Under-Eye ‘Bags’ or Festoons? Why Knowing The Difference Matters

Festoons Before and After
They go by many names ranging from puffy eyes, to severe bags under the eyelids, but the medical term for skin folds in the lower eyelids is “festoon” or “malaria mound.” The multitude for names may have something to do with the fact that festoons aren’t well understood by the public, according to Adam J. Scheiner, M.D., an international eyelid and facial cosmetic surgeon who has been featured on “The Dr. Oz. Show” and “The Doctors.”

There’s a lack of awareness around festoons that often causes them to be misdiagnosed, and the error isn’t simply a vanity issue. While many people who suffer from this condition may consider it simply an unpleasant sign of aging, festoons not only can cause a dramatic aesthetic disturbance, but can lead to peripheral vision loss in severe cases. Festoons can also be a market for pre-cancerous skin conditions on other parts of the face, which is another good reason to learn what to look for in festoons.

What Causes Festoons?

Factors ranging from sun exposure, smoking, genetics and aging can all cause a structural problem beneath the surface of the eyelid. With time and exposure to the sun, underlying muscle-forces cause stress in the overlying skin under the eyes, causing a subtle but progressive damage to the elastic fibers in the skin. This leads to different amounts to swelling or puffiness during different times of the days or month. Many often consider the puffiness to be a sign of “bags,” but considering the cause of festoons, eye creams, gels and other treatments will be completely ineffective against festoons, as topical products cannot cure the problem of herniated tissue and structural problems.  

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Differences Between “Bags” and Festoons:

There are such things as “bags” which often appear as puffy circles directly beneath the eye. “If you touch them, they’re usually firmer, and you can’t easily move them from side to side. That’s an indication they’re ‘bags,'” Dr. Scheiner says. “Also, if you look up, they become more prominent.” 

How To Treat Festoons:

Until recently, surgical removal, oral diuretics and steroid injections were the primary treatments for festoons, but these procedures would yield minimal and often temporary results. With the growing understanding of festoons, many eyelid and facial cosmetic surgeons are specializing in the treatment of festoons, like Dr. Scheiner, to both correct treatments that have been done elsewhere, such as fillers and lower eyelid surgeries that didn’t address patients’ festoons, while offering laser skin resurfacing procedures. 

In his popular blog at www.adamscheinermd.com and in his new book, The True Definition of Beauty, people can learn more about festoons and gain an understanding if this malady is something they suffer from. “The lack of awareness around Festoons and how ubiquitous they are — and how often they are misdiagnosed — is why my practice has executed an educational marketing campaign to bring clarity to combat the misinformation and confusion surrounding this condition,” he adds.

7 thoughts on “Under-Eye ‘Bags’ or Festoons? Why Knowing The Difference Matters”

  1. I’m a new mom and developed dark rings and puffiness from the continuous lack of sleep and long nights. After using dermalmd under eye serum I’m seeing a decrease in my puffiness and dark rings in just a week. And, to my surprise, I’m also seeing a drastic improvement in my spider vein cherry that’s been in my under eye area for years (it’s reduced in size and redness quite a bit).


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