What Are Festoons?

Festoons are swollen or puffy areas on the upper cheek beneath the lower eyelid. Unlike traditional under-eye bags (which result from fat herniation in the lower lid), festoons are more associated with fluid retention, skin laxity, and sun damage in the malar (cheekbone) region.

They can cause:

• A tired or aged appearance
• Shadowing or double contouring below the eyes
• Difficulty improving the under-eye area with makeup or creams

Common Causes of Festoons

Festoons are multifactorial. They may be caused or worsened by:

• Aging and natural loss of skin elasticity
• Chronic sun exposure
• Lymphatic fluid buildup
• Genetics
• Smoking
• Previous lower eyelid surgery
• Rosacea or chronic inflammation

Understanding the cause is essential to choosing the right treatment plan.

Festoons vs. Eye Bags: What’s the Difference?

• Eye Bags
  • Caused by fat protruding from the lower eyelids
  • Best treated with lower blepharoplasty (eyelid surgery)
• Festoons
  • Occur lower, on the upper cheeks (malar area)
  • Involve skin laxity and fluid retention
  • May require different approaches such as skin resurfacing, laser therapy, or direct surgical excision

Treatment Options for Festoons

At SLD, we take a personalized and multi-modality approach based on the severity and structure of your festoons:

1. Laser Skin Resurfacing

• Improves skin texture and tightens loose skin
• Reduces crepiness and mild festoon swelling
• Options: CO2 laser, Erbium laser

2. Radiofrequency Microneedling

• Stimulates collagen and improves skin firmness
• Minimally invasive with little downtime
• Effective for mild to moderate festoons

3. Injectables (Off-Label)

• Diluted doxycycline injections or steroids may reduce fluid retention in some cases
• Targeted Botox can reduce the contributing muscle movement

4. Lower Blepharoplasty

• May be combined with festoon treatment to rejuvenate the entire lower eyelid and cheek region
• Helpful when eye bags and festoons coexist

5. Direct Surgical Excision

• Ideal for advanced festoons with significant excess skin and tissue
• Involves carefully removing malar bags through a small incision near the cheek
• Requires surgical expertise to avoid overcorrection or scarring

Who Is a Candidate for Festoons Treatment?

You may benefit from festoon treatment if:

• You have persistent puffiness beneath the eyes or on the upper cheeks
• You’ve tried creams or fillers without success
• You want a natural, rejuvenated appearance
• You’re in good health with realistic expectations

Why Choose St. Louis Dermatology & Cosmetic Surgery?

• Expertise in facial anatomy and eyelid rejuvenation
• Advanced technology, including fractional CO2 laser and RF microneedling
• Trusted by patients across Troy, Wentzville, and St. Charles
• Focus on natural results and patient satisfaction
• Private, accredited surgical suite for safety and convenience

What to Expect: Consultation & Recovery

At your consultation, our board-certified specialist will:

• Evaluate your facial anatomy and skin quality
• Determine whether your concern is festoons, under-eye bags, or both
• Discuss your treatment options, expected results, and recovery timeline

Recovery Time:

• Non-surgical options: Minimal downtime (1–5 days)
• Laser or RF Microneedling: 3–7 days of redness/swelling
• Surgical options: 7–14 days of bruising, swelling, and downtime

Frequently Asked Questions (FAQ)

Schedule Your Festoons Consultation Today

If under-eye puffiness or cheek swelling affects your appearance or confidence, our team is here to help.

📍 Located in Troy, MO
📞 (314) 834-1400
📅 Book a consultation online