsuccessful treatments, my blepharoplasty plus festoon surgery with Dr. Kass finally gave me the results I wanted. If you suffer from festoons, I highly recommend contacting Tampa Bay Cosmetic Surgery Center. Here’s my full story.
My festoons bothered me starting in my late 30s. I tried lower blepharoplasty, fat transfer, and laser treatments over several years with no success. In fact, the blepharoplasty made them more noticeable.
In 2022, I researched specialists and chose Dr. Kass. After a thorough phone consultation, I felt confident and scheduled surgery.
Dr. Kass was patient and caring during pre-op. Staff arranged local support since I traveled alone. Post-op pain was minimal.
Swelling was worst the morning after surgery but improved daily. By day 8, most bruising was gone. I flew home on day 9.
My eyes looked unusual for weeks post-surgery but normalized by two months. At four months, my festoons are gone, scars fading, and I’m planning family photos.
I was nervous about investing again but am so happy with the outcome. I wish I’d found Tampa Bay Cosmetic Surgery Center sooner!
FAQs
What exactly are festoons and how do they differ from under-eye bags?
Festoons are sagging or puffiness on the cheeks caused by skin and muscle laxity, often with fluid accumulation, creating bulges distinct from under-eye bags which are fat protrusions. They require different treatment approaches.
Are non-surgical treatments effective for festoons?
Most non-surgical options like Botox, fillers, thread lifts, microneedling, or radiofrequency treatments have limited or no lasting effect on festoons. In certain cases, doxycycline injections may help, but surgical treatment often yields better results.
Is eyelid surgery sufficient to correct festoons?
No, standard blepharoplasty targets eyelid fat and skin but does not address festoons. Sometimes, eyelid surgery can make festoons more noticeable if not combined with specialized techniques.
What makes Dr. Kass’s festoon treatment approach different?
Dr. Kass uses a unique combination of vessel ligation, muscle excision and plication, midface lifting, and specialized resurfacing to treat festoons effectively, minimizing scars and avoiding aggressive lasers, leading to superior outcomes.
How long is the recovery after festoon surgery?
Most swelling and bruising improve within 1–2 weeks, with scars fading over several months. Patients often resume normal activities shortly after, with full healing and final results visible by 3–4 months.