Dr. Oz show on "festoons"

We have received numerous calls regarding the recent Dr. Oz show on "festoons" which seems to have created some confusion about festoons and lower eyelid fat bags. Festoons are not very common. The vast majority of patients who complain about puffiness under their eyes have lower lid fat bags due to excess fat pushing out on a weak eyelid. This produces puffiness in the lower lid with a dark shadow under it. It can occur at any age due to heredity, but is most common in people over forty due to loss of elasticity in the lower lid skin and muscle. This is not a festoon. This is fat herniation of the lower lid. Fat bags makes us look tired and ill. They are treated by removing fat from the lower lids with minimal surgery using a laser inside the lids.

A festoon is puffiness lower in the cheek, below the edge of bone that forms the eye socket. The festoon puffiness can be a combination of fluid, fat and loose skin. Festoons can also make us look tired and ill. It may look like we have severs allergies or the flu. Festoons are much less common than lower lid fat bags. They occur primarily in a much older group of people, but may also occur in young people. The best treatment depends upon the size of the festoon, and whether it is due to fat, fluid, excess skin, or a combination of these. If it is mostly due to excess skin, it can be treated well by tightening the skin with a CO2 laser, as noted on the Dr. Oz show. Some festoons respond to steroid injections, but others require surgery to remove the excess skin that cannot be tightened satisfactorily with a laser.

Laser treatment to shrink festoons works best in light skin. It usually cannot be used for darker African American skin or Asian skin. The dark pigment absorbs too much energy and may cause a burn. The energy needs to get to the deeper skin layer below the pigment to produce tightening. But there are other alternatives to treat the festoons. Steroid injections may help, and surgery can be used to remove the excess tissue if laser is not indicated.

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