Single Stage Management of Recalcitrant Eyelid Festoons

Purpose: Lower eyelid festoons are a challenging aesthetic concern characterized by redundant and edematous folds of lower eyelid skin with minimal orbital fat prolapse. We present our surgical approach to managing this condition. Methods: A retrospective chart review was conducted on patients who underwent surgical repair of lower eyelid festoons at two 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. Results: Fifty-four eyes of 27 patients (mean 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 patients developed lagophthalmos, corneal staining, or eyelid retraction. Minor complications occurred in two patients. The recurrence rate was 3.7%. Patient and physician satisfaction were high. Conclusions: 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. Over 10 mm of skin can be safely excised without causing lower eyelid retraction. Outcomes are durable at a mean follow-up of nearly one year.