Malar Mounds and Festoons

Abstract

Blepharoplasty, the most common aesthetic eyelid procedure, sometimes involves a challenging patient subgroup: those who present with malar edema, malar bags, and festoons. In this review article, the authors describe the relevant anatomy in festoon development, discuss the pathophysiological basis of this condition spectrum, outline clinical examination basics, summarize various surgical approaches for treatment and propose an algorithm for their application, and describe the most common postsurgical complications.

Recognising the Key Tear Trough Ligaments

“…Any decision to inject above the zygomatic ligament should be made with caution, as the pre-zygomatic space is prone to post-treatment complications and often manifests in malar mounds. 8 If your best clinical judgment indicates that you treat the cheeks above the zygomatic ligament, then injections directly onto bone are likely to be the least complication prone.…”

“…In the case where there is clear volume loss of the cheek accompanied with infraorbital concerns, it would then be sensible to add volume on the bone of this region using a needle and bolus technique. Any decision to inject above the zygomatic ligament should be made with caution, as the pre-zygomatic space is prone to post-treatment complications and often manifests in malar mounds 8. If your best clinical judgment indicates that you treat the cheeks above the zygomatic ligament, then injections directly onto bone are likely to be the least complication prone.…”

Blepharoplasty basics for the dermatologist

“…Festoons and malar oedema should be noted and discussed with the patient as these will typically not be addressed via standard blepharoplasty techniques. [ 8 12 ]…”

Loss of Lower Eyelid Bulge after the Reconstruction of Zygomatic Complex Fractures

“…1). [1][2][3] Lower eyelid bulge is an age-related change that can be treated by corrective cosmetic surgery for rejuvenation. Fat removal, orbicularis retaining ligament (ORL) release, and septal reset are well-established procedures.…”

“…Fat removal, orbicularis retaining ligament (ORL) release, and septal reset are well-established procedures. [1][2][3][4][5][6] Meanwhile, after reconstruction of the orbital floor fracture, there is reported loss of the lower eyelid bulge, and thus, symmetry of the lower eyelid cannot be obtained. 7,8 The primary purpose of surgery after zygomatic complex fracture (ZCF) is to obtain symmetry of the face.…”