Dr. Gupta begins each consultation with a thorough history, including sun exposure, nasal or sinus disease, allergies, pets, hormonal imbalances (i.e., menopause), salt and alcohol intake, renal or cardiac disease, prior eyelid or facial surgery, and prior neurotoxin, filler, or fat injections around the eyes and cheeks. Medical records from other doctors’ offices are carefully reviewed and patient photographs analyzed. She then performs a detailed examination of the eyelids, festoons, and cheek area to assess the nature of the festoons, as they can result from genetic skin and muscle laxity, fluid buildup from injected hyaluronic acid fillers or autologous fat, lymphedema from cardiac/renal disease or eyelid/facial sugery, sun damage, fluid deposition from allergies, sinus or nasal disease, or fluid retention after salt or alcohol intake. Often, there is more than one trigger.
Dr. Gupta firmly believes in a multimodal approach to achieve the most optimal outcome and prevent recurrences. If the inciting cause is not adequately controlled, festoons have a tendency to recur. It is, therefore, vital for the patient to understand and conscientiously minimize any and all known triggers. An ear-nose-throat (ENT) specialist may be consulted to diagnose and treat any underlying nasal or sinus disease. An allergist may be consulted to diagnose and treat possible allergies. Only after the patient and Dr. Gupta feel that optimal control has been achieved with these methods does she then segue into festoon treatment.