What Are Festoons?
Festoons are unattractive bags on the cheeks that occur in some people, creating a fatigued look to the face. Also called cheek or malar bags, or malar mounds, they’re difficult to cover with makeup when pronounced and can seriously affect appearance. Worse, some people assume someone with festoons is simply sleep-deprived or drinks excessively.
Unlike bags in the lower eyelids, festoons aren’t due to herniated or protruding orbital fat, and they don’t improve with eyelid surgery. In fact, cosmetic surgery on the lower eyelids that doesn’t specifically address festoons may 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 festoons are a non-treatable condition. This is because traditionally, festoons have been difficult to treat. Non-invasive procedures such as Botox, fillers, and thread lifts simply don’t help. Other procedures like microneedling and radiofrequency treatments such as Thermage are often of limited benefit and give disappointing results. As mentioned above, festoons aren’t improved with traditional lower eyelid lifts (blepharoplasty), and unfortunately, they aren’t improved with facelift surgery either.
If festoons are related to filler injections placed years earlier into the cheeks, under the eyes, or in the tear troughs, injections of hyaluronidase may be an appropriate initial treatment option. After this, the only nonsurgical option that might result in significant visible improvement is doxycycline injections to the festoons. Dr. Kass has personally seen positive results in a handful of patients treated with doxycycline, though it should not be injected more than one or two times to each festoon. Not all festoons are the same, and while it would be wonderful if all festoons responded to doxycycline, in Dr. Kass’s experience, many, if not most, do not.
Why Choosing the Right Surgeon Matters
If any surgeon says they know how to treat festoons, ask to see before and after photos of other patients they’ve treated whose festoons look similar to yours. They should be able to show you photos of at least several successfully treated patients. In our opinion, festoons can only be reliably treated by an oculofacial plastic surgeon.
If a non-oculofacial plastic surgeon suggests treating your festoons with commercial fillers or fat transfer, normally a wonderful procedure for other conditions, we suggest finding a different provider before your festoons are worsened or irreversible harm is done to your appearance.
Vigorous laser resurfacing and direct festoon excision can involve prolonged healing times, pigmentary changes with obvious demarcation lines, undercorrection, or unsightly scars.
Dr. Kass has developed treatment options for this difficult problem that have proven greatly successful for the vast majority of patients he’s treated. By combining ligation or cauterization of festoon feeder vessels, excision of hypertrophied orbicularis muscle with orbicularis muscle plication, a midface lift, and, when necessary, a unique resurfacing technique, Dr. Kass avoids the unacceptable scars associated with direct surgical excision and the costly, less predictable, and more dangerous laser procedures used by many other providers.
Very few surgeons, even within the highly selective field of oculofacial plastic surgery, have the knowledge and experience to perform such delicate procedures near the eye. Even among those who do, most rely on aggressive laser treatment that can cause prolonged healing time and permanent pigment abnormalities. Dr. Kass believes his treatment approach is superior, and his many happy patients can attest to that. As with any surgery, there are no guarantees and results can vary, but Dr. Kass’s outcomes consistently exceed the expectations of the vast majority of his patients, and the chances of festoon recurrence are extremely low.
Dr. Kass has treated many patients who arrived desperate and despairing about their festoons, and he routinely treats patients who travel from far away specifically for his expertise and results.
See our photo gallery of before and after results from Dr. Kass’s unique festoon treatment technique, personally developed and perfected over many years.
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 the practice.”
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.”
If You Have Festoons, Call Dr. Kass
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 this practice. Here’s my 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.
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, and 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, and I flew home on day 9. My eyes looked unusual for weeks post-surgery but normalized by two months. At four months, my festoons were gone, scars fading, and I was ready for family photos.
I was nervous about investing in another treatment, but I’m so happy with the outcome. I wish I’d found this practice sooner.
Festoon Treatment 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 doesn’t 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.
How long is the recovery after festoon surgery?
Most swelling and bruising improve within one to two weeks, with scars fading over several months. Patients often resume normal activities shortly after, with full healing and final results visible by three to four months.
Can doxycycline injections treat all types of festoons?
No, doxycycline tends to help only in specific cases, particularly festoons related to prior filler placement. Many, if not most, festoons require the surgical approach for meaningful improvement.
How do I choose the right surgeon for festoon treatment?
Ask any surgeon considering treating your festoons to show before and after photos of patients with similar festoons. Only an experienced oculofacial plastic surgeon should be trusted with this delicate procedure.