Treatment of malar mound and festoon with fractional microneedle bipolar radiofrequency combined with 15% TCA peel

Abstract

Anatomy of the periorbital region is very complex. Aesthetic problems that occur in that region have to be thoroughly assessed so that the right choice of treatment can be done. Kpodzo et al published a review of current management for malar mounds and festoons. Due to the variable terminology and nonstandardized treatment algorithm, the incidence of malar aesthetic problems is not known. In that article, they suggested the standardized terminology to be as said:Malar edema: fluid that accumulates below the infraorbital rim above the malar eminence, Malar mound: chronic swelling in the same area, Festoons: cascades of lax skin and/or orbicularis muscle over the malar eminence. 1 Newberry et.al. also published a systematic review and have proposed the term "malar bags" that encompasses all previously mentioned malar pathologies. 2 Kikkawa et al first described the upper border of region involved as orbitomalar ligament (it separates the lower eyelid and malar eminence).In its anatomic position orbitomalar ligament is osteocutaneous ligament. 3 Lower border was first described by Furnas as the mid-cheek fold. 4 Pessa and Garza described it as the malar septum and Muzaffar et al and Mendelson et al defined it as the zygomaticocutaneus ligament. [5][6][7] The etiology of this aesthetic problem is still unknown. Furnas hypothesized that gravity with loss of laxity in the orbicularis muscle leads to its sagging and causes skin to stretch. 8 Goldman showed that transient edema in that area can occur after injection of botulinum toxin type A. 9 It led to the conclusion that muscle pump is an important