We asked Dr. Adam J. Scheiner, world renowned in laser eyelid and facial plastic surgery, for his insight into under-eye bags and festoons. "One of the biggest problems with festoons and eye bags is that they occur around the most expressive area of the face — our eyes," he says. "The eyes speak volumes, but they can give off the wrong message if they are framed by festoons or eye bags." The message they give off is that you’re tired — even if you’re not.
"They both occur in the lower eyelid area and are often assumed to be part of the same condition," says Scheiner. He describes festoons as a medical condition in which the skin of the lower eyelid becomes significantly damaged, usually by the sun. "This damaged skin can result in folds in the lower eyelids and can lead to swollen mounds on the cheeks. They often occur with age and are more common in people with lighter skin types."
Under-eye bags on the other hand, are caused by fat protruding through the skin in the lower eyelid area, while Festoons, which also protrude, are primarily on the upper part of the cheek, Scheiner says. "The two together can look like one large protrusion, but they’re separate issues."
"Bags" 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,’" Scheiner explains. He also notes that if you look up, they become more prominent.
Festoons however, will be higher up on your cheek, although Scheiner says that they can extend to the lower lid area. "They feel squishy to the touch, and they can be easily moved from side to side and they don’t become more prominent when you look up."
Festoons can also be a marker for pre-cancerous skin conditions on other parts of the face — another good reason Scheiner notes that it’s good to know the difference between festoons and bags.
The aging process doesn’t help when it comes to looking more tired than you actually are. Scheiner explains that there is normal fat around the eyes which is there to help support the eye. "This fat is held back by a membrane called the orbital septum, and with age, this membrane bows forward and the eyeball can fall slightly as well," he says. This process causes the fat under the eye to push forward into the lower eyelid region causing puffiness. "This puffiness can make someone appear tired, sick or older even if they feel vibrant and young inside."
Festoons are usually the result of damage. "Sun exposure, smoking and aging are among the possible causes, and the results can be worsened by the contrasting pull of underlying facial muscles over the years," Scheiner explains, adding that fair-skinned people tend to be more susceptible to festoons.
When it comes to bags, Scheiner says they are best addressed with what he refers to as conservative removal and/or relocation in the areas around the eye. "Effective treatments for removing bags have been available for quite some time, but physicians have struggled with removing festoons," he explains.
Festoons are more complicated to treat but it can be done. "An ablative laser skin resurfacing technique I use called the Laser RESET® Festoon Treatment seems to work well to help treat lower eyelid festoons specifically and skin quality and skin health in general," Scheiner says.
Whether you’re dealing with bags or festoons, or both, being told you look tired gets hard to hear, and as Scheiner notes, it begins to impact how you feel about yourself, as well as your energy level. He explains that the treatment he developed fundamentally changes the quality and the health of the skin. "It takes swollen, sun-damaged skin and makes it smooth, tight and younger. It cleans up the messages around the eyes so that people can appear well and rested."
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