[How to treat a festoon]

In German there is no word for the term "festoon" but it can be used to describe folds due to gravity of the upper and the lower lid, sometimes accompanied by an oedema. The manuals of eyelid surgery (Neubauer or Heilman and Paton) recommend a direct excision, perhaps in combination with a shortening of the lid. But the postoperative result may show a poor scar and a persisting oedema. In cases of low grade festoon a temporary therapy using hyaluronic acid is possible. A combination of different surgical steps, such a subciliary incision, arcus marginalis release, a lift of the malar region, thinning out the subcutaneous oedematous skin region, skin excision and optionally a resurfacing may lead to a better cosmetic outcome.