Radiofrequency (RF) microneedling might be the most reliable and safe needle in a haystack of treatments for removing festoons, according to Roy G. Geronemus, M.D., director of the Laser and Skin Surgery Center of New York and clinical professor of dermatology, New York University Medical Center.
Dr. Geronemus coauthored a paper published in June 2018 in Plastic and Reconstructive Surgery describing two such cases in which he treated patients’ festoons with the Infini (Lutronic) device.
The fluid-filled pouches on the upper malar portion of the cheek have been historically difficult for aesthetic physicians and surgeons to remove, he says.
“Over the years, physicians have tried surgery, ablative lasers and even injecting tetracycline in the malar pouches with minimal success,” Dr. Geronemus says. “We’ve had considerable benefit with a mildly invasive technique utilizing RF microneedling.”
Many believe there are several reasons that people have festoons, which are lax skin and hanging orbicularis muscles between the medial and lateral canthi. Among the likely causes: stretched orbitomalar ligaments or lymphatic imbalance. Surgical approaches aimed at sculpting the lower eye with micro-suction, or using flaps, a midface lift and excisions are only sometimes successful but come at a cost. These often complex procedures can result in skin perforation and more, according to Dr. Geronemus.
Dr. Geronemus treated two Caucasian women’s festoons using RF microneedling. One was in her mid-50s; the other in her early 60s. He has performed more than 20 treatments with this technique on festoons since the paper’s publication.
The patients were pretreated with a topical anesthetic, 15 minutes prior to the RF microneedling treatment. In each case, Dr. Geronemus used three passes, setting the microneedle depth at 2.5 mm at 400 msec for the first pass; 2.0 mm at 200 msec for the second; and 1.5 mm at 100 msec for the third.
Both patients tolerated treatment without a problem but did have some swelling in the treatment areas, which resolved during the following days. The women were satisfied after one treatment because they felt it notably improved the appearance of their festoons, according to Dr. Geronemus.
The patients have since chosen to have more RF microneedling treatments to address what remains of their festoons. The 56-year old patient had two treatments in the course of three months, while the 62-year-old has had five treatments in a year’s time.
Treatment with the device was safe, the festoons haven’t recurred and the patients noted an added benefit of overall rejuvenation of their lower lid complex, according to the paper.
“Bipolar radiofrequency microneedle devices have been reported to improve periorbital wrinkles by increasing collagen and elastic fibers in the areas of treatment. Our two patients showed a significant clinical improvement of festoons, likely by means of a similar process of skin rejuvenation,” the authors write.
While the number of patients Dr. Geronemus has treated with the Infini device for festoons is small, he says he had used RF microneedling successfully to treat acne scars and skin laxity.
The fact that physicians can repeat RF microneedling every one to two months, if needed, is good news for festoon patients, since festoons have been shown to recur even after surgical removal. However, larger studies are needed to assess the efficacy and safety of using RF microneedling to treat festoons, according to Dr. Geronemus.
Jeon, H; Geronemus, R. Successful Noninvasive Treatment of Festoons. Plastic and Reconstructive Surgery. 141(6):977e–978e, JUN 2018