Laser Management of Festoons
Festoons are skin folds and ballottable skin edema that occur between the transition zone of the thin lower eyelid skin above and thick cheek skin below. They can cause a dramatic aesthetic disturbance to the lower lid and are difficult to address. We believe that festoons are caused by damage to the skin overlying the area where the horizontally contracting orbital orbicularis oculi muscle converges with the vertically contracting elevators of the upper lip. Skin/muscle flap surgical procedures to correct festoons can be time intensive and yield suboptimal results. Medical therapy has also typically failed to provide significant resolution. Lasers used for skin resurfacing have been a viable option for the treatment of festoons, with carbon dioxide (CO2 ) and Erbium:Yag (Er:Yag) lasers having been used successfully. The treatment of festoons takes advantage of residual thermal energy, which normally accompanies laser tissue ablation. This residual heat causes relatively deep collagen fiber devitalization, and most importantly contraction, which becomes the framework for new collagen formation. Our clinical endpoint for treatment is the presence of no further visible tissue shrinkage with the final laser application. Proper use of the laser requires following laser safety protocols and blending the treated area with the surrounding untreated skin. Frequent follow-up after the procedure allows for better management of the healing process and early recognition of complications. In our experience, modified laser skin resurfacing is a predictable and effective treatment to reduce festoons, which can greatly improve the overall aesthetic outcome in rejuvenation of the lower eyelid–cheek complex.
KeywordsShrinkage Pseudomonas Epinephrine Lidocaine Tetracycline
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