Awakening Treatments

For a malady that’s as common to aging as waning vision, festoons—also called “malar mounds”—aren’t well understood by the public, says Adam J. Scheiner, M.D., an international eyelid and facial cosmetic surgeon specializing in the treatment of festoons. “The more people know about the causes of festoons and how they are often misdiagnosed, the better informed they are to be their own effective health-care advocates,” says Scheiner.

Knowing the proper treatment and advice for potential clients with festoons is key to returning visits. “A growing part of my practice is correcting treatments with less than favorable results that patients have had done elsewhere; like fillers used under the eyes to treat ‘bags,’ or lower eyelid surgery that doesn’t address the patients’ festoons,” says Scheiner. Educating clients is a smart place to start. “The lack of awareness around festoons and how ubiquitous they are—and how often they are misdiagnosed—is why my practice has executed an educational marketing campaign to bring clarity to combat the misinformation and confusion surrounding this condition,” he adds.

What is the difference between 'bags' and festoons?

“Bags are caused by fat protruding through the skin in the lower eyelid area, while Festoons, which also protrude, are primarily on the upper part of the cheek,” says Scheiner. “The two together can look like one large protrusion, but they’re separate issues.” Physicians will perform procedures to help a patient’s lower eyelid ‘bags,’ but often they leave the Festoons behind. This is because Festoons are notoriously hard to treat. The result? When they are not repaired at the same time as the ‘bags,’ festoons can actually look worse compared against the newly rejuvenated lower lid. Festoons can also be a marker for pre-cancerous skin conditions on other parts of the face—another good reason to know the difference between festoons and ‘bags.’

‘Bags’ often appear as puffy circles directly beneath the eye. “If you touch them, they’re usually firmer, and you can’t easily move them from side to side. That’s an indication they’re ‘bags,’” says Scheiner. “Also, if you look up, they become more prominent.” Festoons, on the other hand, are high on the cheek, although they can extend to the lower lid area. “They feel squishy to the touch, and they can be easily moved from side to side,” he adds. “They don’t become more prominent when you look up.”

What causes them? ‘Bags’ are generally associated with aging, although younger people can also get them. On the other hand, festoons are usually the result of damage. Sun exposure, smoking and aging are among the possible causes, and the results can be worsened by the contrasting pull of underlying facial muscles over the years. Fair-skinned people tend to be more susceptible to festoons.

What can you do about them? “Effective treatments for removing ‘bags’ have been available for quite some time, but physicians have struggled with removing festoons,” says Scheiner. “Festoons are complicated to treat.” Medications and steroid injections can provide temporary improvement, and some older surgical procedures offer mixed results.

One of the biggest problems with festoons and eye “bags” is that they occur around the most expressive area of the face—the eyes. The eyes speak volumes, but they can give off the wrong message if they are framed by these undesirable skin concerns. “My patients say people are always asking them if they’re sick or if they’re tired,” says Scheiner. “It’s hard to hear that over and over again, and it begins to impact self-esteem, as well as energy level. What I love about the advanced laser and heading protocol that I developed is that it fundamentally changes the quality and the health of the skin—it takes swollen, sun-damaged skin and makes it smooth, tight and younger-looking. It cleans up the messages around the eyes so that people can appear well and rested.”