Festoons After Filler: Addressing Post-Treatment Challenges

Medically Reviewed
Medically Reviewed by Dr. Aurora Kalmanson on
Written by Fillers Editorial Team, plastic surgery specialists.

Festoons, the malar mounds that appear as puffy regions on the cheeks just below the eyes, can be exacerbated by dermal fillers, particularly when improperly placed or when the wrong type of filler is used. While fillers are designed to rejuvenate and smooth facial contours, they can sometimes have unintended consequences, such as accentuating festoons or causing additional swelling.

This article delves into the complex relationship between festoons and fillers, exploring how certain fillers can worsen festoons, the role of hyaluronic acid fillers in water retention, and the challenges in treating festoons post-filler. Understanding the nuances of filler application and the underlying causes of festoons is crucial for both prevention and treatment.

Identifying Festoons After Filler Treatments

Recognizing and addressing festoons following filler treatments is essential for achieving optimal aesthetic outcomes and patient satisfaction. Proper identification and differentiation from other post-treatment effects are the first steps toward effective management.

Symptoms and Recognition

Distinguishing Festoons from Normal Post-Treatment Swelling: Differentiating festoons from typical post-filler swelling is a critical diagnostic step. Festoons present as persistent, fluid-filled mounds that remain well after the expected period of post-treatment swelling has passed. They often have a characteristic location on the cheek, just below the lower eyelid, and may have a more pronounced appearance when smiling or animating the face. In contrast, normal post-treatment swelling is usually temporary and subsides as the body adjusts to the filler. Recognizing festoons early on is vital for timely intervention and to prevent long-term aesthetic complications.

Long-Term Persistence of Festoons: Festoons can be a chronic and persistent issue, often not resolving on their own over time. Their long-term presence can be attributed to the ongoing effects of sun damage, aging, and possibly previous treatments that have exacerbated the condition. Even after interventions such as filler dissolutions or targeted treatments, festoons may remain, leading to frustration for patients seeking a smooth, rejuvenated appearance. This persistence underscores the importance of a comprehensive approach to treatment, one that addresses not only the aesthetic concerns but also the underlying causes contributing to the resilience of festoons.

Complications and Challenges in Treating Festoons

Treating festoons comes with challenges and potential complications, making it a delicate process that requires expertise and a nuanced understanding of facial anatomy and the dynamics of aging.

Persistence After Filler Dissolution

Even after the strategic use of hyaluronidase to dissolve hyaluronic acid fillers, festoons may persist, leaving patients and practitioners in a dilemma. The enzyme’s effectiveness in breaking down the filler can vary, and the festoons’ underlying structural issues may still remain. This can result in a continued appearance of puffiness and sagging that is resistant to simple corrective measures. The persistence of festoons post-dissolution is a testament to the complexity of this condition and the need for a complex treatment approach that may include surgical intervention or advanced skin resurfacing techniques.

Risks and Common Mistakes in Treatment

Misuse of Fillers for Camouflage: Utilizing fillers to camouflage festoons can be a risky attempt that often leads to suboptimal results. The temptation to fill the area beneath the festoons to create an illusion of smoothness can backfire, as the added volume may accentuate the festoons by pushing them outward. This misuse of fillers can lead to an unnatural appearance and further complicate the treatment process. It is crucial for practitioners to recognize when fillers are not the appropriate solution and to consider alternative treatments that address the root cause of festoons.

Inappropriate Surgical Interventions: Surgical interventions for festoons must be carefully considered, as inappropriate procedures can exacerbate the condition. Surgeries not specifically designed to address festoons, such as traditional facelifts or standard lower eyelid procedures, may not adequately settle the issue and can even lead to more pronounced festoons. It is essential for surgeons to employ techniques adapted to the unique challenges festoons present, ensuring that the chosen intervention aligns with the specific needs of the patient’s facial structure and skin condition.

Treatment Options for Festoons After Filler

A variety of treatment options exist for addressing festoons after filler, ranging from non-surgical approaches to more invasive procedures, each with its own set of considerations and potential outcomes.

Non-Surgical Treatments

Hyaluronidase Injections (Timing and Dosage Considerations): Hyaluronidase injections are a non-surgical option for treating festoons exacerbated by hyaluronic acid fillers. The enzyme works by breaking down the filler, potentially reducing the festoon’s prominence. Timing is critical; waiting too long after the initial filler treatment may lead to less effective results, while administering hyaluronidase too soon can cause unnecessary swelling. Dosage is equally important, as too much can lead to overcorrection and too little may not sufficiently address the festoons. Multiple sessions may be required, and each should be spaced appropriately to allow for the assessment of results and to minimize tissue trauma.

Laser Skin Resurfacing: Laser skin resurfacing can improve the appearance of festoons by removing damaged skin layers and stimulating collagen production, leading to tighter and smoother skin. This non-surgical treatment requires precision and an understanding of the laser’s effects on different skin types. Recovery time varies, and patients may experience redness and peeling as the skin heals. Multiple treatments are often necessary to achieve desired results, and the procedure should be performed by a skilled practitioner to minimize risks such as scarring or changes in skin pigmentation.

Radiofrequency and Microneedling: Combining radiofrequency with microneedling can be an effective non-surgical approach to treating festoons. This treatment targets the deeper layers of the skin, promoting collagen and elastin production, which can lead to firmer, more youthful-looking skin. The procedure is generally well-tolerated, with minimal downtime compared to more invasive surgeries. However, as with any cosmetic treatment, there are considerations such as the number of sessions needed and the potential for temporary side effects like swelling or bruising. It’s essential for patients to have realistic expectations and for practitioners to adapt the treatment to the individual’s skin condition and festoon severity.

Surgical Treatments

Lower Eyelid Blepharoplasty and CO2 Laser Resurfacing: For persistent and pronounced festoons, surgical intervention may be considered. Lower eyelid blepharoplasty, when combined with CO2 laser resurfacing, can address both the excess skin and the textural changes associated with festoons. Blepharoplasty involves the removal or repositioning of fat and the tightening of skin, while CO2 laser resurfacing can improve skin texture and promote collagen renewal. This combination can lead to more significant improvements in the appearance of festoons compared to non-surgical treatments. However, it requires careful patient selection and an experienced surgeon to minimize risks and ensure a natural-looking outcome. Post-operative care is crucial for healing and achieving the best results.

Frequently Asked Questions

Can festoons be prevented if I want to get under eye fillers?

While under eye fillers can enhance the appearance of the eye area, careful selection of filler type, injection technique, and volume is essential to minimize the risk of festoon development.

How long do festoons last after filler treatment?

Festoons may persist for an extended period after filler treatment, especially if the underlying causes are not addressed. The duration varies from person to person.

Are there any home remedies for festoons after filler?

Home remedies such as lymphatic massage, cold compresses, and a low-salt diet may help reduce the appearance of festoons, but they are not a substitute for professional treatment.

How long should I wait to treat festoons after noticing them post-filler?

It's best to consult with a healthcare professional as soon as you notice festoons post-filler to discuss appropriate treatment options and timing.

What should I do if hyaluronidase injections do not improve my festoons?

If hyaluronidase injections do not improve your festoons, seek advice from a specialist who may suggest alternative treatments such as laser therapy or surgical options.

How long should I wait before considering surgery for festoons?

Consider surgery for festoons only after non-surgical treatments have been explored and if festoons significantly impact your quality of life. Consult with a specialist to determine the appropriate timing.


Festoons are a complex condition that can be exacerbated by dermal fillers, but with careful management, they can be treated effectively. A combination of preventative measures, appropriate filler selection, and advanced treatment options, both non-surgical and surgical, can address the aesthetic concerns festoons present. It is essential for individuals to consult with experienced professionals to create a treatment plan that considers the unique aspects of their facial anatomy and the specific characteristics of their festoons.

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Funt D. K. (2011). Avoiding malar edema during midface/cheek augmentation with dermal fillers.

Zein, M., Tie-Shue, R., Pirakitikulr, N., & Lee, W. W. (2020). Complications after cosmetic periocular filler: prevention and management.

Asaadi, M., Gazonas, C. B., Didzbalis, C. J., Colon, A., & Tran, B. N. N. (2023). Outcomes of Surgical Treatment of Malar Mounds and Festoons.

Dr. Aurora Kalmanson

Always Consult a Medical Specialist

The information provided in this blog is for informational and educational purposes only and should not be interpreted as personalized medical advice. It's crucial to understand that while we are medical professionals, the insights and advice we provide are based on general research and studies. They are not tailored to individual health needs or conditions. Thus, it is essential to consult directly with a healthcare provider who can offer personalized medical advice relevant to your specific situation.