Tetracycline injections can lead to improvement in festoons

Tetracycline injections can lead to improvement in festoons


This retrospective chart review details outcomes for patients receiving tetracycline injections for treatment of festoons.

Study design

The authors’ analysis included 61 patients undergoing 0.2 to 0.3 cc of 2% tetracycline injection for treating lower eyelid festoons over a 10-year period.


From 61 responses, 59% of patients noted improvement in the appearance of festoons, with 26.2% reporting complete resolution. Two-thirds of patients would consider repeating the injection. The most common adverse side effect was discomfort, experienced by 18% of patients, followed by swelling (15%), bruising (13%) and face not looking smooth (10%).


By nature, quantitative assessment of festoons are difficult as they represent a 3-dimenstional polymorphous space. Therefore, the accuracy of questionnaires is limited by patient recall. Additionally, the FACE-Q checklist may not completely apply to this treatment. The authors were unable to access long term post-procedure photographs to evaluate for other potential complications such as hyperpigmentation.

Clinical significance

Festoons are difficult to treat given their recurrent nature and association with chronic fluid retention. Nonsurgical options are fairly limited and surgical options can be quite invasive. Intralesional tetracycline appears to be a safe, quick and minimally invasive option for symptom improvement. The majority of patients in this study noted improvement and at a least a quarter had complete long-term resolution.