Dr. Boyd


Festoons: The Baggage You Don’t Want

Posted July 08, 2024 in Eyelid Surgery (Blepharoplasty)

Female touching her eye with one finger

Festoons, under-eye bags, or hanging malar mounds are a common cosmetic concern for many individuals. The name derives from the hanging sweep of draperies in fashionable window dressings. Swollen, puffy areas of skin and bulging fat beneath the eyes can progress to festoons when they start to hang and cast a shadow on the cheeks. Obviously, this is aesthetically unappealing and a source of discomfort for those affected. In this blog, we’ll delve into the causes of festoons, explore various treatment options, and discuss how plastic surgeons can lower potential complications of surgical corrective procedures.

5 Min Read:

What Causes Festoons?

Everyone wants to look bright-eyed, but dark circles and baggy, droopy skin under your eyes make no one look good. Under-eye bags typically develop as a result of the following factors.


As we age, the skin loses elasticity and firmness, leading to sagging and the formation of wrinkles and folds. The delicate skin around the eyes is particularly susceptible to these changes, contributing to the characteristic appearance of festoons. Within the bony orbit, the eyeball is surrounded and cushioned by a layer of fat. Once we get older, the ligaments that retain this fat stretch out, allowing the fat to bulge into the upper and lower eyelids. In the lower eyelid, this, too, contributes to the festoon.


Some individuals may be predisposed to developing festoons due to genetics. Family history can play a significant role in determining one’s susceptibility to this condition. Those with shallow orbits are particularly prone to this condition.

Sun Exposure

Prolonged exposure to the sun’s harmful UV rays can accelerate aging and contribute to the development of under-eye bags. UV radiation damages the skin’s collagen and elastin fibers, leading to loss of elasticity and the formation of wrinkles and sagging skin.

Fluid Retention

Fluid buildup in the lower eyelid area can cause swelling and puffiness, exacerbating the appearance of festoons. Factors such as chronic soft tissue inflammation, allergies, sinus issues, hormonal fluctuations, kidney failure, and dietary habits can all contribute to fluid retention.

Treating Under-Eye Bags and Puffiness

Several techniques can reduce or eliminate festoons, with the following options available:

Cosmetic Surgery

For substantial cases, surgical intervention is the most effective way to address festoons.

  • Lower eyelid surgery: Lower blepharoplasty is a plastic surgery procedure that can correct lower eyelid bags, droopy upper eyelids, or both for a smooth and youthful eye appearance. The incision is placed 2 millimeters under the eyelashes. In severe cases, a ‘direct excision’ of the festoon places the incision at the eyelid/cheek junction.
  • A midface lift: When volume loss or sagging skin contributes to under-eye bags, a midface lift can remove excess skin and tissue, tighten underlying muscles, and improve the overall contour of the lower eyelid area.

Ectropion Treatment and Prevention

Ectropion, a condition where the lower eyelid turns outward and away from the eye, can occur naturally or as a complication of surgery. A lower blepharoplasty performed by a board-certified plastic surgeon can often correct this condition and reduce the risk of ectropion as a surgical complication.

Festoons with poor skin tone predispose patients to postoperative ectropion. A skilled and experienced plastic surgeon will employ the following techniques to minimize the risk of ectropion and ensure optimal surgical outcomes:

  • Precise incision placement: During blepharoplasty and other eyelid surgeries, the plastic surgeon carefully plans and executes incisions to minimize tension on the lower eyelid and prevent postoperative ectropion.
  • Muscle suspension techniques: Suturing techniques to tighten or suspend the ocular muscles as a sling can provide additional support to the lower eyelid, reducing the likelihood of ectropion.
  • Conservative tissue excision: Conservative tissue removal to preserve adequate tension combined with lid tightening helps reduce the risk of postoperative complications.
  • Close monitoring and follow-up: Post-operative care is crucial in preventing complications such as ectropion. Plastic surgeons closely monitor patients during recovery and provide appropriate follow-up care to address any concerns promptly.

Festoons can significantly impact an individual’s self-confidence and quality of life, but with advancements in cosmetic surgery and proper post-operative care, effective treatment options are available. Qualified plastic surgeons play a vital role in addressing festoons and minimizing the risk of complications such as post-surgical ectropion.

Non-Surgical Treatments

Some non-surgical treatments may improve the appearance of the puffy lower eyelids for milder under-eye bags.

  • Minimally-invasive midface lift: The Silhouette InstaLift™ is less invasive than eyelid surgery and can help smooth the under-eye regions by providing lift to these areas and ongoing collagen production to strengthen the skin below the eyes. However, this will not be effective with severe festoons.
  • Injectable facial fillers: Hyaluronic acid fillers can be injected into the under-eye areas to fill in hollows and smooth out contours, diminishing the appearance of festoons and restoring volume to the area.
  • Microneedling treatments: In some cases, combining microneedling with laser or light therapy and topical serums like Environ® skin care products can improve the appearance of under-eye bags by promoting collagen production, tightening skin, and reducing puffiness.
  • Chemical peels, such as a TCA peel, can tighten the skin and improve appearance but will not fundamentally alter the bulging fat.

By understanding the underlying causes of festoons, exploring various treatment modalities, and implementing preventative measures, patients can achieve smoother, more youthful-looking under-eye contours and enjoy renewed confidence in their appearance.

Correcting Festoons in Palos Verdes, CA, With Our Board-Certified Plastic Surgeon

Dr. Brian Boyd offers surgical and non-surgical treatment for under-eye bags in Palos Verdes, California. Our highly skilled, board-certified plastic surgeon provides the highest level of care and is committed to helping you achieve your cosmetic goals with the lowest risk.

Call (310) 597-4734 to schedule a consultation and learn more about your options for treating festoons.

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Dr. Boyd's office is located in Palos Verdes (Rolling Hills Estates)

550 Deep Valley Drive, Suite 283
Rolling Hills Estates, CA 90274

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