Long Term Outcomes of Surgical Treatment of Festoons: A Series of 75 Patients

Goals/Purpose: Malar mounds (congenital) and festoons (acquired) are persistent puffiness in the prezygomatic space between the orbicularis retaining ligament (ORL) and zygomaticocutaneous ligament (ZCL). Non-surgical treatments often yield unsatisfactory results. This study outlines the author’s surgical technique of treating malar mounds and festoons, and reviews outcomes in 75 cases.

Methods/Technique: Correction of malar mounds and festoons were achieved with subcilliary skin muscle flap, release of the ORL and ZCL, midface lift, canthopexy and muscle suspension. We performed a retrospective review of all cases in the past 10 years and documented outcomes in cases with at least 6 month follow-up.

Results/Complications: The majority of patients presented with acquired festoons (72/75) with prior attempts of correction (32/75). The mean follow up is 13 months. Persistent malar edema (>6 weeks) was documented in 15 patients, that mainly resolved with diuretics. Two patients received additional injections of deoxycholic acid, two needed filler for smoother contour of the lower eyelids. Two patients with severe malar mounds required multiple reoperations. One incidence of transient lid retraction was reported in a patient with previous facelift and facial nerve injury.

Conclusion: Malar mounds and festoons present a unique challenge to plastic surgeons. They are persistent in nature and requires close interval, long term follow up as additional injections and reoperations are warranted. Our approach to malar mound and festoon correction is safe and effective, and provides long lasting results.