Single-Stage Management of Recalcitrant Eyelid Festoons

Lower eyelid festoons are a challenging aesthetic concern characterized by redundant and edematous folds of lower eyelid skin with minimal orbital fat prolapse. The authors present their surgical approach to managing this condition.

A retrospective chart review was conducted on patients who underwent surgical repair of lower eyelid festoons at 2 academic centers. Data collected included various measurements, examinations, and satisfaction rates. The procedure involved lower eyelid tightening, an infraorbital curvilinear incision along the base of the lowest festoon, subcutaneous dissection, skin redraping, and closure with a running 7-0 Prolene suture. The orbital septum was kept intact with no orbital fat manipulation.

Fifty-four eyes of 27 patients (mean patient age, 69 ± 10 years) were studied, with a mean follow-up of 11 months. The average vertical extent of excised skin was 15 mm. No patient developed lagophthalmos, corneal staining, or eyelid retraction. Minor complications occurred in 2 patients. The recurrence rate was 3.7%. The patient and physician satisfaction rates were high.

Direct infraorbital excision of festoons with concomitant preservation of the inferior tarsal orbicularis oculi muscle, lower eyelid tightening, and septal preservation is a simple and effective treatment option. More than 10 mm of skin can be excised safely without causing lower eyelid retraction. Outcomes are durable at a mean follow-up of nearly 1 year.

Therapeutic, IV.