What’s This Bag Under My Under Eye?

Photo-Illustration: by The Cut; Photo: Getty Images

Of all the ways aging can creatively decorate your face, none are more sardonically named than a festoon. Who wouldn’t want to be enhanced with a festoon or two? I’ll tell you who: You, and this reader who recently — and unhappily — discovered them.

I’m a 73-year-old former magazine editor with decades of experience in the beauty industry and a philosophical, sometimes gimlet-eyed approach to trends and products. If that perspective entices you, you’re in the right place.

Q: Your outlook on beauty and aging has truly helped me embrace my face as it ages and celebrate my life as more than just looking good. That said, there’s been a new, very recent development to my face that I am extremely unhappy about, namely pouches under my orbital bone. Learning the name for them — festoons, or malar mounds — only made me feel worse. 

I’ve cut out drinking, monitored my thyroid, and tried face massage, but nothing seems to help. Reading about how to treat them online is confusing and only makes me wonder what actually works to reduce them. Do you have any useful advice? 

A: In my many years answering beauty questions from readers, I’ve never come across a query about festoons or malar mounds, even though under-eye issues are some of the most common issues women complain about. Why? I think it’s because most of us are unaware of the difference between an under-eye pouch and discoloration, and the festoon or malar mound. Something looks weird under your eyes — who cares what you call it? But actually, it’s important to differentiate between a festoon and other conditions because the treatment (should you want to treat it) is not the same.

We can thank David Furnas, M.D., for the festive name attached to the swelling, or excess tissue below the orbital rim, who, in a paper published nearly 50 years ago, described baggy eyelids and drapey muscle and tissue as a festoon. Since then, says dermatologist Jessica Weiser, M.D., a spectrum of this pathology has been developed: a mild condition known as malar edema; a moderate one, called a malar mound; and a severe presentation — the one honored with the descriptive handle — a malar festoon.

Typically, the fullness is the result of a variety of factors — loose muscle around the eye, the shift or bulge of fat in the eye area with age, and/or fluid retention in the soft tissue (at any age), said Weiser. A mild case (malar edema) might be exacerbated by allergies or a sinus condition or an overly salty diet, causing the puffiness. More severe cases (the malar mound and festoon) are more difficult to treat, said plastic surgeon Alan Matarasso, M.D. He pointed out that festoons cannot be corrected by blepharoplasty (typical under-eye surgery to remove or relocate excess fat) and can even temporarily look more pronounced afterward. (So a correct diagnosis is critical!) Plastic surgery on the area (festoon excision) can give some relief, though the trade-off can be a more visible scar than what you may get with some of the more common plastic-surgery operations, he added. Even so, only surgery can address all the factors involved, such as fat, muscle, and skin, said Weiser.

Raise your hand if you dislike sharp objects near your face. First, you’ll want to consider noninvasive treatment options. Ultrasound and radio frequency can be precisely delivered into the subcutaneous fat to slowly and gradually reduce the fat pad, said Weiser. If your case is very mild, it’s worth trying a low-salt diet, elevating your head at night, or lymphatic-drainage massage, none of which can hurt (but, alas, are often not especially effective). Intralesional tetracycline (a shot of the antibiotic into the lower eyelid) has been more recently used with good results, said Weiser. And if you happen to have a history of filler in your cheek and under-eye area, hyaluronidase injections are also a potential treatment because filler may cause worsening of malar edema, she added. One more reason to be wary of filler.

Bottom line: If you choose to treat your festoons, your best bet is to start with a consultation with a board-certified dermatologist who can diagnose your condition. As Weiser pointed out, most dermatologists tend to be conservative about surgery; if more invasive treatment is called for, then it’s time for a visit with a plastic surgeon.

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What’s This Bag Under My Under Eye?