Plastic Surgery

Festoon Excision

Removes festoons, addressing puffy lower eyelids for a smoother and rejuvenated facial appearance.

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Festoon Excision

Festoon excision is a surgical procedure that is performed to correct the appearance of the lower eyelid/upper cheek region that has become saggy or swollen at the junction of the lower eyelid and cheek. “Festoons”, also called “malar edema or swelling”, describes a specific type of upper cheek swelling, which is very different from prolapsed eyelid fat, which is most commonly referred to as “eyelid bags”. A festoon is actually swelling in the deeper layer of skin of the lower eyelid at the junction of the underlying muscle and is the stasis of fluid within the tissue. Although conditions such as thyroid eye disease, rosacea, prior surgery and natural aging can lead to this problem, these days, the most common cause of festoons is retained fluid from hyaluronic acid filler injection into the cheeks or eyelids. This swelling can occur even years after the injection procedure has taken place, long after the time frame which we expect the filler to last.

Although many different types of festoon treatments have been tried, such as laser resurfacing, chemical peels, sclerotherapy, cautery, and aggressive lower blepharoplasty with skin/muscle flap, the two procedures that Dr. Amadi currently recommends are:
Morpheus Radiofrequency MicroNeedling combined with Facetite treatment for mild to moderate festoons- this is discussed in the Morpheus and Facetite section of the website.
Surgical excision of the festoon for moderate to severe festoons.

The surgical excision, which is the most predictable way of treating festoons, is designed to restore the youthful appearance of the lower eyelids/cheek region by removing the excess swollen skin, underlying soft tissue, and sometimes muscle. Festoon excision can be performed as a standalone procedure or in combination with other facial plastic surgery procedures such as a facelift or brow lift.

The process of Festoon Excision involves marking the tissue to be excised in the shape of an ellipse, making incisions in the lower eyelid crease, removing the tissue and closing the wound with sutures. This allows the plastic surgeon to access the underlying soft tissue and remove the excess skin while removing the tissue that is retaining fluid.

The patient needs to understand that this surgery will trade the fluid bags of skin with a subtle, linear scar which can be further improved with resurfacing treatment during the recovery period. This trade-off only makes sense if the festoons are moderate to severe. Milder variants of festoons are better addressed with Morpheus RadioFrequency MicroNeedling in combination with Accutite RF.

Prior to surgery, one should ensure that any residual filler is first dissolved with Hyaluronidase enzyme, as that may completely treat the problem non-surgically.

One of the benefits of Festoon Excision is that it can provide a more youthful and refreshed appearance to the lower eyelids, while reducing the appearance of dark circles and hollows under the eyes.

Festoon excision is a safe and effective procedure that is performed under local anesthesia or with IV Sedation. The recovery time is relatively short, and patients can return to their normal activities within a week, with the understanding that the scar will continue to mature and improve in appearance for over a year. It is important to follow the post-operative instructions provided by your surgeon to ensure the best possible results.

Festoon Excision is a highly effective solution for individuals who have unresolving malar bags (swelling at the eyelid/cheek junction) and are looking for a highly predictable and effective approach to rejuvenating the appearance of their lower eyelids. If you are interested in learning more about Festoon Excision or other periorbital rejuvenation techniques, it is important to consult with an experienced Oculofacial plastic surgeon with a background in various techniques of festoon correction and eyelid surgery.

Dr. AJ Amadi


Dr. AJ Amadi

Focusing on a natural and age-appropriate look, Dr. Amadi will deliver the finest personalized care, giving you the results you desire.

Meet Dr. Amadi