If you’ve been struggling with persistent under-eye puffiness that won’t go away, it might be festoons — and we’re here to help.
If you’re noticing persistent puffiness or sagging under your eyes — even after a good night’s sleep — you may be dealing with festoons, also known as malar bags or malar edema. Unlike typical under-eye circles or bags, festoons are a unique and often misunderstood condition that can’t be corrected with filler alone.
At St. Louis Dermatology & Cosmetic Surgery in Troy, MO, we specialize in diagnosing and treating festoons with advanced, customized surgical or non-surgical care to restore a refreshed, youthful appearance.
What Are Festoons?
Festoons are swollen, sagging pouches that form on the upper cheek (malar area), just below the lower eyelids. They’re often mistaken for under-eye bags, but festoons sit lower on the face and may appear more prominent when smiling or lying down.
They can:
- Appear as puffy, fluid-filled, or fatty bulges
- Vary in size and symmetry
- Become more noticeable with age or fatigue
Festoons vs. Under-Eye Bags: What’s the Difference?
| Feature | Under-Eye Bags | Festoons (Malar Bags) |
|---|---|---|
| Location | Below the lower eyelid, on upper cheek | Below the lower eyelid, on the upper cheek |
| Cause | Fat pad herniation, skin laxity | Lymphatic fluid retention, fat, or muscle sagging |
| Movement | Static | May change with facial expressions |
| Treatment | Fillers, blepharoplasty | Specialized treatment needed (see below) |
What Causes Festoons?
Festoons develop from a mix of:
- Lymphatic dysfunction: fluid retention in the malar area
- Sun damage: collagen breakdown and skin laxity
- Muscle weakness: sagging of the orbicularis oculi muscle
- Genetics: inherited facial anatomy
- Aging: skin and fat pad descent with age
Festoons are not caused solely by allergies, hydration, or sleep issues, though these can exacerbate their appearance.
Are Festoons Treatable?
Yes, but successful treatment requires an accurate diagnosis and a multimodal approach. At SLD, we create customized treatment plans based on the type and severity of your festoons.
Treatment Options for Festoons
🔹 1. Non-Surgical Treatments
Ideal for mild to moderate festoons or patients not ready for surgery:
• Laser Skin Resurfacing (e.g., CO2 or Erbium)
- Tightens skin, stimulates collagen
- Reduces festoon prominence over time
• Radiofrequency Microneedling
- Non-invasive tightening of the malar skin and muscle
- Improves skin texture and tone
• Injectable Treatments
- Doxycycline injection (off-label): reduces lymphatic fluid in certain festoons
- Botox®: can be used conservatively to adjust orbicularis oculi muscle tension
Note: Dermal fillers are not recommended for festoons and may worsen their appearance if misused.
🔹 2. Surgical Treatments
For moderate to severe festoons or when non-surgical options aren’t effective:
• Lower Blepharoplasty with Malar Modification
- Removes excess fat and skin under the eye
- May include repositioning the orbicularis muscle
• Direct Festoon Excision
- Surgical removal of festoon tissue for dramatic improvement
- Minimally visible scar placed in a natural crease
• Midface Lift or Cheek Lift
- Elevates the cheek and lower eyelid complex
- Best for festoons caused by midface descent
Our board-certified surgeons at St. Louis Dermatology & Cosmetic Surgery will recommend the best procedure for your anatomy, goals, and lifestyle.
Recovery and Results
Recovery time varies depending on treatment type:
- Non-surgical options: Minimal downtime (1–7 days)
- Surgical treatments: 1–2 weeks of initial swelling and bruising; full results in 6–12 weeks
We’ll provide detailed aftercare and follow-up to ensure your recovery is smooth and your results are long-lasting.
Why Choose SLD for Festoon Treatment?
- 🧠 Expertise in both dermatology and facial surgery
- 🏥 In-office treatment options in Troy, MO
- 💬 Thorough diagnostic consultation to avoid misdiagnosis
- 📍 Trusted by patients throughout St. Charles County, O’Fallon, Wentzville, and Lincoln County
- ⭐ 5-star reviews for precision care and natural results
Book a Consultation for Festoon Treatment in Troy, MO
If you’ve been struggling with persistent under-eye puffiness that won’t go away, it might be festoons — and we’re here to help. Schedule a consultation today with our dermatology and cosmetic surgery experts at St. Louis Dermatology & Cosmetic Surgery.
📞 Call us at (314) 834-1400 or request your appointment online.
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