Festoons and Malar Mounds describe soft tissue swelling underneath the eyelids, along the upper cheek. Many believe this is another sign of ageing causing a significant aesthetic disturbance, making one look tired or even sick. What is the difference between bags and festoons? Lower eyelid ‘bags’ are caused by fat that has protruded forward in the lower eyelid that stays in the same place, but may appear more significant when you look upwards. Festoons appear on the upper cheek/lower eyelid but seem to move, are ‘squisy’ and fluctuate in size and do not look more prominent when you look up. What Causes Festoons? Festoons are caused when spaces are created within the skin layers and this leads to different amounts of swelling and puffiness throughout the days. You can be pre-disposed to festoons genetically, but sun exposure, smoking and ageing make them worse. Festoons can be treated with surgical removal, diuretics and steroid injections but this often creates only minimal and temporary results. Unfortunately, eye creams and other topical agents do not work to improve festoons. Similarly blepharoplasty does not work to improve festoons because they are not caused by herniated tissues and can often highlight the puffiness of the festoons. The only surgical correction is to directly excise the festoons often resulting in unacceptable scars. However, there are specialized laser resurfacing procedures that can dramatically improve the appearance of the festoons but needs critical would healing. Erbium:Yag (Er:Yag) and Carbon Dioxide (CO2) lasers are a preferred option for the treatment of festoons. These laser treatments work because they cause a specific amount of damage to the skin with subsequent wound healing with better quality skin. While these lasers take about 10-15 minutes per festoon and are significantly less invasive then surgery, it is important to have frequent follow up.