The ill-defined lid-cheek junction continues to be one of the most challenging regions for rejuvenation. Malar mounds, festoons or palpebral bags, may occur alone, or in combination, in the infraorbital area. These pathological variants are distinctly different and may contribute to patients’ perception of their eyebags. Traditional lower blepharoplasty (fat repositioning/ removal) with skin adjustment alone may be insufficient in addressing all of these pathologies, and recurrence may occur. This literature review aims to look at current definitions and treatment of festoons, malar mounds, and palpebral bags in Asian blepharoplasty. A Medline literature search for articles with anatomic descriptions of malar mounds, palpebral bags and festoons, particularly in Asian eyelids, was performed. This was supplemented by a manual search of the references of articles obtained. The details of all of the different surgical options for eyelid rejuvenation are beyond the scope of this review article. Thus, only the basic concepts that illustrate the anatomical relationship and the natural progression of malar mounds, festoons, and palpebral bags will be discussed in this article. Some of the treatment options, both invasive and non-invasive, will also be reviewed. There is no singular treatment for malar mounds, festoons, and palpebral bags. Standard lower blepharoplasty with skin excision is ineffective to lift and re-drape malar mounds or festoons. Repositioning of the malar septum, on the other hand, allows for resolution of the edema (malar festoons) above its cutaneous insertion. A number of liposculpturing techniques to volumize deficient areas, such as fat repositioning (cheek, suborbicularis and descended malar fat pad) with lifting of the midface, can be beneficial to restore a smooth lid-cheek junction.Non-invasive techniques like laser resurfacing and Ultherapy^? (Ulthera, Inc., Meza, AZ, USA) may be useful in periorbital rejuvenation in selected cases.

Keywords: festoon, malar mound, palpebral bag, orbitomalar septum, periorbital rejuvenation

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