Festoons are fat puffy excesses that occur above the upper jaw bone. Festoons are areas of swelling that occur in the middle of the cheek. For this reason they are often called “midcheek mounds” or “midmalar mounds”. Patients with festoons often come to us saying they have severe under eye bags.
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Malar bags or festoons are not a result of aging. Anatomically, the bottom of the festoon represents an area — called a ‘septum’ — where the tissues that close the eye come into contact with tissues that elevate the mouth, allowing us to smile and give expression to our lower faces. This septum and the tissues above it can swell with varying conditions, including:
Festoons can be seen at a very young age in those who inherit them from one side of the family.
Treated or untreated, this inflammatory skin condition can cause congestion of the veins and lymphatics that drain the eye and cause intermittent swelling and festoons.
Imbalance thyroid levels or a history of autoimmune thyroid disease (Hashimoto’s thyroiditis) can cause festoons. Often other signs like loss of the outer part of the eyebrow may be present. They rarely improve with normalization of thyroid function.
These can worsen the festoon, particularly in the morning when the head lies below the heart and the skin swells.
The most common cause of festooning we see now is the use of HA fillers under the eyes or cheeks, presumably to improve the appearance of the eyes. These fillers remain in place for years and gum up lymphatic flow, and they may migrate making festoons apparent. Often a patient will go to a provider who will offer more filler as a means of treatment of the festoon. This never works and usually makes the situation worse—and the patient more desperate to find a solution—or makes the patient despair about ever finding one.
For unknown reasons, this area is prone to swelling in those whose blood carbon dioxide levels become elevated at night when their respirations slow. In addition, a sleep apnea mask can put pressure on the cheeks, resulting in an increase in swelling and an exacerbation of the festooning.
Under eye bags and festoons almost always benefit from aggressive treatments. Dr. Allan Wulc is a pioneer in the treatment of festoons. He offers patients in Philadelphia—and nationally– effective and innovative treatments. If the festoons are moderate, patients can profit from radiofrequency microneedling treatments. We have presented our technique at national aesthetic meetings and are preparing the largest series in the country looking at this treatment to reduce festoons.
As with any surgery, there are minor risks involved with festoon treatment surgery. Patients may experience scarring, infection, anesthesia complications, or a poor cosmetic outcome. These complication can be reduced by working with a board-certified surgeon who uses proper techniques such as Dr.Wulc.
He is Board Certified in
We have extensive experience and a variety of techniques to take care of this problem!
Patients who undergo our festoon treatment may experience bruising and swelling after surgery. Absorbable sutures are used when sutures are necessary. Patients notice results as the swelling and bruising fades, a week or so after surgery. We provide post-operative care instructions for how to speed up the healing process using light and lasers in our office.
After eyelid surgery, you will typically need to wait at least several days before wearing contacts again as the eye area heals. Dr. Wulc will be able to advise you on your limitations post-surgery and give you a timeline for resuming your normal habits, including wearing contacts.
Most creams and topical treatments are ineffective for treating malar bags. Surgical intervention is almost always necessary for meaningful results.
Dr. Wulc will give each patient instructions for their recovery period, including exercise guidelines. Most patients will need to wait at least a week or two, often longer, before resuming strenuous exercise.
Yes. Many patients are interested in comprehensive rejuvenation and wish to improve several signs of aging at once. Patients with loose or excess skin, wrinkles, and excess fat may choose to combine malar bags treatment with procedures like upper eyelid surgery or fillers for unwanted wrinkles. Some doctors excise malar bags, but malar bag excision is always associated with a scar. The scar heals but not always inconspicuously. It is not our preference and we rarely excise festoons. We find other treatments to be sufficient in the treatment of even the most severe. These include radiofrequency external treatments, Thermitight, Renuvion, midface lift, and most commonly, laser resurfacing.
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