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The area of your face surrounding your eyes is the first area to show signs of aging. Correction of eyelid hooding and removal of bags and dark circles under the eyes using a technique called Blepharoplasty is one of the most frequently performed Plastic Surgery operations in the United States.
Many people however have excess puffy skin on the cheekbone just beneath the eyelid, called a festoon or malar bag, which a blepharoplasty or face-lift will not correct. In fact, after a lower eyelid blepharoplasty, festoons can actually look worse, because after the removal of the puffiness of the lower eyelid above the festoon, the festoon stands out and is much more noticeable.
Festoons, or malar bags are a very difficult problem to solve. The most common complaint about festoons arises after a blepharoplasty has been done to remove puffiness or bags from the lower eyelids. Following a lower eyelid blepharoplasty the festoons often look worse, and patients notice them for the first time.
Direct excision or surgical removal is the contemporary standard however the scars are unacceptable.
There have been experimental results with laser resurfacing using the CO2 laser-but the recovery requires 3-4 weeks of redness and a difficult recovery. In addition although the festoon is tightened, long term the treated area is hypo pigmented, of a lighter color than the surrounding untreated skin
A newer method we are using and have had encouraging results with is "skin tightening" with Infrared or radiofrequency energy-there is no down time but 4-5 treatments are necessary spaced 4-5 weeks apart and a final result takes 6 months.
There is a new Radiofrequency skin-tightening machine, the Aluma that is designed to allow us to treat this specific small area of the face.
If you are considering facial or eyelid rejuvenation be sure to check for the presence of malar bags or festoons. If you have festoons and undergo a blepharoplasty there is risk that the festoons will look more prominent. Be sure to discuss the possibility of skin tightening or other treatment of the festoon with your plastic surgeon.
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