New Treatment for Malar Festoons and Big Eyelid Bags

Festoons are still the bane of the existence of plastic surgeons. They are the bags that fall on the cheeks, below the lower eyelids, that make you look like you haven’t slept for weeks. They are bags seen in familial form but are most commonly the result of either thyroid problems, rosacea, sleep apnea, or filler. 

Patients who wear occlusive sleep masks over the cheeks are more likely to develop festoons.

It is generally a mistake to add fillers to festoons because they are probably a result of slow drainage through the facial lymphatics. Fluid buildup from lying flat accumulates in the cheeks, and in the presence of slow lymphatic flow, just sits there. The gooey substance of fillers tends to make festoons worse. In fact, long-standing filler under the eyes can migrate and give rise to festoons.  

We have multiple means of treating festoons in our practice, ranging from radiofrequency energy treatments to laser surgery to midface suspension.

But, there is a new means of treating festoons involving the injection of an antibiotic. No, festoons are not a result of an infection, but tetracycline and related antibiotic doxycycline, are known to cause the collapse of cavities and may diminish the size of the edema pocket seen in festoons.

The treatment can be done in the office or the operating room under local anesthesia with sedation, and improvement can be noted usually within two months.  

A recent study of 102 patients treated at the Cleveland Clinic surveyed patients that had undergone the procedure. Approximately 59 percent of patients who responded to the survey noted improvement, and the authors concluded that these injections appear to improve festoons in the majority of patients. 

In our practice, we employ doxycycline, which is supplied in liquid form and is generally employed for intravenous use. Results thus far are encouraging, and we reserve its use for those who have not had a complete response to the usual treatments we employ in our practice. 

Interested in Learning More About Festoons?

If you are interested in this treatment for troublesome festoons, whether you’ve exhausted other treatments or not, you might be a candidate for this procedure. 
If you are interested in learning more, contact Dr. Allan Wulc at W Cosmetic Surgery by calling (610) 828-8880 or filling out our online contact form.