19.6Conclusion

We have had tremendous success using laser skin resurfacing techniques to treat festoons. We believe this suggests that festoons are primarily a cutaneous rather than muscular pathologic entity. As previously stated, the clinical endpoint of laser skin resurfacing with all laser systems is the presence of no further visible tissue shrinkage with the final laser application. This holds true with the technique of festoon treatment described in this chapter. The effect of the initial 1 or 2 passes by most ablative systems has been showed histological to be largely confined to vaporizing epithelium and superficial papillary dermis [23, 24]. When additional laser passes are made, progressive thermal injury to the underlying tissue has been demonstrated histologically [15, 24, 25, 28–30]. By extrapolating from studies of burn pathology, this represents thermal damage to the reticular dermis [31]. Our clinical endpoint at which no further tissue shrinkage results suggests that the resolution of festoons occurs as a result of changes induced by thermal damage within the skin.

Modified laser skin resurfacing offers a predictable, rapid (10 min per lid), and safe treatment for lower eyelid festoons. Standard intraoperative laser safety guidelines, prudent postoperative care, and detailed management of the healing process are necessary to achieve the optimal clinical result. Laser skin resurfacing in general, and laser assisted festoon reduction, when needed, can add greatly to the overall aesthetic outcome in rejuvenation of the lower eyelid–cheek complex.

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