Medical Minute: Can Malar Mounds and Eyelid Festoons Be Treated?

When we see another person, our brains scan the other person’s face for nonverbal facial cues. We naturally focus on the eye and mouth region, and when we see heavy upper or lower eyelids, malar mounds or eyelid festoons, we tend to interpret what we see as meaning that the other person tired, sick or even drunk.

Malar mounds and eyelid festoons have traditionally been very difficult conditions to correct, and when lower eyelid surgery is performed without correcting festoons and malar mounds, the person often looks worse afterwards. This is because we expect heavy lower lids to accompany eyelid festoons and malar mounds. When only one of these conditions is still present, the festoons and malar mounds left behind are accentuated and stand out. The best cosmetic option is to correct festoons, malar mounds and lower lid bags at the same time. Doing so gives the most beautiful and natural result.

The options for treating malar mounds and eyelid festoons include attempting to stretch them out by making an incision above them and pulling them upwards. This has provided mild and often disappointing results. Another option is to cut the festoon and malar mounds out, but doing so leaves a visible scar on this focal area of the face. Some have tried to put fillers around the festoon and malar mounds to blend the edges and make them less noticeable, but this tends to leave the festoons and malar mounds in a swollen mound when the goal should be to flatten them.

My preferred option for dramatically improving eyelid festoons and malar mounds involves using lasers to tighten them from the outside in. This causes malar mounds and festoons to flatten into the surrounding contour. Although this procedure requires some recovery time associated with healing, my patients prefer the results and don’t mind spending time to get the results they seek.