Hello I’m dr. Greg Chernoff and I’m going to show you a procedure today that’s I’ve been working on for the past 10 to 15 years and that’s in perfecting the softening of malar festoons. Malar festoons are a very common feature exhibited by many patients and it’s really the natural anatomic junction of where your cheek muscles insert onto your skull and where your eyelid muscles insert onto your skull and it’s this little triangular piece of lymphatic and fatty tissue that’s troublesome to many patients they can give a tired look it’s worse if your body’s water is higher it’s worse if you’re get swollen as well. So we’re going to be going through one of the, Mat give me a big grin we’re going to go through under the natural crow’s feet and relax and we’re going to use a cautery to decrease the tissue from underneath will then be removing the excess fat from the lower eyelid and then resurfacing to shrink up the skin so we’ll show you how this is done in the operating room.
So, we’ve inserted our insulated cautery probe, my non-dominant hand really acts as the temperature gauge and I’m just starting to gradually cauterize now feeling the heat on the . We don’t want to cause any damage to the under surface of the dermis but I’m actually feeling the tissue decrease in bulk as we as we go along and you can actually hear the hear the cautery reducing the tissue under the under the skin. So, now we’re going to perform the cauterization on her right side so we’re in we’re inserting the cauterization device and again as I begin I’m palpating, the tissue as we come out feeling the heat and you can actually hear the hear the reduction of the tissue as it is happening you can actually see the tissue shrinking as I cauterize. So, this is a very very nice way to reduce the actual malar festoon and then to facilitate the recoil process will be laser resurfacing her tissue. So now we’ve completed the cauterization process on the right side. You really get a good sense as to why we resurface, because we also rely on the recoil ability of the skin and you can see some of the decreased elasticity that she has.
What’s interesting now is that now you see the fat in her lower eyelid that’s now more protuberant than her malar festoons whereas before we did this it was the opposite the festoon was more protuberant than the eyelid fat so when we come around and look again from the top you can see the nicer profile that that we’ve been able to achieve with her both, in the on the right malar region and on the left. So here are the fat pads that we’ve sculpted out of her left lower eyelid. You can see that with that fat gone now we have really a beautiful contour and a nice sweep to her cheekbone with the normal contour of the lower eyelid and the malar prominence now at a normal height so now we’re doing co2 laser surfacing on the lower lids to affect a shrinkage of the tissue which will again make her lower lid skin look beautiful, we’ve got eye guards in protecting her eyes. We’ve now completed the external cauterization of this patient’s malar festoons the removal of her lower lid fat pads and co2 laser resurfacing of the tissue to shrink up the tissue. She now has a beautiful sweep to her cheekbones by laterally with very nice contour to her lower eyelids.