What are festoons ?

Festoons, cheek bags, and malar mounds

These are all part of the same aesthetic problem. They are bags or bulges found on your upper cheek, below the eyelids and below the bony circle under your eyes called the orbital rim.  They are seen in both young and old people, yet they tend to get worse with age.

Festoons and eye bags are not the same things

Eye bags are the puffy areas within the eyelids that are caused by bulging fat orbital fat pads, the fat that lives around the eyeballs.  Festoons occur lower on the face, at the upper cheeks.

cheek bags





One side looks worse than the other- why?

It’s not uncommon for one cheek to look worse than the other.  Facial asymmetry is noticeable in almost everyone, and festoons follow this rule.  Here’s an example of a severe festoon on one side:

uneven cheek bags


Why do we get cheek bags?

Festoons are caused by several conditions happening at once.  The location of the folding skin and creasing is formed by the connective tissue bands that provide structural support between the skin, fat, muscle, and bones in your face.  These bands or “ligaments” dictate the position of creases and folds on your face.  With age, you may lose structural support and volume in your face.  Volume loss combined with gravitational effects leads to aging signs such as jowls, sagging eyebrows and eyelids, and you guessed it, festoons.

Is there a correction for festoons?

Yes.  Treatment involves a combination approach that addresses each of the underlying causes of the problem.  Laser skin resurfacing, volume replacement (fat or filler injections), and lower eyelid lift surgery are often used to minimize or eliminate the festoon.

Here is an example of my patient who underwent lower eyelid surgery, fractional laser skin resurfacing, and fat injections to reduce both eye bags and festoons in a single procedure.

eyes fat grafting

Lower eyelid lift with fat grafting





















I routinely see clients who are concerned with festoons in my NY office and I’ve noticed that the festoon page on my website is one of the most frequently visited.


Brett Kotlus, M.D.

135 E. 71 street

Phone: 212-882-1011

What is a laser eyelift ?

laser eyelift advertisement

What does the term Laser Eyelift mean? Is it used by cosmetic eyelid surgeons purely for marketing or does the laser truly improve cosmetic eyelid surgery results?  The answer is both.

The word “laser” added to any procedure makes it sound more modern, cleaner, and better.  And it is used to market medical and surgical procedures including laser facelift, laser liposuction, laser toenail fungus removal, and laser teeth cleaning. Here in NY the word laser is thrown about quite frequently in medical advertising- I’ve seen all sorts of laser procedures on billboards on the NYC subway.

Lasers are used in cosmetic eyelid surgery in 2 ways:

1. Creating an incision and dissecting tissue: A focused laser cuts the skin and vaporizes tissue with pinpoint accuracy.  This can be better than using a scalpel because it theoretically gives the surgeon more manual control and seals blood vessels as it cuts.  On the other hand, stitches often need to remain longer after laser upper eyelid surgery and studies have shown similar end results when laser versus scalpel was used to make the upper eyelid incision.

2. Resurfacing the upper eyelid and surrounding skin: Laser energy is used to remove the eyelid skin surface, leaving room for new skin to replace sun-damaged skin.  This can be done on its own or at the same time as eyelid skin removal.  Laser resurfacing improves the quality of the skin, reducing wrinkles and brown spots.  This approach does improve on traditional upper eyelid lifts that didn’t commonly include resurfacing.  Last year, I presented my upper eyelid skin laser resurfacing technique to a large group of surgeons at an oculoplastic surgery conference in New Orleans and it was received with much interest.  Lower eyelid skin resurfacing is quite common and I expect upper eyelid skin resurfacing to become more popular in the next 5 years.